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Li M, Yao L, Lu Z, Yang L, Fan H. Preliminary MRS study of critical values of relevant brain metabolites in elderly Chinese patients with post-stroke cognitive impairment. IBRO Neurosci Rep 2023; 15:287-292. [PMID: 37885832 PMCID: PMC10598682 DOI: 10.1016/j.ibneur.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/18/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023] Open
Abstract
Objective Proton magnetic resonance spectroscopy (1H-MRS) was applied in this study to detect metabolite changes in the brain of post-stroke cognitive impairment (PSCI) and normal volunteers. The levels of N-acetylaspartate (NAA) and creatinine (Cr) and in the frontal lobe, hippocampus and cingulate gyrus were measured to distinguish patients with post-stroke cognitive impairment (PSCI) and normal control group (NC). The relationship between them and cognitive function was explored and a critical value of the metabolite ratio was predicted. This study may serve as a reference for the diagnosis of cognitive dysfunction after stroke. Methods A total of 46 patients with PSCI (PSCI group, all patients are unilateral cerebral infarction or intracerebral haemorrhage) were screened by the Mini-Mental Status Examination (MMSE), and 35 healthy volunteers were selected as normal control group (NC group). The general information of gender, age, and education level was matched between the two groups. Two groups of subjects were examined using MRS and evaluated for cognitive function using the MMSE test and the Montreal Cognitive Assessment Scale (MoCA). The correlation between MRS and neurobehavioral scale (MMSE test and MoCA scale) was analysed, and the possible demarcation points of the brain metabolism of PSCI were evaluated. Result The MMSE and MoCA scores of patients with PSCI were lower significantly when compared with those of the NC group (P < 0.05). The NAA/Cr values of the bilateral hippocampus, bilateral frontal lobe and bilateral anterior and posterior cingulate gyrus in the PSCI group were lower than those in the NC group (P < 0.05). The NAA/Cr cut-off value for the right frontal lobe was 1.533, and the NAA/Cr sensitivity, specificity and Youden index for the right frontal lobe were 0.943, 0.935, and 0.878. Conclusion NAA/Cr values in the MRS bilateral frontal, bilateral hippocampus and bilateral anterior and posterior cingulate gyrus were reduced in the cognitively impaired post-stroke patients compared to the normal control group. MRS was also found to be correlated with the score of neurobehavioral scale (MMSE test and MoCA scale) and the combination of the two could evaluate cognitive dysfunction more comprehensively and objectively. NAA/Cr value of the right frontal lobe < 1.533 indicated that PSCI may occur. In accordance with this cut-off point, PSCI could be detected as early as possible and timely intervention could be carried out.
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Affiliation(s)
- MengQi Li
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, PR China
| | - LingLing Yao
- Department of Rehabilitation, Shaoxing People’s Hospital (The First Affiliated Hospital of Shaoxing University), Shaoxing, Zhejiang, PR China
| | - ZengXin Lu
- Department of Radiology, Shaoxing People’s Hospital (The First Affiliated Hospital of Shaoxing University), Shaoxing, Zhejiang, PR China
| | - LiMing Yang
- Department of Radiology, Shaoxing People’s Hospital (The First Affiliated Hospital of Shaoxing University), Shaoxing, Zhejiang, PR China
| | - Hong Fan
- Department of Geriatrics, Shaoxing People’s Hospital (The First Affiliated Hospital of Shaoxing University), Shaoxing, Zhejiang, PR China
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Mai W, Zhang A, Liu Q, Tang L, Wei Y, Su J, Duan G, Teng J, Nong X, Yu B, Li C, Shao L, Deng D, Chen S, Zhao L. Effects of Moxa Cone Moxibustion Therapy on Cognitive Function and Brain Metabolic Changes in MCI Patients: A Pilot 1H-MRS Study. Front Aging Neurosci 2022; 14:773687. [PMID: 35721029 PMCID: PMC9204283 DOI: 10.3389/fnagi.2022.773687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the effect of moxa cone moxibustion on N-acetyl aspartate/total creatinine (NAA/tCr) and choline/total creatinine (Cho/tCr) in the bilateral hippocampus (HIP) and bilateral posterior cingulate gyrus (PCG) in patients with mild cognitive impairment (MCI) using hydrogen proton magnetic resonance spectroscopy (1H-MRS) and to provide imaging basis for moxa cone moxibustion treatment for MCI. Methods One hundred eight patients with MCI were served as the MCI group, and 67 age-matched subjects were enrolled as the normal control group. The MCI group was randomized and allocated into acupoint group, drug group, and sham acupoint group, with 36 cases in each group. Some patients in each group withdrew. Finally, 25 cases were included in the acupoint group, 24 cases in the drug group, and 20 cases in the sham acupoint group. The drug group was treated with oral donepezil hydrochloride. The acupoint group and sham acupoint group received moxa cone moxibustion treatment. Mini-mental state exam (MMSE) and Montreal cognitive assessment (MoCA) scores were recorded before intervention, at the end of the first and the second months of intervention, and in the 5th month of follow-up. The NAA/tCr and Cho/tCr ratios in the HIP and PCG were bilaterally measured by 1H-MRS before and after intervention. Results Before intervention, compared with the normal control group, the MMSE and MoCA scores, the Cho/tCr ratio in the right HIP, the NAA/tCr ratio in the bilateral HIP, and the NAA/tCr ratio in the left PCG in the three treatment groups decreased significantly (both p < 0.01), and the NAA/tCr ratio in the right PCG significantly reduced in the acupoint and drug groups (p < 0.05). After two months of treatment, compared with the normal control group, there were no differences in the MoCA scores, the NAA/tCr, and Cho/tCr ratios in the bilateral PCG and bilateral HIP in the three treatment groups (p > 0.05). However, the MMSE scores in the drug group decreased when compared with the acupoint group and normal control group (p < 0.05, p < 0.01). The scores of MMSE and MoCA in the acupoint group and sham acupoint group at all time points were better than those in the drug group, which were similar to those in the normal control group. Conclusion Our findings suggest that moxibustion could improve the cognitive function of patients with MCI. The mechanism may be related to the improvement of abnormal brain metabolism in HIP and PCG.
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Affiliation(s)
- Wei Mai
- Guangxi University of Chinese Medicine, Nanning, China
- Department of Traditional Chinese Medicine, Guangxi Tumour Hospital, Nanning, China
| | | | - Qiang Liu
- Xinghu Outpatient Department, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Liying Tang
- Xinghu Outpatient Department, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yichen Wei
- Department of Radiology, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Jiahui Su
- Department of Acupuncture, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Gaoxiong Duan
- Department of Radiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinlong Teng
- Department of Acupuncture, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Xiucheng Nong
- Department of Acupuncture, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Bihan Yu
- Department of Acupuncture, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Chong Li
- Department of Acupuncture, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Lijuan Shao
- Department of Acupuncture, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Demao Deng
- Department of Radiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Demao Deng,
| | - Shangjie Chen
- Department of Rehabilitation, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shangjie Chen,
| | - Lihua Zhao
- Department of Acupuncture, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
- *Correspondence: Lihua Zhao,
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Mitochondrial dysfunction, oxidative stress, neuroinflammation, and metabolic alterations in the progression of Alzheimer's disease: A meta-analysis of in vivo magnetic resonance spectroscopy studies. Ageing Res Rev 2021; 72:101503. [PMID: 34751136 DOI: 10.1016/j.arr.2021.101503] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
Accumulating evidence demonstrates that metabolic changes in the brain associated with neuroinflammation, oxidative stress, and mitochondrial dysfunction play an important role in the pathophysiology of mild cognitive impairment (MCI) and Alzheimer's disease (AD). However, the neural signatures associated with these metabolic alterations and underlying molecular mechanisms are still elusive. Accordingly, we reviewed the literature on in vivo human brain 1H and 31P-MRS studies and use meta-analyses to identify patterns of brain metabolic alterations in MCI and AD. 40 and 39 studies on MCI and AD, respectively, were classified according to brain regions. Our results indicate decreased N-acetyl aspartate and creatine but increased myo-inositol levels in both MCI and AD, decreased glutathione level in MCI as well as disrupted energy metabolism in AD. In addition, the hippocampus shows the strongest alterations in most of these metabolites. This meta-analysis also illustrates progressive metabolite alterations from MCI to AD. Taken together, it suggests that 1) neuroinflammation and oxidative stress may occur in the early stages of AD, and likely precede neuron loss in its progression; 2) the hippocampus is a sensitive region of interest for early diagnosis and monitoring the response of interventions; 3) targeting bioenergetics associated with neuroinflammation/oxidative stress is a promising approach for treating AD.
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Liu H, Zhang D, Lin H, Zhang Q, Zheng L, Zheng Y, Yin X, Li Z, Liang S, Huang S. Meta-Analysis of Neurochemical Changes Estimated via Magnetic Resonance Spectroscopy in Mild Cognitive Impairment and Alzheimer's Disease. Front Aging Neurosci 2021; 13:738971. [PMID: 34744689 PMCID: PMC8569809 DOI: 10.3389/fnagi.2021.738971] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
The changes of neurochemicals in mild cognitive impairment (MCI) and Alzheimer's disease (AD) patients has been observed via magnetic resonance spectroscopy in several studies. However, whether it exists the consistent pattern of changes of neurochemicals in the encephalic region during the progression of MCI to AD were still not clear. The study performed meta-analysis to investigate the patterns of neurochemical changes in the encephalic region in the progress of AD. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases, and finally included 63 studies comprising 1,086 MCI patients, 1,256 AD patients, and 1,907 healthy controls. It showed that during the progression from MCI to AD, N-acetyl aspartate (NAA) decreased continuously in the posterior cingulate (PC) (SMD: −0.42 [95% CI: −0.62 to −0.21], z = −3.89, P < 0.05), NAA/Cr (creatine) was consistently reduced in PC (SMD: −0.58 [95% CI: −0.86 to −0.30], z = −4.06, P < 0.05) and hippocampus (SMD: −0.65 [95% CI: −1.11 to −0.12], z = −2.44, P < 0.05), while myo-inositol (mI) (SMD: 0.44 [95% CI: 0.26–0.61], z = 4.97, P < 0.05) and mI/Cr (SMD: 0.43 [95% CI: 0.17–0.68], z = 3.30, P < 0.05) were raised in PC. Furthermore, these results were further verified by a sustained decrease in the NAA/mI of PC (SMD: −0.94 [95% CI: −1.24 to −0.65], z = −6.26, P < 0.05). Therefore, the levels of NAA and mI were associated with the cognitive decline and might be used as potentially biomarkers to predict the possible progression from MCI to AD. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020200308.
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Affiliation(s)
- Huanhuan Liu
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Dandan Zhang
- College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huawei Lin
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qi Zhang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ling Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yuxin Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaolong Yin
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zuanfang Li
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fuzhou, China
| | - Shengxiang Liang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Saie Huang
- Department of Neurological Rehabilitation, Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou, China
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Cerebrospinal Fluid Amyloid Beta, Tau Levels, Apolipoprotein, and 1H-MRS Brain Metabolites in Alzheimer's Disease: A Systematic Review. Acad Radiol 2021; 28:1447-1463. [PMID: 32651050 DOI: 10.1016/j.acra.2020.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/09/2020] [Accepted: 06/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is compelling evidence that neurochemical changes measured by proton magnetic resonance spectroscopy (1H-MRS) occur at different phases of Alzheimer's disease (AD). However, the extent to which these neurochemical changes are associated with validated AD biomarkers and/or apolipoprotein (APOE) ε4 is yet to be established. OBJECTIVE This systematic review analyzed the available evidence on (1) neurochemical changes; and (2) the relations between brain metabolite and validated cerebrospinal fluid biomarkers, and/or APOE in AD. METHODS PubMed, Cochrane, Scopus, and gray literature were systematically screened for studies deemed fit for the purpose of the current systematic review. RESULTS Twenty four articles met the inclusion criteria. Decreased levels of N-acetyl aspartate (NAA), NAA/(creatine) Cr, and NAA/(myo-inositol) ml, and increased ml, ml/Cr, Cho (choline)/Cr, and ml/NAA were found in the posterior cingulate cortex/precuneus. Increased ml is associated with increased tau levels, reduced NAA/Cr is associated with increased tau. ml/Cr is negatively correlated with Aβ42, and ml/Cr is positively correlated with t-tau. NAA and glutathione levels are reduced in APOE ε4 carriers. APOE ε4 exerts no modulatory effect on NAA/Cr. There is interaction between APOE ε4, Aβ42, and ml/Cr. CONCLUSION NAA, ml, NAA/Cr, NAA/ml and ml/Cr may be potentially useful biomarkers that may highlight functional changes in the clinical stages of AD. The combinations of ml and tau, NAA/Cr and Aβ42, and NAA/Cr and tau may support the diagnostic process of differentiating MCI/AD from healthy individuals. Large, longitudinal studies are required to clarify the effect of APOE ε4 on brain metabolites.
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Yang Z, Wan X, Zhao X, Rong Y, Wu Y, Cao Z, Xie Q, Luo M, Liu Y. Brain neurometabolites differences in individuals with subjective cognitive decline plus: a quantitative single- and multi-voxel proton magnetic resonance spectroscopy study. Quant Imaging Med Surg 2021; 11:4074-4096. [PMID: 34476190 DOI: 10.21037/qims-20-1254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/23/2021] [Indexed: 11/06/2022]
Abstract
Background Subjective cognitive decline plus could be an extremely early phase of Alzheimer's disease; however, changes of N-acetylaspartate, myoinositol, and N-acetylaspartate/myoinositol is still unknown at this stage. This study aimed to explore brain neurometabolic alterations in patients with subjective cognitive decline plus using quantitative single-voxel and multi-voxel 1H-magnetic resonance spectroscopy. Methods A total of 91 participants were enrolled and underwent a GE 3.0-T magnetic resonance imaging, including 33 elderly controls, 27 patients with subjective cognitive decline plus, and 31 patients with amnestic mild cognitive impairment (MCI). Single-voxel and multi-voxel 1H-magnetic resonance spectroscopy were used to investigate the differences in neurometabolite levels among the three groups. Results Compared with elderly controls, patients with subjective cognitive decline plus showed significant decline in N-acetylaspartate and N-acetylaspartate/myoinositol values in multiple regions, and amnestic MCI participants demonstrated more significant decreased N-acetylaspartate and N-acetylaspartate/myoinositol levels in multiple regions. The combined concentrations of N-acetylaspartate with myoinositol showed an excellent discrimination between those with subjective cognitive decline plus and elderly controls as compared to that obtained using N-acetylaspartate/myoinositol ratios with the area under the receiver operating characteristic curve of 0.895 and 0.860, respectively. Likewise, the combined area under the curve for differentiating patients with subjective cognitive decline plus from amnestic MCI was obtained using the combined levels of N-acetylaspartate with myoinositol was 0.892. This was also higher than the combined area under the curve of 0.836 obtained using N-acetylaspartate/myoinositol ratios. Moreover, N-acetylaspartate levels in the left hippocampus and left posterior cingulate cortex (PCC) was positively related to the Auditory Verbal Learning Test delayed recall scores in patients with subjective cognitive decline plus, whereas only the N-acetylaspartate/myoinositol ratio was positively related to this scale scores in the left hippocampus. Conclusions Quantitative single-voxel and multi-voxel 1H-magnetic resonance spectroscopy can provide valuable information to detect alterative brain neurometabolites characteristics in patients with subjective cognitive decline plus. N-acetylaspartate concentrations may be used as one of the earliest neuroimaging markers at this stage, while N-acetylaspartate/myoinositol ratio could be more suitable for monitoring Alzheimer's disease progression.
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Affiliation(s)
- Zhongxian Yang
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Medical Imaging Center, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Xing Wan
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xinzhu Zhao
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Rong
- Department of Neurology, the People's Hospital of Gaozhou City, Maoming, China
| | - Yi Wu
- Department of Neurology, Shantou Central Hospital and Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Zhen Cao
- Medical Imaging Center, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Qiuxia Xie
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Min Luo
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yubao Liu
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Zhao L, Teng J, Mai W, Su J, Yu B, Nong X, Li C, Wei Y, Duan G, Deng X, Deng D, Chen S. A Pilot Study on the Cutoff Value of Related Brain Metabolite in Chinese Elderly Patients With Mild Cognitive Impairment Using MRS. Front Aging Neurosci 2021; 13:617611. [PMID: 33897404 PMCID: PMC8063036 DOI: 10.3389/fnagi.2021.617611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/12/2021] [Indexed: 11/27/2022] Open
Abstract
Objective: This cross-sectional study aimed to distinguish patients with mild cognitive impairment (MCI) from patients with normal controls (NCs) by measuring the levels of N-acetyl aspartate (NAA), total creatinine (tCr), and choline (Cho) in their hippocampus (HIP) and their posterior cingulate gyrus (PCG) by using proton magnetic resonance spectroscopy (MRS) and to predict the cutoff value on the ratios of metabolites. We further aimed to provide a reference for the diagnosis of MCI in elderly patients in China. Methods: About 69 patients who underwent a clinical diagnosis of the MCI group and 67 patients with NCs, the Mini-Mental Status Examination (MMSE) score, the Montreal Cognitive Assessment (MoCA) score, and MRS of the bilateral HIP and bilateral PCG were considered. The ratio of NAA/tCr and Cho/tCr in the bilateral HIP and bilateral PCG was calculated. The relationship between the ratios of metabolites and the scores of MMSE and MoCA was analyzed, and the possible brain metabolite cutoff point for the diagnosis of MCI was evaluated. Results: Compared with the NC group, the scores of MMSE and MoCA in the MCI group decreased significantly (p < 0.05); the ratio of NAA/tCr in the bilateral HIP and bilateral PCG and the ratio of Cho/tCr at the right HIP in the MCI group decreased significantly (p < 0.05); however, there was no significant difference in the ratio of Cho/tCr in the left HIP and bilateral PCG between the two groups (p > 0.05). The correlation coefficient between MMSE/MoCA and the ratio of NAA/tCr was 0.49–0.56 in the bilateral HIP (p < 0.01). The best cutoff value of NAA/creatine (Cr) in the left HIP and the right HIP was 1.195 and 1.19. Sensitivity, specificity, and the Youden index (YDI) in the left HIP and the right HIP were (0.725, 0.803, 0.528) and (0.754, 0.803, 0.557), respectively. Conclusion: The level of metabolites in the HIP and the PCG of patients with MCI and of those with normal subjects has a certain correlation with the score of their MMSE and MoCA. When the value of NAA/tCr in the left HIP and right HIP is <1.19, it suggests that MCI may have occurred. According to this cutoff point, elderly patients with MCI in China could be screened.
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Affiliation(s)
- Lihua Zhao
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Jinlong Teng
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Wei Mai
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Jiahui Su
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Bihan Yu
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Xiucheng Nong
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Chong Li
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Yichen Wei
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Gaoxiong Duan
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Xiangming Deng
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Demao Deng
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Shangjie Chen
- Department of Rehabilitation, Bao'an Hospital, Southern Medical University, Shenzhen, China
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Emoto R, Kawaguchi A, Takahashi K, Matsui S. Effect-Size Estimation Using Semiparametric Hierarchical Mixture Models in Disease-Association Studies with Neuroimaging Data. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:7482403. [PMID: 33488762 PMCID: PMC7787870 DOI: 10.1155/2020/7482403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/08/2020] [Accepted: 11/27/2020] [Indexed: 11/20/2022]
Abstract
In disease-association studies using neuroimaging data, evaluating the biological or clinical significance of individual associations requires not only detection of disease-associated areas of the brain but also estimation of the magnitudes of the associations or effect sizes for individual brain areas. In this paper, we propose a model-based framework for voxel-based inferences under spatial dependency in neuroimaging data. Specifically, we employ hierarchical mixture models with a hidden Markov random field structure to incorporate the spatial dependency between voxels. A nonparametric specification is proposed for the effect size distribution to flexibly estimate the underlying effect size distribution. Simulation experiments demonstrate that compared with a naive estimation method, the proposed methods can substantially reduce the selection bias in the effect size estimates of the selected voxels with the greatest observed associations. An application to neuroimaging data from an Alzheimer's disease study is provided.
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Affiliation(s)
- Ryo Emoto
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya 466-0003, Japan
| | | | - Kunihiko Takahashi
- Medical and Dental Data Science Center, Tokyo Medical and Dental University, Tokyo 101-0062, Japan
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya 466-0003, Japan
- Department of Data Science, The Institute of Statistical Mathematics, Tachikawa 190-8562, Japan
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9
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Song K, Liu X, Zheng Q, Zhang L, Zhang H, Yu H, Zhu Y, Huang LA, Chen Y. Secondary injury to distal regions after intracerebral hemorrhage influence neurological functional outcome. Aging (Albany NY) 2020; 12:4283-4298. [PMID: 32146443 PMCID: PMC7093199 DOI: 10.18632/aging.102880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
Abstract
Although many studies have focused on functional impairment after intracerebral hemorrhage, little is known about the relationship between secondary injuries to distal regions and neurological function. Our study aimed to evaluate the secondary injuries after intracerebral hemorrhage and explore their relationship to neurological functional outcome. Twenty-one patients with hemorrhages in supratentorial, deep locations and 10 healthy subjects were recruited. Longitudinal examinations of diffusion tensor imaging, hydrogen proton magnetic resonance spectroscopy imaging and neuropsychological assessment were performed after weeks 1 and 12 to elucidate the relationship between magnetic resonance imaging parameters and neurologic outcomes. By week 12, motor function had significantly improved, but cognitive function had deteriorated compared to week 1. Fractional anisotropy values for the ipsilateral cerebral peduncle correlated with motor function at week 1. No significant correlation between fractional anisotropy for the ipsilateral cerebral peduncle and the Fugl-Meyer Motor Scale was found at week 12. Fractional anisotropy values for the ipsilateral hippocampus were related to the Montreal Cognitive Assessment and Mini-Mental State Examination at weeks 1 and 12. Deep supratentorial hemorrhage may result in injury to distal regions, which correlate with impaired motor and cognitive function.
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Affiliation(s)
- Kangping Song
- Department of Neurology, Institute of Clinical Neuroscience, The First Affiliated Hospital, Jinan University, Guangzhou 510632, Guangdong, China.,Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Xiaojie Liu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Qiuyue Zheng
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Lingling Zhang
- Department of Neurology, Institute of Clinical Neuroscience, The First Affiliated Hospital, Jinan University, Guangzhou 510632, Guangdong, China
| | - Hongying Zhang
- Medical Imaging Center, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Hailong Yu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Yan Zhu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Li-An Huang
- Department of Neurology, Institute of Clinical Neuroscience, The First Affiliated Hospital, Jinan University, Guangzhou 510632, Guangdong, China
| | - Yingzhu Chen
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
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10
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Joe E, Medina LD, Ringman JM, O'Neill J. 1H MRS spectroscopy in preclinical autosomal dominant Alzheimer disease. Brain Imaging Behav 2020; 13:925-932. [PMID: 29907927 DOI: 10.1007/s11682-018-9913-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
1H magnetic resonance spectroscopy (MRS) can reveal changes in brain biochemistry in vivo in humans and has been applied to late onset Alzheimer disease (AD). Carriers of mutations for autosomal dominant Alzheimer disease (ADAD) may show changes in levels of metabolites prior to the onset of clinical symptoms. Proton MR spectra were acquired at 1.5 T for 16 cognitively asymptomatic or mildly symptomatic mutation carriers (CDR < 1) and 11 non-carriers as part of a comprehensive cross-sectional study of preclinical ADAD. Levels of N-acetyl-aspartate+N-acetyl-aspartyl-glutamate (NAA), glutamate/glutamine (Glx), creatine/phosphocreate (Cr), choline (Cho), and myo-inositol (mI) in the left and right anterior cingulate and midline posterior cingulate and precuneus were compared between mutation carriers (MCs) and non-carriers (NCs) using multivariate analysis of variance with age as a covariate. Among MCs, correlations between metabolite levels and time until expected age of dementia diagnosis were calculated. MCs had significantly lower levels of NAA and Glx in the left pregenual anterior cingulate cortex, and lower levels of NAA and higher levels of mI and Cho in the precuneus compared to NCs. Increased levels of mI were seen in these regions in association with increased proximity to expected age of dementia onset. MRS shows effects of ADAD similar to those seen in late onset AD even during the preclinical period including lower levels of NAA and higher levels of mI. These indices of neuronal and glial dysfunction might serve as surrogate outcome measures in prevention studies of putative disease-modifying agents.
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Affiliation(s)
- Elizabeth Joe
- Alzheimer Disease Research Center, Keck School of Medicine, Univeristy of Southern California, Center for Health Professions, 1540 Alcazar Street, Los Angeles, CA, 90033, USA.
| | - Luis D Medina
- Easton Center for Alzheimer's Disease Research, University of California, Los Angeles, 710 Westwood Plaza, Room C-224, Los Angeles, CA, 90095, USA.,Department of Neurosurgery, University of Colorado School of Medicine, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA
| | - John M Ringman
- Alzheimer Disease Research Center, Keck School of Medicine, Univeristy of Southern California, Center for Health Professions, 1540 Alcazar Street, Los Angeles, CA, 90033, USA.,Easton Center for Alzheimer's Disease Research, University of California, Los Angeles, 710 Westwood Plaza, Room C-224, Los Angeles, CA, 90095, USA
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Semel Institute For Neuroscience, University of California, Los Angeles, 760 Westwood Plaza, 58-227, Los Angeles, CA, 90095, USA
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11
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Fayed N, Oliván B, Lopez del Hoyo Y, Andrés E, Perez-Yus MC, Fayed A, Angel LF, Serrano-Blanco A, Roca M, Garcia Campayo J. Changes in metabolites in the brain of patients with fibromyalgia after treatment with an NMDA receptor antagonist. Neuroradiol J 2019; 32:408-419. [PMID: 31215319 PMCID: PMC6856999 DOI: 10.1177/1971400919857544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The aims of this work were to evaluate whether the treatment of patients with fibromyalgia with memantine is associated with significant changes in metabolite concentrations in the brain, and to explore any changes in clinical outcome measures. Magnetic resonance spectroscopy was performed of the right anterior and posterior insula, both hippocampi and the posterior cingulate cortex. Questionnaires on pain, anxiety, depression, global function, quality of life and cognitive impairment were used. Ten patients were studied at baseline and after three months of treatment with memantine. Significant increases were observed in the following areas: N-acetylaspartate (4.47 at baseline vs. 4.71 at three months, p = 0.02) and N-acetylaspartate+N-acetylaspartate glutamate in the left hippocampus (5.89 vs. 5.98; p = 0.007); N-acetylaspartate+N-acetylaspartate glutamate in the right hippocampus (5.31 vs 5.79; p = 0.01) and the anterior insula (7.56 vs. 7.70; p = 0.033); glutamate+glutamine/creatine ratio in the anterior insula (2.03 vs. 2.17; p = 0.022) and the posterior insula (1.77 vs. 2.00; p = 0.004); choline/creatine ratio in the posterior cingulate (0.18 vs. 0.19; p = 0.023); and creatine in the right hippocampus (3.60 vs. 3.85; p = 0.007). At the three-month follow-up, memantine improved cognitive function assessed by the Cognition Mini-Exam (31.50, SD = 2.95 vs. 34.40, SD = 0.6; p = 0.005), depression measured by the Hamilton Depression Scale (7.70, SD = 0.81 vs. 7.56, SD = 0.68; p = 0.042) and severity of illness measured by the Clinical Global Impression severity scale (5.79, SD = 0.96 vs. 5.31, SD = 1.12; p = 0.007). Depression, clinical global impression and cognitive function showed improvement with memantine. Magnetic resonance spectroscopy could be useful in monitoring response to the pharmacological treatment of fibromyalgia.
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Affiliation(s)
- Nicolas Fayed
- Department of Radiology, Quirónsalud
Hospital, Spain
| | - Barbara Oliván
- Department of Psychology and Sociology,
University of Zaragoza, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Yolanda Lopez del Hoyo
- Department of Psychology and Sociology,
University of Zaragoza, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Eva Andrés
- CIBER Epidemiology and Public Health,
Clinical Epidemiology Unit, October 12 Hospital, Spain
| | | | - Alicia Fayed
- Department of Neurorehabilitation, San
Juan de Dios Hospital, Spain
| | - Luisa F Angel
- Department of Radiology, Quirónsalud
Hospital, Spain
| | - Antoni Serrano-Blanco
- Department of Psychiatry, Parc Sanitari
St. Joan of God and the St. Joan of God Foundation, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Miquel Roca
- Health Sciences Research University
Institute, Juan March Hospital, Illes Balears University, Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
| | - Javier Garcia Campayo
- Department of Psychiatry, Miguel Servet
Hospital and the University of Zaragoza. Aragon Institute for Health Research (IIS
Aragon), Spain
- Preventative Activities and Health
Promotion Network (REDIAPP) (G06/170)
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12
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Cardiovascular risks impact human brain N-acetylaspartate in regionally specific patterns. Proc Natl Acad Sci U S A 2019; 116:25243-25249. [PMID: 31754041 DOI: 10.1073/pnas.1907730116] [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] [Indexed: 11/18/2022] Open
Abstract
Cardiovascular risk factors such as dyslipidemia and hypertension increase the risk for white matter pathology and cognitive decline. We hypothesize that white matter levels of N-acetylaspartate (NAA), a chemical involved in the metabolic pathway for myelin lipid synthesis, could serve as a biomarker that tracks the influence of cardiovascular risk factors on white matter prior to emergence of clinical changes. To test this, we measured levels of NAA across white matter and gray matter in the brain using echo planar spectroscopic imaging (EPSI) in 163 individuals and examined the relationship of regional NAA levels and cardiovascular risk factors as indexed by the Framingham Cardiovascular Risk Score (FCVRS). NAA was strongly and negatively correlated with FCVRS across the brain, but, after accounting for age and sex, the association was found primarily in white matter regions, with additional effects found in the thalamus, hippocampus, and cingulate gyrus. FCVRS was also negatively correlated with creatine levels, again primarily in white matter. The results suggest that cardiovascular risks are related to neurochemistry with a predominantly white matter pattern and some subcortical and cortical gray matter involvement. NAA mapping of the brain may provide early surveillance for the potential subclinical impact of cardiovascular and metabolic risk factors on the brain.
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13
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Voevodskaya O, Poulakis K, Sundgren P, van Westen D, Palmqvist S, Wahlund LO, Stomrud E, Hansson O, Westman E. Brain myoinositol as a potential marker of amyloid-related pathology: A longitudinal study. Neurology 2019; 92:e395-e405. [PMID: 30610093 PMCID: PMC6369900 DOI: 10.1212/wnl.0000000000006852] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/18/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the association between longitudinal changes in proton magnetic resonance spectroscopy (MRS) metabolites and amyloid pathology in individuals without dementia, and to explore the relationship between MRS and cognitive decline. METHODS In this longitudinal multiple time point study (a subset of the Swedish BioFINDER), we included cognitively healthy participants, individuals with subjective cognitive decline, and individuals with mild cognitive impairment. MRS was acquired serially in 294 participants (670 individual spectra) from the posterior cingulate/precuneus. Using mixed-effects models, we assessed the association between MRS and baseline β-amyloid (Aβ), and between MRS and the longitudinal Mini-Mental State Examination, accounting for APOE, age, and sex. RESULTS While baseline MRS metabolites were similar in Aβ positive (Aβ+) and negative (Aβ-) individuals, in the Aβ+ group, the estimated rate of change was +1.9%/y for myo-inositol (mI)/creatine (Cr) and -2.0%/y for N-acetylaspartate (NAA)/mI. In the Aβ- group, mI/Cr and NAA/mI yearly change was -0.05% and +1.2%; however, this was not significant across time points. The mild cognitive impairment Aβ+ group showed the steepest MRS changes, with an estimated rate of +2.93%/y (p = 0.07) for mI/Cr and -3.55%/y (p < 0.01) for NAA/mI. Furthermore, in the entire cohort, we found that Aβ+ individuals with low baseline NAA/mI had a significantly higher rate of cognitive decline than Aβ+ individuals with high baseline NAA/mI. CONCLUSION We demonstrate that the longitudinal change in mI/Cr and NAA/mI is associated with underlying amyloid pathology. MRS may be a useful noninvasive marker of Aβ-related processes over time. In addition, we show that in Aβ+ individuals, baseline NAA/mI may predict the rate of future cognitive decline.
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Affiliation(s)
- Olga Voevodskaya
- From the Division of Clinical Geriatrics (O.V., K.P., L.-O.W., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; Department of Diagnostic Radiology (P.S., D.v.W.), Lund University; Imaging and Function (D.v.W.), Skåne University Health Care, Lund; Clinical Memory Research Unit (S.P., E.S., O.H.), Department of Clinical Sciences, Malmö, Lund University; Memory Clinic (E.S., O.H.), Skåne University Hospital, Malmö, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Konstantinos Poulakis
- From the Division of Clinical Geriatrics (O.V., K.P., L.-O.W., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; Department of Diagnostic Radiology (P.S., D.v.W.), Lund University; Imaging and Function (D.v.W.), Skåne University Health Care, Lund; Clinical Memory Research Unit (S.P., E.S., O.H.), Department of Clinical Sciences, Malmö, Lund University; Memory Clinic (E.S., O.H.), Skåne University Hospital, Malmö, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Pia Sundgren
- From the Division of Clinical Geriatrics (O.V., K.P., L.-O.W., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; Department of Diagnostic Radiology (P.S., D.v.W.), Lund University; Imaging and Function (D.v.W.), Skåne University Health Care, Lund; Clinical Memory Research Unit (S.P., E.S., O.H.), Department of Clinical Sciences, Malmö, Lund University; Memory Clinic (E.S., O.H.), Skåne University Hospital, Malmö, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Danielle van Westen
- From the Division of Clinical Geriatrics (O.V., K.P., L.-O.W., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; Department of Diagnostic Radiology (P.S., D.v.W.), Lund University; Imaging and Function (D.v.W.), Skåne University Health Care, Lund; Clinical Memory Research Unit (S.P., E.S., O.H.), Department of Clinical Sciences, Malmö, Lund University; Memory Clinic (E.S., O.H.), Skåne University Hospital, Malmö, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sebastian Palmqvist
- From the Division of Clinical Geriatrics (O.V., K.P., L.-O.W., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; Department of Diagnostic Radiology (P.S., D.v.W.), Lund University; Imaging and Function (D.v.W.), Skåne University Health Care, Lund; Clinical Memory Research Unit (S.P., E.S., O.H.), Department of Clinical Sciences, Malmö, Lund University; Memory Clinic (E.S., O.H.), Skåne University Hospital, Malmö, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lars-Olof Wahlund
- From the Division of Clinical Geriatrics (O.V., K.P., L.-O.W., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; Department of Diagnostic Radiology (P.S., D.v.W.), Lund University; Imaging and Function (D.v.W.), Skåne University Health Care, Lund; Clinical Memory Research Unit (S.P., E.S., O.H.), Department of Clinical Sciences, Malmö, Lund University; Memory Clinic (E.S., O.H.), Skåne University Hospital, Malmö, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Erik Stomrud
- From the Division of Clinical Geriatrics (O.V., K.P., L.-O.W., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; Department of Diagnostic Radiology (P.S., D.v.W.), Lund University; Imaging and Function (D.v.W.), Skåne University Health Care, Lund; Clinical Memory Research Unit (S.P., E.S., O.H.), Department of Clinical Sciences, Malmö, Lund University; Memory Clinic (E.S., O.H.), Skåne University Hospital, Malmö, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Oskar Hansson
- From the Division of Clinical Geriatrics (O.V., K.P., L.-O.W., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; Department of Diagnostic Radiology (P.S., D.v.W.), Lund University; Imaging and Function (D.v.W.), Skåne University Health Care, Lund; Clinical Memory Research Unit (S.P., E.S., O.H.), Department of Clinical Sciences, Malmö, Lund University; Memory Clinic (E.S., O.H.), Skåne University Hospital, Malmö, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Eric Westman
- From the Division of Clinical Geriatrics (O.V., K.P., L.-O.W., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; Department of Diagnostic Radiology (P.S., D.v.W.), Lund University; Imaging and Function (D.v.W.), Skåne University Health Care, Lund; Clinical Memory Research Unit (S.P., E.S., O.H.), Department of Clinical Sciences, Malmö, Lund University; Memory Clinic (E.S., O.H.), Skåne University Hospital, Malmö, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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14
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Kroll JL, Steele AM, Pinkham AE, Choi C, Khan DA, Patel SV, Chen JR, Aslan S, Sherwood Brown E, Ritz T. Hippocampal metabolites in asthma and their implications for cognitive function. Neuroimage Clin 2018; 19:213-221. [PMID: 30035015 PMCID: PMC6051470 DOI: 10.1016/j.nicl.2018.04.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/07/2018] [Accepted: 04/11/2018] [Indexed: 12/16/2022]
Abstract
Emerging research indicates that individuals with asthma have an increased risk of cognitive impairment, yet the associations of asthma with neural correlates of memory remain relatively unknown. The hippocampus is the predominant neural structure involved in memory, and alterations in the hippocampal metabolic profile are observed in individuals with mild cognitive impairment. We therefore hypothesized that individuals with asthma may have altered hippocampal metabolites compared to healthy controls. Structural magnetic resonance imaging (sMRI) and proton magnetic resonance spectroscopy (1H-MRS) were used to compare hippocampal volume and metabolites of otherwise healthy adults with and without asthma (N = 40), and to study the association of these measures with cognitive function and asthma-related variables. Participants underwent 3-Tesla sMRI and 1H-MRS, with the volume of interest placed in the left hippocampus to measure levels of N-acetylaspartate (NAA), glutamate (Glu), creatine (Cr), and myo-inositol (MI), as indicators of neuronal viability, cellular activity, cellular energy reserve, as well as glial activation. Individuals with asthma had lower hippocampal NAA compared to healthy controls. For all participants, poorer cognitive function was associated with reduced NAA and Glu. For individuals with asthma, poorer cognitive function was associated with reduced disease control. Additionally, short-acting rescue bronchodilator use was associated with significantly lower NAA, and Glu, whereas inhaled corticosteroid use was related to significantly higher Cr and in tendency higher NAA and Glu. All findings controlled for left hippocampal volume, which was not different between groups. These findings highlight that asthma and/or its treatment may affect hippocampal chemistry. It is possible that the observed reductions in hippocampal metabolites in younger individuals with asthma may precede cognitive and hippocampal structural deficits observed in older individuals with asthma.
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Affiliation(s)
- Juliet L Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Ashton M Steele
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas, Dallas, TX, USA
| | - Changho Choi
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David A Khan
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sheenal V Patel
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Justin R Chen
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sina Aslan
- School of Behavioral and Brain Sciences, The University of Texas, Dallas, TX, USA; Advance MRI LLC, Frisco, TX, USA; Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
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15
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In Vivo Imaging of CNS Injury and Disease. J Neurosci 2017; 37:10808-10816. [PMID: 29118209 DOI: 10.1523/jneurosci.1826-17.2017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 02/06/2023] Open
Abstract
In vivo optical imaging has emerged as a powerful tool with which to study cellular responses to injury and disease in the mammalian CNS. Important new insights have emerged regarding axonal degeneration and regeneration, glial responses and neuroinflammation, changes in the neurovascular unit, and, more recently, neural transplantations. Accompanying a 2017 SfN Mini-Symposium, here, we discuss selected recent advances in understanding the neuronal, glial, and other cellular responses to CNS injury and disease with in vivo imaging of the rodent brain or spinal cord. We anticipate that in vivo optical imaging will continue to be at the forefront of breakthrough discoveries of fundamental mechanisms and therapies for CNS injury and disease.
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16
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Zeydan B, Deelchand DK, Tosakulwong N, Lesnick TG, Kantarci OH, Machulda MM, Knopman DS, Lowe VJ, Jack CR, Petersen RC, Öz G, Kantarci K. Decreased Glutamate Levels in Patients with Amnestic Mild Cognitive Impairment: An sLASER Proton MR Spectroscopy and PiB-PET Study. J Neuroimaging 2017; 27:630-636. [PMID: 28661060 DOI: 10.1111/jon.12454] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Glutamate levels may be informative about the declining neuronal health in the central nervous system. We used an advanced proton MR spectroscopy (1 H-MRS) protocol composed of semi-localization by adiabatic selective refocusing (sLASER) localization and FAST(EST)MAP shimming for detection of alterations in brain glutamate concentrations in patients with amnestic mild cognitive impairment. METHODS Participants with amnestic mild cognitive impairment (n = 14; median age = 80) and age- and sex-matched clinically normal controls (n = 32; median age = 79) from the population-based Mayo Clinic Study of Aging were recruited prospectively to the 3T single-voxel 1 H-MRS study that examined metabolite changes in the posterior cingulate gyri. To be included, controls had to have low β-amyloid load on [11 C] Pittsburgh Compound B (PiB)-PET (standard uptake value ratio; SUVr < 1.42) and patients with amnestic mild cognitive impairment had to have high β-amyloid load (SUVr ≥ 1.42). RESULTS Glutamate concentration and the glutamate/myo-inositol ratio were lower in patients with amnestic mild cognitive impairment than clinically normal controls (P < .05). Higher global cortical PiB-PET SUVr correlated with lower glutamate/myo-inositol (r = -.3, P = .04). CONCLUSIONS The advanced sLASER with FAST(EST)MAP shimming is a promising protocol for identifying glutamate alterations. Advanced 1 H-MRS protocols may add to the understanding of early Alzheimer's disease pathophysiology through detection of glutamate concentration in posterior cingulate gyri of individuals with amnestic mild cognitive impairment.
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Affiliation(s)
- Burcu Zeydan
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Dinesh K Deelchand
- Department of Radiology, University of Minnesota, Center for Magnetic Resonance Research, Minneapolis, MN
| | - Nirubol Tosakulwong
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Orhun H Kantarci
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN
| | - David S Knopman
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Val J Lowe
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Gülin Öz
- Department of Radiology, University of Minnesota, Center for Magnetic Resonance Research, Minneapolis, MN
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
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17
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Guo S, Lai C, Wu C, Cen G. Conversion Discriminative Analysis on Mild Cognitive Impairment Using Multiple Cortical Features from MR Images. Front Aging Neurosci 2017; 9:146. [PMID: 28572766 PMCID: PMC5435825 DOI: 10.3389/fnagi.2017.00146] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/01/2017] [Indexed: 01/18/2023] Open
Abstract
Neuroimaging measurements derived from magnetic resonance imaging provide important information required for detecting changes related to the progression of mild cognitive impairment (MCI). Cortical features and changes play a crucial role in revealing unique anatomical patterns of brain regions, and further differentiate MCI patients from normal states. Four cortical features, namely, gray matter volume, cortical thickness, surface area, and mean curvature, were explored for discriminative analysis among three groups including the stable MCI (sMCI), the converted MCI (cMCI), and the normal control (NC) groups. In this study, 158 subjects (72 NC, 46 sMCI, and 40 cMCI) were selected from the Alzheimer's Disease Neuroimaging Initiative. A sparse-constrained regression model based on the l2-1-norm was introduced to reduce the feature dimensionality and retrieve essential features for the discrimination of the three groups by using a support vector machine (SVM). An optimized strategy of feature addition based on the weight of each feature was adopted for the SVM classifier in order to achieve the best classification performance. The baseline cortical features combined with the longitudinal measurements for 2 years of follow-up data yielded prominent classification results. In particular, the cortical thickness produced a classification with 98.84% accuracy, 97.5% sensitivity, and 100% specificity for the sMCI–cMCI comparison; 92.37% accuracy, 84.78% sensitivity, and 97.22% specificity for the cMCI–NC comparison; and 93.75% accuracy, 92.5% sensitivity, and 94.44% specificity for the sMCI–NC comparison. The best performances obtained by the SVM classifier using the essential features were 5–40% more than those using all of the retained features. The feasibility of the cortical features for the recognition of anatomical patterns was certified; thus, the proposed method has the potential to improve the clinical diagnosis of sub-types of MCI and predict the risk of its conversion to Alzheimer's disease.
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Affiliation(s)
- Shengwen Guo
- Department of Biomedical Engineering, South China University of TechnologyGuangzhou, China
| | - Chunren Lai
- Department of Biomedical Engineering, South China University of TechnologyGuangzhou, China
| | - Congling Wu
- Department of Biomedical Engineering, South China University of TechnologyGuangzhou, China
| | - Guiyin Cen
- Guangdong General HospitalGuangzhou, China
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18
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Fayed N, Modrego PJ, García-Martí G, Sanz-Requena R, Marti-Bonmatí L. Magnetic resonance spectroscopy and brain volumetry in mild cognitive impairment. A prospective study. Magn Reson Imaging 2016; 38:27-32. [PMID: 27964994 DOI: 10.1016/j.mri.2016.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the accuracy of magnetic resonance spectroscopy (1H-MRS) and brain volumetry in mild cognitive impairment (MCI) to predict conversion to probable Alzheimer's disease (AD). METHODS Forty-eight patients fulfilling the criteria of amnestic MCI who underwent a conventional magnetic resonance imaging (MRI) followed by MRS, and T1-3D on 1.5 Tesla MR unit. At baseline the patients underwent neuropsychological examination. 1H-MRS of the brain was carried out by exploring the left medial occipital lobe and ventral posterior cingulated cortex (vPCC) using the LCModel software. A high resolution T1-3D sequence was acquired to carry out the volumetric measurement. A cortical and subcortical parcellation strategy was used to obtain the volumes of each area within the brain. The patients were followed up to detect conversion to probable AD. RESULTS After a 3-year follow-up, 15 (31.2%) patients converted to AD. The myo-inositol in the occipital cortex and glutamate+glutamine (Glx) in the posterior cingulate cortex predicted conversion to probable AD at 46.1% sensitivity and 90.6% specificity. The positive predictive value was 66.7%, and the negative predictive value was 80.6%, with an overall cross-validated classification accuracy of 77.8%. The volume of the third ventricle, the total white matter and entorhinal cortex predict conversion to probable AD at 46.7% sensitivity and 90.9% specificity. The positive predictive value was 70%, and the negative predictive value was 78.9%, with an overall cross-validated classification accuracy of 77.1%. Combining volumetric measures in addition to the MRS measures the prediction to probable AD has a 38.5% sensitivity and 87.5% specificity, with a positive predictive value of 55.6%, a negative predictive value of 77.8% and an overall accuracy of 73.3%. CONCLUSION Either MRS or brain volumetric measures are markers separately of cognitive decline and may serve as a noninvasive tool to monitor cognitive changes and progression to dementia in patients with amnestic MCI, but the results do not support the routine use in the clinical settings.
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Affiliation(s)
- Nicolás Fayed
- Radiology Department, Quirón Hospital, Zaragoza 50009, Spain
| | - Pedro J Modrego
- Department of Neurology, Miguel Servet Hospital, Zaragoza 50009, Spain.
| | - Gracián García-Martí
- Biomedical Engineering, Quirón Hospital, Valencia, Spain; CIBERSAM, Mental Research Network, Valencia, Spain
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Calderón-Garcidueñas L, Mora-Tiscareño A, Melo-Sánchez G, Rodríguez-Díaz J, Torres-Jardón R, Styner M, Mukherjee PS, Lin W, Jewells V. A Critical Proton MR Spectroscopy Marker of Alzheimer's Disease Early Neurodegenerative Change: Low Hippocampal NAA/Cr Ratio Impacts APOE ɛ4 Mexico City Children and Their Parents. J Alzheimers Dis 2016; 48:1065-75. [PMID: 26402110 DOI: 10.3233/jad-150415] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Severe air pollution exposures produce systemic, respiratory, myocardial, and brain inflammation and Alzheimer's disease (AD) hallmarks in clinically healthy children. We tested whether hippocampal metabolite ratios are associated with contrasting levels of air pollution, APOE, and body mass index (BMI) in paired healthy children and one parent sharing the same APOE alleles. We used 1H-MRS to interrogate bilateral hippocampal single-voxel in 57 children (12.45 ± 3.4 years) and their 48 parents (37.5 ± 6.78 years) from a low pollution city versus Mexico City (MC). NAA/Cr, Cho/Cr, and mI/Cr metabolite ratios were analyzed. The right hippocampus NAA/Cr ratio was significantly different between cohorts (p = 0.007). The NAA/Cr ratio in right hippocampus in controls versus APOE ɛ4 MC children and in left hippocampus in MC APOE ɛ4 parents versus their children was significantly different after adjusting for age, gender, and BMI (p = 0.027 and 0.01, respectively). The NAA/Cr ratio is considered reflective of neuronal density/functional integrity/loss of synapses/higher pTau burden, thus a significant decrease in hippocampal NAA/Cr ratios may constitute a spectral marker of early neurodegeneration in young urbanites. Decreases in NAA/Cr correlate well with cognitive function, behavioral symptoms, and dementia severity; thus, since the progression of AD starts decades before clinical diagnosis, our findings support the hypothesis that under chronic exposures to fine particulate matter and ozone above the standards, neurodegenerative processes start in childhood and APOE ɛ4 carriers are at higher risk. Gene and environmental factors are critical in the development of AD and the identification and neuroprotection of young urbanites at high risk must become a public health priority.
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Affiliation(s)
- Lilian Calderón-Garcidueñas
- The Center for Structural and Functional Neurosciences, The University of Montana, Missoula, MT, USA.,Escuela de Ciencias de la Salud, Universidad del Valle de México, Campus Saltillo, Saltillo, Coahuila, México
| | | | - Gastón Melo-Sánchez
- Escuela de Ciencias de la Salud, Universidad del Valle de México, Campus Saltillo, Saltillo, Coahuila, México
| | | | - Ricardo Torres-Jardón
- Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Martin Styner
- Department of Psychiatry and Computer Science, University of North Carolina, Chapel Hill, NC, USA
| | | | - Weili Lin
- Neuroradiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Valerie Jewells
- Neuroradiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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20
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(1)H-MRS asymmetry changes in the anterior and posterior cingulate gyrus in patients with mild cognitive impairment and mild Alzheimer's disease. Compr Psychiatry 2016; 69:179-85. [PMID: 27423359 DOI: 10.1016/j.comppsych.2016.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/13/2016] [Accepted: 06/04/2016] [Indexed: 11/20/2022] Open
Abstract
Alzheimer's disease (AD) is the most common cause of dementia worldwide. Amnestic mild cognitive impairment (aMCI) is often the prodromal stage to AD. Most patients with aMCI harbor the pathologic changes of AD and demonstrate transition to AD at a rate of 10%-15% per year. Patients with AD and aMCI experience progressive brain metabolite changes. Accumulating evidence indicates that the asymmetry changes of left and right brain happen in the early stage of AD. However, the features of asymmetry changes in both anterior cingulate gyrus (ACG) and posterior cingulate gyrus (PCG) are still unclear. Here, we examine the left-right asymmetry changes of metabolites in ACG and PCG. Fifteen cases of mild AD patients meeting criteria for probable AD of NINDS-ADRDA, thirteen cases of aMCI according to the Mayo Clinic Alzheimer's Disease Research Center criteria, and sixteen cases of age-matched normal controls (NC) received Proton magnetic resonance spectroscopy ((1)H-MRS) for measurement of NAA/mI, NAA/Cr, Cho/Cr, and mI/Cr ratios in the PCG and ACG bilaterally. We analyzed (1)H-MRS data by paired t-test to validate the left-right asymmetry of (1)H-MRS data in the PCG and ACG. In AD, there was a significant difference in mI/Cr between the left and right ACG (P<0.001) and the left and right PCG (P=0.007). In aMCI, there was a significant difference in mI/Cr between the left and right ACG (P<0.001). In NC, there were no differences in the ratio value of metabolites NAA/mI, NAA/Cr, Cho/Cr, and mI/Cr between the left and right ACG and PCG. Thus, the left-right asymmetry of mI/Cr in the ACG and PCG may be an important biological indicator of mild AD.
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21
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Alberdi A, Aztiria A, Basarab A. On the early diagnosis of Alzheimer's Disease from multimodal signals: A survey. Artif Intell Med 2016; 71:1-29. [PMID: 27506128 DOI: 10.1016/j.artmed.2016.06.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/23/2016] [Accepted: 06/07/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The number of Alzheimer's Disease (AD) patients is increasing with increased life expectancy and 115.4 million people are expected to be affected in 2050. Unfortunately, AD is commonly diagnosed too late, when irreversible damages have been caused in the patient. OBJECTIVE An automatic, continuous and unobtrusive early AD detection method would be required to improve patients' life quality and avoid big healthcare costs. Thus, the objective of this survey is to review the multimodal signals that could be used in the development of such a system, emphasizing on the accuracy that they have shown up to date for AD detection. Some useful tools and specific issues towards this goal will also have to be reviewed. METHODS An extensive literature review was performed following a specific search strategy, inclusion criteria, data extraction and quality assessment in the Inspec, Compendex and PubMed databases. RESULTS This work reviews the extensive list of psychological, physiological, behavioural and cognitive measurements that could be used for AD detection. The most promising measurements seem to be magnetic resonance imaging (MRI) for AD vs control (CTL) discrimination with an 98.95% accuracy, while electroencephalogram (EEG) shows the best results for mild cognitive impairment (MCI) vs CTL (97.88%) and MCI vs AD distinction (94.05%). Available physiological and behavioural AD datasets are listed, as well as medical imaging analysis steps and neuroimaging processing toolboxes. Some issues such as "label noise" and multi-site data are discussed. CONCLUSIONS The development of an unobtrusive and transparent AD detection system should be based on a multimodal system in order to take full advantage of all kinds of symptoms, detect even the smallest changes and combine them, so as to detect AD as early as possible. Such a multimodal system might probably be based on physiological monitoring of MRI or EEG, as well as behavioural measurements like the ones proposed along the article. The mentioned AD datasets and image processing toolboxes are available for their use towards this goal. Issues like "label noise" and multi-site neuroimaging incompatibilities may also have to be overcome, but methods for this purpose are already available.
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Affiliation(s)
- Ane Alberdi
- Mondragon University, Electronics and Computing Department, Goiru Kalea, 2, Arrasate 20500, Spain.
| | - Asier Aztiria
- Mondragon University, Electronics and Computing Department, Goiru Kalea, 2, Arrasate 20500, Spain.
| | - Adrian Basarab
- Université de Toulouse, Institut de Recherche en Informatique de Toulouse, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5505, Université Paul Sabatier, 118 Route de Narbonne, 31062 Toulouse, France.
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22
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Proton magnetic resonance spectroscopy as a diagnostic biomarker in mild cognitive impairment following stroke in acute phase. Neuroreport 2016; 27:559-63. [PMID: 26981713 DOI: 10.1097/wnr.0000000000000555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To investigate proton magnetic resonance spectroscopy (HMRS) as a diagnostic biomarker to identify mild cognitive impairment (MCI) following stroke in the acute phase. A total of 72 stroke patients were recruited in the acute phase of stroke from the Department of Neurology, including 36 stroke patients with MCI and 36 stroke patients without MCI. All patients underwent brain MRI/MRS examination on a 3.0 T scanner and a neuropsychological test in the acute phase of stroke. Single-voxel HMRS was performed to obtain hippocampal metabolism intensities and brain infarcts were assessed on MRI. Group difference in metabolite ratios was analyzed using a T-test. Spearman rank correlation was used to study the correlation between metabolite ratios and Montreal Cognitive Assessment scores. The hippocampal n-acetylaspartate/creatine (NAA/Cr) ratio was found to be significantly lower in stroke patients with MCI compared with stroke patients without MCI (P<0.02). However, we found no differences in the metabolite ratios between hippocampus ipsilateral to infarctions and the contralateral side (P>0.05) in stroke patients with MCI. Furthermore, a correlation was found between hippocampal NAA/Cr ratios and Montreal Cognitive Assessment scores in stroke patients with MCI (P<0.01). HMRS could be a biomarker to identify MCI following stroke in the acute phase by capturing neurodegenerative changes.
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23
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Almuqbel M, Melzer TR, Myall DJ, MacAskill MR, Pitcher TL, Livingston L, Wood KL, Keenan RJ, Dalrymple-Alford JC, Anderson TJ. Metabolite ratios in the posterior cingulate cortex do not track cognitive decline in Parkinson's disease in a clinical setting. Parkinsonism Relat Disord 2016; 22:54-61. [DOI: 10.1016/j.parkreldis.2015.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/27/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
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Watanabe T, Shiino A, Akiguchi I. [Prediction of conversion from amnestic mild cognitive impairment to Alzheimer's disease using proton magnetic resonance spectroscopy]. Rinsho Shinkeigaku 2015; 55:709-15. [PMID: 26369373 DOI: 10.5692/clinicalneurol.cn-000751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Amnestic mild cognitive impairment (aMCI) has been considered to be a transitional state between healthy aging and very mild Alzheimer's disease (AD). Most patients with aMCI convert to AD over time, but some of them remain stable as aMCI. In this study, 22 patients with aMCI underwent proton magnetic resonance spectroscopy (1H-MRS) of hippocampus and posterior cingulate cortex. Ten patients converted to AD had significantly lower N-acetylaspartate (NAA) concentrations in both hippocampi when compared to 12 patients remained stable to be aMCI. The mean NAA concentration of both hippocampi equal to or lower than 7.6 mmol/l predicted conversion to AD at 1.0 sensitivity and 1.0 specificity and the area under receiver operating curve (ROC) was 1.0. Absolute quantification of 1H-MRS of hippocampus seems to be a useful marker for predicting conversion to AD from patients with aMCI .
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25
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Penner J, Wells JL, Borrie MJ, Woolmore-Goodwin SM, Bartha R. Reduced N-acetylaspartate to creatine ratio in the posterior cingulate correlates with cognition in Alzheimer's disease following four months of rivastigmine treatment. Dement Geriatr Cogn Disord 2015; 39:68-80. [PMID: 25358336 DOI: 10.1159/000367685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/19/2022] Open
Abstract
AIM To determine whether 4 months of rivastigmine treatment would result in metabolic changes and whether metabolic changes correlate with changes in cognition in people with Alzheimer's disease (AD). METHODS Magnetic resonance spectra were acquired from the posterior cingulate cortex of subjects with AD at 3 T. Magnetic resonance imaging scans and cognitive tests were performed before and 4 months after the beginning of the treatment. Metabolite concentrations were quantified and used to calculate the metabolite ratios. RESULTS On average, the N-acetylaspartate/creatine (NAA/Cr) ratio decreased by 12.7% following 4 months of rivastigmine treatment, but changes in the NAA/Cr ratio correlated positively with changes in Mini-Mental State Examination scores. CONCLUSION This positive correlation between changes in NAA/Cr and changes in cognitive performance suggests that the NAA/Cr ratio could be an objective indicator of a response to rivastigmine treatment.
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Affiliation(s)
- Jacob Penner
- Centre for Functional and Metabolic Mapping (CFMM), Robarts Research Institute, and Department of Medical Biophysics, University of Western Ontario, London, Ont., Canada
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26
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Brain metabolism assessed via proton magnetic resonance spectroscopy in patients with amnestic or vascular mild cognitive impairment. Clin Neurol Neurosurg 2015; 130:80-5. [DOI: 10.1016/j.clineuro.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 11/27/2014] [Accepted: 12/01/2014] [Indexed: 11/18/2022]
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27
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Gao L, Liu Y, Li X, Bai Q, Liu P. Abnormal retinal nerve fiber layer thickness and macula lutea in patients with mild cognitive impairment and Alzheimer's disease. Arch Gerontol Geriatr 2014; 60:162-7. [PMID: 25459918 DOI: 10.1016/j.archger.2014.10.011] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/09/2014] [Accepted: 10/11/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We investigated possible abnormalities in the retinal nerve fiber layer (RNFL) and macula lutea of patients diagnosed with Alzheimer's disease (AD) and mild cognitive impairment (MCI) and tested for any correlation with the severity of dementia. METHODS A total of 72 subjects, comprising 25 AD patients, 26 MCI patients and 21 healthy individuals (controls) were enrolled in this study. The thickness of the RNFL and volume of the macula lutea was determined using optical coherence tomography (OCT). RESULTS When compared with controls, we found statistically significant thinning of the RNFL in AD patients at all clock-hour positions except 12:00, and nasal quadrant, 2:00, 3:00 and 4:00. After adjusting several risk factors, the average thickness of the RNFL was reduced in MCI patients compared to AD patients, with specific reductions at inferior quadrant, 5:00 and 6:00. Compared to controls, MCI patients showed a significant decrease in RNFL thickness only in the temporal quadrant, 8:00, 9:00 and 10:00. We found significant reduction in the volume of the macula lutea both in AD and MCI patients. Finally, we could not establish any correlation between patient Mini-Mental State Examination (MMSE) scores (an estimation of the severity of cognitive impairment) and any OCT parameter. CONCLUSION Retinal degeneration in AD and MCI patients results in decreased thickness of the RNFL, and reduced macular volume in AD and MCI patients. However, there seems to be no correlation between these changes and the severity of dementia.
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Affiliation(s)
- LiYan Gao
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, People's Republic of China
| | - Ying Liu
- Department of Neurology, Dalian Municipal Friendship Hospital, Dalian, People's Republic of China
| | - XiaoHong Li
- Department of Neurology, Dalian Municipal Friendship Hospital, Dalian, People's Republic of China
| | - QuanHao Bai
- Department of Ophthalmology, Dalian Municipal Friendship Hospital, Dalian, People's Republic of China
| | - Ping Liu
- Department of Neurology, The Third People's Hospital of Dalian, Dalian, People's Republic of China.
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28
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Fayed N, Olivan-Blázquez B, Herrera-Mercadal P, Puebla-Guedea M, Pérez-Yus MC, Andrés E, López del Hoyo Y, Magallon R, Viguera L, Garcia-Campayo J. Changes in metabolites after treatment with memantine in fibromyalgia. A double-blind randomized controlled trial with magnetic resonance spectroscopy with a 6-month follow-up. CNS Neurosci Ther 2014; 20:999-1007. [PMID: 25230216 DOI: 10.1111/cns.12314] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/24/2014] [Accepted: 07/26/2014] [Indexed: 12/11/2022] Open
Abstract
AIM To evaluate the efficacy of memantine on metabolite levels in different areas of the brain and to determine whether changes in metabolite levels correlate with clinical variables in Fibromyalgia (FM) patients. METHODS Doubled-blind parallel randomized controlled trial. Twenty-five patients diagnosed with FM were enrolled in the study. Patients were administered questionnaires on pain, anxiety, depression, quality of life, and cognitive impairment, and single-voxel MRS of the brain was performed. All assessments were performed at baseline and after 6 months of treatment with memantine or placebo. RESULTS Patients treated with memantine exhibited a significant increase in the glutamate (P = 0.010), glutamate/creatine ratio (P = 0.013), combined glutamate + glutamine (P = 0.016) and total N-acetyl-aspartate (NAA+NAAG) (P = 0.034) in the posterior cingulate cortex compared with those on placebo. Furthermore, the memantine group exhibited increases in creatine (P = 0.013) and choline (Cho) (P = 0.025) in the right posterior insula and also a correlation between choline and the Fibromyalgia Impact Questionnaire (FIQ) in the posterior insula (P = 0.050) was observed. CONCLUSION Memantine treatment resulted in an increase in cerebral metabolism in FM patients, suggesting its utility for the treatment of the illness.
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Affiliation(s)
- Nicolás Fayed
- Magnetic Resonance Unit, Department of Radiology, Clinica Quiron, Zaragoza, Spain
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29
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Liu YY, Yang ZX, Shen ZW, Xiao YY, Cheng XF, Chen W, Chen YW, Wu RH. Magnetic Resonance Spectroscopy Study of Amnestic Mild Cognitive Impairment and Vascular Cognitive Impairment With No Dementia. Am J Alzheimers Dis Other Demen 2014; 29:474-81. [PMID: 23823139 PMCID: PMC10852712 DOI: 10.1177/1533317513495106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Amnestic mild cognitive impairment (aMCI) and vascular cognitive impairment with no dementia (VCIND) are highly predictive of Alzheimer's disease and vascular dementia. In this study, a 2-dimensional magnetic resonance spectroscopy was performed in 25 patients with aMCI, 28 patients with VCIND, and 32 normal controls (NCs). The concentrations of N-acetyl aspartate (NAA), choline (Cho), myoinositol (MI), and creatine (Cr) were measured, and their ratios were calculated. The patients with aMCI displayed significantly lower NAA/MI bilaterally in the posterior cingulate gyrus (PCG) and white matter of occipital lobe (OLWM) than NC participants or patients with VCIND , whereas patients with VCIND displayed markedly lower NAA/Cho bilaterally in the white matter of frontal lobe (FLWM) and left OLWM, and right dorsal thalamus (DT) than patients with NC or aMCI. Compared with the controls, patients with aMCI displayed lower NAA and NAA/Cr in bilateral PCG, left precuneus, and DT, whereas patients with VCIND displayed lower NAA/Cr in bilateral DT and FLWM. In addition, increased MI in right PCG of patients with aMCI and increased Cho in left FLWM of patients with VCIND were also observed. The results might help guide a clinical differentiation between the 2 disorders.
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Affiliation(s)
- Yan-Yan Liu
- Department of Medical Imaging Center, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Zhong-Xian Yang
- Department of Medical Imaging Center, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Zhi-Wei Shen
- Department of Medical Imaging Center, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Ye-Yu Xiao
- Department of Medical Imaging Center, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Xiao-Fang Cheng
- Department of Medical Imaging Center, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Wei Chen
- Department of Neurology, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Yao-Wen Chen
- Department of Medical Imaging Center, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Ren-Hua Wu
- Department of Medical Imaging Center, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China Provincial Key Laboratory of Medical Molecular Imaging, Guangdong, Shantou, China
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30
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Mohamed RE, Aboelsafa AA, Abo-Sheisha DM. In vivo neurobiochemical changes of the posterior cingulate gyrus in patients with Alzheimer’s disease detected by multivoxel proton magnetic resonance spectroscopy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Zhang N, Song X, Bartha R, Beyea S, D’Arcy R, Zhang Y, Rockwood K. Advances in high-field magnetic resonance spectroscopy in Alzheimer's disease. Curr Alzheimer Res 2014; 11:367-88. [PMID: 24597505 PMCID: PMC4108086 DOI: 10.2174/1567205011666140302200312] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 02/21/2014] [Accepted: 02/25/2014] [Indexed: 12/20/2022]
Abstract
Alzheimer's disease (AD) affects several important molecules in brain metabolism. The resulting neurochemical changes can be quantified non-invasively in localized brain regions using in vivo single-voxel proton magnetic resonance spectroscopy (SV 1H MRS). Although the often heralded diagnostic potential of MRS in AD largely remains unfulfilled, more recent use of high magnetic fields has led to significantly improved signal-to-noise ratios and spectral resolutions, thereby allowing clinical applications with increased measurement reliability. The present article provides a comprehensive review of SV 1H MRS studies on AD at high magnetic fields (3.0 Tesla and above). This review suggests that patterned regional differences and longitudinal alterations in several neurometabolites are associated with clinically established AD. Changes in multiple metabolites are identifiable even at early stages of AD development. By combining information of neurochemicals in different brain regions revealing either pathological or compensatory changes, high field MRS can be evaluated in AD diagnosis and in the detection of treatment effects. To achieve this, standardization of data acquisition and analytical approaches is needed.
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Affiliation(s)
- Ningnannan Zhang
- National Research Council Canada, Institute for Biodiagnostics – Atlantic, Halifax, Nova Scotia, Canada
- Department
of Radiology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaowei Song
- National Research Council Canada, Institute for Biodiagnostics – Atlantic, Halifax, Nova Scotia, Canada
- Division of Geriatric Medicine,
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Neuroimaging Research Laboratory,
Biomedical Translational Imaging Centre, Halifax, Nova Scotia, Canada
| | - Robert Bartha
- Centre for Functional and Metabolic
Mapping, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
- Department of
Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Steven Beyea
- National Research Council Canada, Institute for Biodiagnostics – Atlantic, Halifax, Nova Scotia, Canada
- Neuroimaging Research Laboratory,
Biomedical Translational Imaging Centre, Halifax, Nova Scotia, Canada
- Department of Physics, Dalhousie
University, Halifax, Nova Scotia, Canada
| | - Ryan D’Arcy
- National Research Council Canada, Institute for Biodiagnostics – Atlantic, Halifax, Nova Scotia, Canada
- Department of Applied Science, Simon Fraser University, Surrey, British
Columbia, Canada
- Surrey Memorial Hospital, Fraser Health Foundation Innovation, Surrey, British Columbia,
Canada
| | - Yunting Zhang
- Department
of Radiology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Kenneth Rockwood
- Division of Geriatric Medicine,
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Health Care of the Elderly, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
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Fu JL, Liu Y, Li YM, Chang C, Li WB. Use of diffusion tensor imaging for evaluating changes in the microstructural integrity of white matter over 3 years in patients with amnesic-type mild cognitive impairment converting to Alzheimer's disease. J Neuroimaging 2013; 24:343-8. [PMID: 24251793 DOI: 10.1111/jon.12061] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Patients with amnestic mild cognitive impairment (aMCI) are at risk of developing Alzheimer's disease (AD). It is therefore important to identify biomarkers of conversion to AD. This study examined whether the integrity of white matter can predict this conversion. METHODS Magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) and neuropsychological features of aMCI subjects (n = 41) were compared with normal controls (n = 20) for 12-36 months. RESULTS Compared to controls, 22 aMCI subjects had lower fractional anisotropy (FA) values in the cingulate fasciculus (CF) at baseline, and 19 of those converted to AD during follow-up. Only two of the other 19 aMCI patients converted to AD. Compared to baseline, AD converters showed lower FA values in the anterior frontal lobe, temporal lobe, hippocampus, inferior fronto-occipital fascicles, corpus callosum genu and CF, and higher apparent diffusion coefficient values in the temporal lobe and hippocampus. CONCLUSIONS Those aMCI subjects with lower than normal FA values in the CF were more likely to convert to AD. The connectivity of the hippocampus and cingulate bundles may be affected in the early stage of AD. Impairment of white matter and fiber bundles was more severe at the AD stage than the aMCI stage.
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Affiliation(s)
- Jian-Liang Fu
- Department of Neurology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
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Targosz-Gajniak MG, Siuda JS, Wicher MM, Banasik TJ, Bujak MA, Augusciak-Duma AM, Opala G. Magnetic resonance spectroscopy as a predictor of conversion of mild cognitive impairment to dementia. J Neurol Sci 2013; 335:58-63. [PMID: 24035276 DOI: 10.1016/j.jns.2013.08.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 08/13/2013] [Accepted: 08/16/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Proton magnetic resonance spectroscopy ((1)H-MRS) is one of the imaging techniques that could be potentially useful for identification of patients with mild cognitive impairment (MCI) who are at increased risk of developing dementia. The aim of the study was to investigate if there is a difference in brain metabolism between stable MCI patients and converters to dementia and if a use of (1)H-MRS can predict the conversion from MCI to dementia. MATERIAL AND METHODS Forty-one amnestic MCI patients and 35 cognitively unimpaired controls were examined by (1)H-MRS (TE - 35 ms) at baseline. Metabolite ratios (NAA/Cr, Cho/Cr, mI/Cr, Glx/Cr, NAA/Cho) were estimated in four different brain regions: posterior cingulate gyrus (PCG), left hippocampus (LH), cortical area of right (RPL) and left parietal lobe (LPL). Participants were followed up for a period of 12 months. RESULTS Twelve subjects with MCI progressed to Alzheimer's disease (AD) after one year. Analysis showed that the NAA/Cr ratio in the LH was significantly lower in MCI patients than in controls (p=0.008), but there were no differences in metabolite ratios at baseline between MCI converters and stable subjects. mI/Cr ratio in RPL predicted the conversion to AD with sensitivity 70% and specificity 85% (p<0.0004). Coexistence of diabetes improved prediction, yielding 70% sensitivity and 96% specificity (p<0.0001). CONCLUSIONS (1)H-MRS in MCI can be a predictor of cognitive decline and conversion to dementia, especially in MCI patients with coexisting diabetes. Further studies are needed to confirm this finding.
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Magnetic resonance spectroscopy in mild cognitive impairment: systematic review and meta-analysis. Neurosci Biobehav Rev 2013; 37:2571-86. [PMID: 23969177 DOI: 10.1016/j.neubiorev.2013.08.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 07/17/2013] [Accepted: 08/11/2013] [Indexed: 01/28/2023]
Abstract
Research using proton magnetic resonance spectroscopy (MRS) can potentially elucidate metabolite changes representing early degeneration in Mild Cognitive Impairment (MCI), an early stage of dementia. We integrated the published literature using meta-analysis to identify patterns of metabolite changes in MCI. 29 MRS studies (with a total of 607 MCI patients and 862 healthy controls) were classified according to brain regions. Hedges' g was used as effect size in a random effects model. N-Acetyl Aspartate (NAA) measures were consistently reduced in posterior cingulate (PC), hippocampus, and the paratrigonal white matter (PWM). Creatine (Cr) concentration was reduced in the hippocampus and PWM. Choline (Cho) concentration was reduced in the hippocampus while Cho/Cr ratio was raised in the PC. Myo-inositol (mI) concentration was raised in the PC and mI/Cr ratio was raised in the hippocampus. NAA/mI ratio was reduced in the PC. NAA may be the most reliable marker of brain dysfunction in MCI though mI, Cho, and Cr may also contribute towards this.
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Burhan AM, Bartha R, Bocti C, Borrie M, Laforce R, Rosa-Neto P, Soucy JP. Role of emerging neuroimaging modalities in patients with cognitive impairment: a review from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. ALZHEIMERS RESEARCH & THERAPY 2013; 5:S4. [PMID: 24565285 PMCID: PMC3981649 DOI: 10.1186/alzrt200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) was held 3 to 4 May 2012 in Montreal, Quebec, Canada. A group of neuroimaging experts were assigned the task of reviewing and summarizing the literature on clinical and research applications of different neuroimaging modalities in cognitive disorders. This paper summarizes the literature and recommendations made to the conference regarding the role of several emerging neuroimaging modalities in cognitive disorders. Functional magnetic resonance imaging (MRI), magnetic resonance spectroscopy, and diffusion tensor imaging are discussed in detail within this paper. Other emergent neuroimaging modalities such as positron emission tomography with novel ligands, high-field MRI, arterial spin labeling MRI and noncerebral blood flow single-photon emission computerized tomography are only discussed briefly. Neuroimaging modalities that were recommended at the CCCDTD4 for both clinical and research applications such as amyloid and flurodeoxyglucose positron emission tomography, computerized tomography and structural MRI are discussed in a separate paper by the same authors. A literature search was conducted using the PubMed database including articles in English that involved human subjects and covered the period from the last CCCDTD publication (CCCDTD3; January 2006) until April 2012. Search terms included the name of the specific modality, dementia, Alzheimer's disease, and mild cognitive impairment. A separate search used the same parameters but was restricted to review articles to identify recent evidence-based reviews. Case studies and small case series were not included. Papers representing current evidence were selected, reviewed, and summarized, and the results were presented at the CCCDTD4 meeting with recommendations regarding the utility of various neuroimaging modalities in cognitive disorders. The evidence was graded according to the Oxford Centre for Evidence Based Medicine guidelines. Due to the limitations of current evidence, the neuroimaging modalities discussed in this paper were not recommended for clinical investigation of patients presenting with cognitive impairment. However, in the research setting, each modality provides a unique contribution to the understanding of basic mechanisms and neuropathological markers of cognitive disorders, to the identification of markers for early detection and for the risk of conversion to dementia in the at-risk populations, to the differentiation between different types of cognitive disorders, and to the identification of treatment targets and indicators of treatment response. In conclusion, for all of the neuroimaging modalities discussed in this paper, further studies are needed to establish diagnostic utility such as validity, reliability, and predictive and prognostic value. More multicenter studies are therefore needed with standardized image acquisition, experimental protocols, definition of the clinical population studied, larger numbers of participants, and longer duration of follow-up to allow generalizability of the results to the individual patient.
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Zueva IB, Moroshkina NV, Barantsevich ER, Trufanov GE. MAGNETIC RESONANCE SPECTROSCOPY IN EVALUATION OF COGNITIVE FUNCTIONS IN PATIENTS WITH METABOLIC SYNDROME. ACTA ACUST UNITED AC 2013. [DOI: 10.18705/1607-419x-2013-19-1-51-58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective. To evaluate the role of magnetic resonance spectroscopy (MR-spectroscopy) in the study of cognitive functions in patients with metabolic syndrome (MS).Design and methods. The study included patients with MS (10 patients without cognitive impairment and 11 subjects with cognitive dysfunction). All patients underwent neuropsychological testing, and cognitive evoked potential for the assessment of cognitive functions. Brain metabolism was studied by proton MR-spectroscopy.Results. In patients with MS and cognitive impairment, and without cognitive dysfunction no morphological changes in the brain according to the magnetic resonance imaging (MRI) were found. According to MR-spectroscopy of the brain in patients with MS and cognitive dysfunction the metabolism impairment is primarily associated with the increase in lactate and inositol.Conclusion. Indicators of neuropsychological testing, the cognitive evoked potential are associated with the violation of brain metabolism in patients with MS and cognitive impairment.
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Affiliation(s)
- I. B. Zueva
- Almazov Federal Heart, Blood, and Endocrinology Centre, St Petersburg
| | - N. V. Moroshkina
- Almazov Federal Heart, Blood, and Endocrinology Centre, St Petersburg
| | - E. R. Barantsevich
- Almazov Federal Heart, Blood, and Endocrinology Centre, St Petersburg; Pavlov St Petersburg State Medical University, St Petersburg
| | - G. E. Trufanov
- Military Medical Academy named after S.M. Kirov, St Petersburg
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van Bruggen T, Stieltjes B, Thomann PA, Parzer P, Meinzer HP, Fritzsche KH. Do Alzheimer-specific microstructural changes in mild cognitive impairment predict conversion? Psychiatry Res 2012; 203:184-93. [PMID: 22947309 DOI: 10.1016/j.pscychresns.2011.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/24/2011] [Accepted: 12/08/2011] [Indexed: 01/18/2023]
Abstract
Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique that provides information on the fiber architecture of the brain by measuring water diffusion. Prior work has shown that neuronal degeneration in Alzheimer's disease (AD) and mild cognitive impairment (MCI) alters this architecture. Since the conversion rate to AD is much higher for MCI patients than for normal healthy people, it is important to identify biomarkers with a predictive value on this conversion. In this study, we applied tract-based spatial statistics (TBSS) on datasets of 15 healthy controls, 15 AD patients, and 17 MCI patients. Of these MCI patients eight remained stable, whereas nine developed AD within the first 12-18 months of follow-up investigations. Analysis using TBSS combined with a maximum likelihood regression with random effects of the fornix, the corpus callosum, and the cingulum identified significant differences between these two types of MCI patients in fractional anisotropy (FA) and radial diffusivity (DR). Thus, DTI reveals Alzheimer-specific changes in those MCI subjects that later convert, although they were clinically identical to the other MCI-patients at the time the data were acquired. This finding could lead to early identification of AD and thereby aid early clinical intervention.
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Affiliation(s)
- Thomas van Bruggen
- Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany
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Riba I, Jarca CI, Mundet X, Tovar JL, Orfila F, Nafría C, Raga A, Girona A, Fernández-Lara P, Castañé X, Alvarez Sabin J, Fernández Cortiñas I, Maisterra O, Montaner J, Delgado P. Cognitive assessment protocol design in the ISSYS (Investigating Silent Strokes in hYpertensives: a magnetic resonance imaging Study). J Neurol Sci 2012; 322:79-81. [PMID: 22836018 DOI: 10.1016/j.jns.2012.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 06/01/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
Hypertension and silent cerebrovascular lesions (SCL) detected by brain magnetic resonance imaging (MRI) are associated with an increased risk of cognitive decline. In a prospective observational study in 1000 hypertensive patients, aged 50-70 years, with no prior history of stroke or dementia, we will study the presence of mild cognitive impairment (MCI) and the relationship between SCL and cognition. All participants will be assessed by means of the Dementia Rating Scale-2 (DRS-2) and will undergo a brain MRI. In order to better characterize MCI and future dementia risk in our cohort, those patients that are suspected to be cognitively impaired according to the DRS-2 results will have a further neurological evaluation and complete neuropsychological testing. Follow-up for the entire cohort is planned to last for at least 3 years.
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Affiliation(s)
- I Riba
- Neurovascular Research Laboratory, Vall Hebron's Research Institute, Neurovascular Section, Vall Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
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Gazova I, Vlcek K, Laczó J, Nedelska Z, Hyncicova E, Mokrisova I, Sheardova K, Hort J. Spatial navigation-a unique window into physiological and pathological aging. Front Aging Neurosci 2012; 4:16. [PMID: 22737124 PMCID: PMC3380196 DOI: 10.3389/fnagi.2012.00016] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 06/07/2012] [Indexed: 12/05/2022] Open
Abstract
Spatial navigation is a skill of determining and maintaining a trajectory from one place to another. Mild progressive decline of spatial navigation develops gradually during the course of physiological ageing. Nevertheless, severe spatial navigation deficit can be the first sign of incipient Alzheimer's disease (AD), occurring in the stage of mild cognitive impairment (MCI), preceding the development of a full blown dementia. Patients with amnestic MCI, especially those with the hippocampal type of amnestic syndrome, are at very high risk of AD. These patients present with the same pattern of spatial navigation impairment as do the patients with mild AD. Spatial navigation testing of elderly as well as computer tests developed for routine clinical use thus represents a possibility for further investigation of this cognitive domain, but most of all, an opportunity for making early diagnosis of AD.
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Affiliation(s)
- Ivana Gazova
- Department of Neurology, Memory Disorders Clinic, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol Prague 5, Czech Republic
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Modrego PJ, Fayed N. Longitudinal magnetic resonance spectroscopy as marker of cognitive deterioration in mild cognitive impairment. Am J Alzheimers Dis Other Demen 2011; 26:631-6. [PMID: 22323830 PMCID: PMC10845573 DOI: 10.1177/1533317511433809] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Amnestic mild cognitive impairment (MCI) is highly predictive of Alzheimer's disease but the pace of deterioration varies across patients. We hypothesize that magnetic resonance spectroscopy (MRS) could be a useful surrogate marker to monitor progression of cognitive impairment in patients with amnestic MCI. METHODS A cohort of patients with amnestic MCI underwent single-voxel (1)H-MRS at baseline and at 2-year follow-up. We included 16 patients who converted to dementia of Alzheimer type and other 16 who did not. Changes in cognitive function were compared with the changes in the metabolite levels assessed in vivo. RESULTS At baseline the converters had lower mean N-acetyl-aspartate (NAA)/creatine (Cr) ratios in the posteromedial parietal cortex (1.41) than nonconverters (1.47). Most patients tended to lose points in the Mini-Mental test after 2-year follow-up in parallel with decreases in NAA levels (r = .53; P = .002) in the posteromedial parietal cortex as well. The converters showed significant decreases in NAA levels and Cr ratios, whereas the nonconverters did not (P = .001 and .02, respectively) in this area. CONCLUSION We conclude that MRS is a technique sensitive enough to monitor cognitive changes and progression to dementia in patients with amnestic MCI.
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Affiliation(s)
- Pedro J Modrego
- Department of Neurology, Hospital Miguel Servet, Zaragoza, Spain.
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