1
|
Fu X, Sun P, Zhang X, Zhu D, Qin Q, Lu J, Wang J. GABA in the anterior cingulate cortex mediates the association of white matter hyperintensities with executive function: a magnetic resonance spectroscopy study. Aging (Albany NY) 2024; 16:4282-4298. [PMID: 38441529 PMCID: PMC10968699 DOI: 10.18632/aging.205585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/24/2024] [Indexed: 03/22/2024]
Abstract
White matter hyperintensities (WMH) and gamma-aminobutyric acid (GABA) are associated with executive function. Multiple studies suggested cortical alterations mediate WMH-related cognitive decline. The aim of this study was to investigate the crucial role of cortical GABA in the WMH patients. In the 87 WMH patients (46 mild and 41 moderate to severe) examined in this study, GABA levels in the anterior cingulate cortex (ACC) and posterior cingulate cortex (PCC) assessed by the Meshcher-Garwood point resolved spectroscopy (MEGA-PRESS) sequence, WMH volume and executive function were compared between the two groups. Partial correlation and mediation analyses were carried out to examine the GABA levels in mediating the association between WMH volume and executive function. Patients with moderate to severe WMH had lower GABA+/Cr in the ACC (p = 0.034) and worse executive function (p = 0.004) than mild WMH patients. In all WMH cases, the GABA+/Cr levels in the ACC mediated the negative correlation between WMH and executive function (ab: effect = -0.020, BootSE = 0.010, 95% CI: -0.042 to -0.004). This finding suggested GABA+/Cr levels in the ACC might serve as a protective factor or potential target for preventing the occurrence and progression of executive function decline in WMH people.
Collapse
Affiliation(s)
- Xiaona Fu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Peng Sun
- Clinical and Technical Support, Philips Healthcare, Beijing 100600, China
| | - Xinli Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Dongyong Zhu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Qian Qin
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Jue Lu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| |
Collapse
|
2
|
Wang X, Shi Y, Chen Y, Gao Y, Wang T, Li Z, Wang Y. Blood-Brain Barrier Breakdown is a Sensitive Biomarker of Cognitive and Language Impairment in Patients with White Matter Hyperintensities. Neurol Ther 2023; 12:1745-1758. [PMID: 37490234 PMCID: PMC10444912 DOI: 10.1007/s40120-023-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Similar white matter hyperintensities (WMH) burden may have varied cognitive outcomes in patients with cerebral small vessel disease (CSVD). This study aimed to evaluate whether blood-brain barrier (BBB) permeability is associated with cognitive impairment (CI) heterogeneity in patients with WMH. METHODS We recruited 51 participants with WMH. We evaluated WMH burden using the Fazekas scale and WMH volume on structural magnetic resonance imaging (MRI), and assessed BBB permeability using dynamic contrast-enhanced (DCE)-MRI. We used permeability-surface area product (PS) from the Patlak model to represent BBB permeability. All patients underwent Mini-Mental State Examination (MMSE), Boston Naming Test (BNT) and animal verbal fluency test (VFT) for cognitive assessment. We divided patients into CI and non-CI groups based on their MMSE scores (< 27 or ≥ 27) and used multiple linear regression models to investigate the associations between MRI parameters and cognitive function. RESULTS Patients in the two groups did not differ in Fazekas scores and WMH volume. However, patients in the CI group showed significantly higher PS in the WMH regions than those in non-CI group (1.89 × 10-3 versus 1.00 × 10-3, p = 0.032 in periventricular WMH [PVWMH]; 1.27 × 10-3 versus 0.74 × 10-3, p = 0.043 in deep WMH [DWMH]), indicating the breakdown of BBB in the CI group. In all patients with WMH, increased BBB permeability in PVWMH and DWMH was significantly associated with lower cognitive and language function after adjustment for age, education level (EL) and intracranial volume (ICV). In the CI group, this correlation remained significant. WMH volume was not associated with cognitive performance in either all patients or those with CI. CONCLUSION BBB impairment might be a more sensitive indicator for cognitive and language dysfunction than WMH volume in patients with WMH and possibly explains the heterogeneity of cognitive performance in patients with similar WMH burden.
Collapse
Affiliation(s)
- Xing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Yulu Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Yiyi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Ying Gao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Tingting Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Zhengyang Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- Chinese Institute for Brain Research, Beijing, 100070, China.
- National Centre for Neurological Diseases, Beijing, 100070, China.
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China.
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China.
| |
Collapse
|
3
|
Kau YL, Lin IH, Juang CL, Chang CK, Ho WH, Wen HC. Metabolite Variations in the Hippocampus and Corpus Callosum of Patients with Mild Cognitive Impairment Using Magnetic Resonance Spectroscopy with Three-Dimensional Chemical Shift Images. Brain Sci 2023; 13:1244. [PMID: 37759845 PMCID: PMC10526271 DOI: 10.3390/brainsci13091244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/30/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
This study compared the metabolites in the brain regions of hippocampus and corpus callosum between patients with mild cognitive impairment (MCI) and healthy controls using no-radiation and high-sensitivity magnetic resonance spectroscopy (MRS) with three-dimensional chemical shift images (3D-CSI). Twenty volunteers (seven patients with MCI and 13 healthy controls) aged 50-71 years were recruited for this prospective study. MRS with 3D-CSI images of a variety of metabolites was collected from the hippocampus and corpus callosum. Sex and weight showed no significant differences between the two groups. The metabolite levels in the hippocampus and corpus callosum of the MCI group were generally lower than in those of the healthy group, especially for creatine (p < 0.001 in the hippocampus and p = 0.020 in the corpus callosum) and N-acetyl aspartate/creatine (p < 0.001 in the hippocampus and p = 0.020 in the corpus callosum); however, choline/creatine showed a significant difference (p < 0.001) only in the hippocampus, and myo-inositol/creatine showed a significant difference (p < 0.001) only in the corpus callosum. Our study demonstrated that MRS with 3D-CSI can be used to measure these metabolite levels to determine the differences between patients with MCI and healthy individuals. This would aid early diagnosis of MCI in clinical practice, and patients could receive prompt intervention to improve their quality of life.
Collapse
Affiliation(s)
- Yen-Lon Kau
- Department of Medical Imaging, Camillian St. Mary’s Hospital, Luodong, Yilan 265502, Taiwan; (Y.-L.K.); (W.-H.H.)
- Department of Medical Imaging and Radiological Sciences, Yuanpei University, Hsinchu 30015, Taiwan;
| | - I-Hung Lin
- Nobel Eye Institute, Taipei 100008, Taiwan;
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chi-Long Juang
- Department of Medical Imaging and Radiological Sciences, Yuanpei University, Hsinchu 30015, Taiwan;
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 100008, Taiwan;
- Department of Optometry, Yuanpei University, Hsinchu 30015, Taiwan;
| | - Wen-Hsiang Ho
- Department of Medical Imaging, Camillian St. Mary’s Hospital, Luodong, Yilan 265502, Taiwan; (Y.-L.K.); (W.-H.H.)
| | - Hsiao-Chuan Wen
- Department of Pet Healthcare, Yuanpei University, Hsinchu 300, Taiwan
| |
Collapse
|
4
|
Erchinger VJ, Craven AR, Ersland L, Oedegaard KJ, Bartz-Johannessen CA, Hammar Å, Haavik J, Riemer F, Kessler U, Oltedal L. Electroconvulsive therapy triggers a reversible decrease in brain N-acetylaspartate. Front Psychiatry 2023; 14:1155689. [PMID: 37363174 PMCID: PMC10289547 DOI: 10.3389/fpsyt.2023.1155689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Based on previous research on electroconvulsive therapy (ECT) we have proposed a model where disruption, potentiation, and rewiring of brain networks occur in sequence and serve as the underlying therapeutic mechanism of ECT. This model implies that a temporary disturbance of neuronal networks (disruption) is followed by a trophic effect (potentiation), which enables the rewiring of neuronal circuits to a more euthymic functioning brain. We hypothesized that disruption of neuronal networks could trigger biochemical alterations leading to a temporary decrease in N-acetylaspartate (tNAA, considered a marker of neuronal integrity), while choline (a membrane component), myo-Inositol (mI, astroglia marker), and glutamate/glutamine (Glx, excitatory neurotransmitter) were postulated to increase. Previous magnetic resonance spectroscopy studies, reporting diverse findings, have used two different referencing methods - creatine ratios and tissue corrected values referenced to water - for the quantification of brain metabolites. Changes in creatine during ECT have also been reported, which may confound estimates adopting this as an internal reference. Methods Using MR spectroscopy, we investigated 31 moderately to severely depressed patients and 19 healthy controls before, during, and after ECT or at similar time points (for controls). We tested whether biochemical alterations in tNAA, choline, mI, and Glx lend support to the disrupt, potentiate, and rewire hypothesis. We used both creatine ratios and water-scaled values for the quantification of brain metabolites to validate the results across referencing methods. Results Levels of tNAA in the anterior cingulate cortex decreased after an ECT treatment series (average 10.6 sessions) by 6% (p = 0.007, creatine ratio) and 3% (p = 0.02, water referenced) but returned to baseline 6 months after ECT. Compared to after treatment series tNAA levels at 6-month follow-up had increased in both creatine ratio (+6%, p < 0.001) and water referenced data (+7%, p < 0.001). Findings for other brain metabolites varied and could not be validated across referencing methods. Discussion Our findings suggest that prior research must be interpreted with care, as several referencing and processing methods have been used in the past. Yet, the results for tNAA were robust across quantification methods and concur with relevant parts of the disrupt, potentiate, and rewire model.
Collapse
Affiliation(s)
- Vera J. Erchinger
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Alexander R. Craven
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Ketil J. Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
5
|
Meng F, Yang Y, Jin G. Research Progress on MRI for White Matter Hyperintensity of Presumed Vascular Origin and Cognitive Impairment. Front Neurol 2022; 13:865920. [PMID: 35873763 PMCID: PMC9301233 DOI: 10.3389/fneur.2022.865920] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
White matter hyperintensity of presumed vascular origin (WMH) is a common medical imaging manifestation in the brains of middle-aged and elderly individuals. WMH can lead to cognitive decline and an increased risk of cognitive impairment and dementia. However, the pathogenesis of cognitive impairment in patients with WMH remains unclear. WMH increases the risk of cognitive impairment, the nature and severity of which depend on lesion volume and location and the patient's cognitive reserve. Abnormal changes in microstructure, cerebral blood flow, metabolites, and resting brain function are observed in patients with WMH with cognitive impairment. Magnetic resonance imaging (MRI) is an indispensable tool for detecting WMH, and novel MRI techniques have emerged as the key approaches for exploring WMH and cognitive impairment. This article provides an overview of the association between WMH and cognitive impairment and the application of dynamic contrast-enhanced MRI, structural MRI, diffusion tensor imaging, 3D-arterial spin labeling, intravoxel incoherent motion, magnetic resonance spectroscopy, and resting-state functional MRI for examining WMH and cognitive impairment.
Collapse
Affiliation(s)
- Fanhua Meng
- North China University of Science and Technology, Tangshan, China
| | - Ying Yang
- Department of Radiology, China Emergency General Hospital, Beijing, China
| | - Guangwei Jin
- Department of Radiology, China Emergency General Hospital, Beijing, China
- *Correspondence: Guangwei Jin
| |
Collapse
|
6
|
Yuan CL, Yi R, Dong Q, Yao LF, Liu B. The relationship between diabetes-related cognitive dysfunction and leukoaraiosis. Acta Neurol Belg 2021; 121:1101-1110. [PMID: 33893981 DOI: 10.1007/s13760-021-01676-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/10/2021] [Indexed: 12/17/2022]
Abstract
Cognitive dysfunction is a degenerative disease of the central nervous system, which often associates with ageing brain as well as neurodegenerative diseases. A growing body of evidence suggests that patients with diabetes mellitus (DM) have a significantly higher risk of cognitive impairment. In recent years, studies have found that patients with diabetes-related cognitive dysfunction have an increased burden of leukoaraiosis (LA), and larger white matter hyperintensity (WMH) volume. With the recent advancement of technologies, multimodal imaging is widely exploited for the precise evaluation of central nervous system diseases. Emerging studies suggest that LA pathology can be used as a predictive signal of white matter lesions in patients with diabetes-related cognitive dysfunction, providing support for early identification and diagnosis of disease. This article reviews the findings, epidemiological characteristics, pathogenesis, imaging features, prevention and treatment of LA pathophysiology in patients with diabetes-related cognitive dysfunction.
Collapse
Affiliation(s)
- Chun-Lan Yuan
- Department of Neurology, The First Affiliated Hospital Of Harbin Medical University, No. 23 Youzheng Street, Harbin, 150001, People's Republic of China
| | - Ran Yi
- Department of Endocrine, The First Affiliated Hospital Of Harbin Medical University, No. 23 Youzheng Street, Harbin, 150001, People's Republic of China
| | - Qi Dong
- Department of Neurology, The First Affiliated Hospital Of Harbin Medical University, No. 23 Youzheng Street, Harbin, 150001, People's Republic of China.
| | - Li-Fen Yao
- Department of Neurology, The First Affiliated Hospital Of Harbin Medical University, No. 23 Youzheng Street, Harbin, 150001, People's Republic of China
| | - Bin Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37 Yiyuan Street, Harbin, 150001, People's Republic of China.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Chen Y, Wang X, Guan L, Wang Y. Role of White Matter Hyperintensities and Related Risk Factors in Vascular Cognitive Impairment: A Review. Biomolecules 2021; 11:biom11081102. [PMID: 34439769 PMCID: PMC8391787 DOI: 10.3390/biom11081102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/24/2021] [Accepted: 07/25/2021] [Indexed: 02/06/2023] Open
Abstract
White matter hyperintensities (WMHs) of presumed vascular origin are one of the imaging markers of cerebral small-vessel disease, which is prevalent in older individuals and closely associated with the occurrence and development of cognitive impairment. The heterogeneous nature of the imaging manifestations of WMHs creates difficulties for early detection and diagnosis of vascular cognitive impairment (VCI) associated with WMHs. Because the underlying pathological processes and biomarkers of WMHs and their development in cognitive impairment remain uncertain, progress in prevention and treatment is lagging. For this reason, this paper reviews the status of research on the features of WMHs related to VCI, as well as mediators associated with both WMHs and VCI, and summarizes potential treatment strategies for the prevention and intervention in WMHs associated with VCI.
Collapse
Affiliation(s)
- Yiyi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Y.C.); (X.W.)
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
| | - Xing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Y.C.); (X.W.)
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
- Department of Neurology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400000, China
| | - Ling Guan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Y.C.); (X.W.)
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
- Correspondence: (L.G.); (Y.W.)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Y.C.); (X.W.)
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
- Correspondence: (L.G.); (Y.W.)
| |
Collapse
|
9
|
Vedel AG, Holmgaard F, Danielsen ER, Langkilde A, Paulson OB, Ravn HB, Rasmussen LS, Nilsson JC. Blood pressure and brain injury in cardiac surgery: a secondary analysis of a randomized trial. Eur J Cardiothorac Surg 2021; 58:1035-1044. [PMID: 32840297 DOI: 10.1093/ejcts/ezaa216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Brain dysfunction is a serious complication after cardiac surgery. In the Perfusion Pressure Cerebral Infarcts trial, we allocated cardiac surgery patients to a mean arterial pressure of either 70-80 or 40-50 mmHg during cardiopulmonary bypass (CPB). In this secondary analysis, we compared selected cerebral metabolites using magnetic resonance spectroscopy hypothesizing that a postoperative decrease in occipital grey matter (GM) N-acetylaspartate-to-total-creatine ratio, indicative of ischaemic injury, would be found in the high-target group. METHODS Of the 197 patients randomized in the Perfusion Pressure Cerebral Infarcts trial, 55 and 42 patients had complete and useful data from GM and white matter (WM), respectively. Spectroscopies were done preoperatively and on postoperative days 3-6. Cognitive function was assessed prior to surgery, at discharge and at 3 months. We predefined the statistical significance level to be 0.01. RESULTS A postoperative decrease was found in GM N-acetylaspartate-to-total-creatine ratio in the high-target group [mean difference -0.09 (95% confidence interval -0.14 to -0.04), P = 0.014]. No significant differences were found in other metabolite ratios investigated in GM or WM. No significant association was found between changes in metabolite ratios and new cerebral infarcts, WM lesion score or cognitive dysfunction. CONCLUSIONS A higher mean arterial pressure during CPB was associated with signs of impaired cerebral metabolism, though not at the predefined significance level of 0.01. No significant association was found between metabolite ratio changes and neuroradiological pathology or change in cognitive function. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT02185885.
Collapse
Affiliation(s)
- Anne G Vedel
- D epartment of Cardiothoracic Anaesthesiology, Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,D epartment of Anaesthesia, Center of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Holmgaard
- D epartment of Cardiothoracic Anaesthesiology, Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Else R Danielsen
- D epartment of Radiology, Diagnostic Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annika Langkilde
- D epartment of Radiology, Diagnostic Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Neurobiology Research Unit, Neuroscience Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne B Ravn
- D epartment of Cardiothoracic Anaesthesiology, Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars S Rasmussen
- D epartment of Anaesthesia, Center of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens C Nilsson
- D epartment of Cardiothoracic Anaesthesiology, Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
10
|
Near J, Harris AD, Juchem C, Kreis R, Marjańska M, Öz G, Slotboom J, Wilson M, Gasparovic C. Preprocessing, analysis and quantification in single-voxel magnetic resonance spectroscopy: experts' consensus recommendations. NMR IN BIOMEDICINE 2021; 34:e4257. [PMID: 32084297 PMCID: PMC7442593 DOI: 10.1002/nbm.4257] [Citation(s) in RCA: 153] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/21/2019] [Accepted: 12/22/2019] [Indexed: 05/05/2023]
Abstract
Once an MRS dataset has been acquired, several important steps must be taken to obtain the desired metabolite concentration measures. First, the data must be preprocessed to prepare them for analysis. Next, the intensity of the metabolite signal(s) of interest must be estimated. Finally, the measured metabolite signal intensities must be converted into scaled concentration units employing a quantitative reference signal to allow meaningful interpretation. In this paper, we review these three main steps in the post-acquisition workflow of a single-voxel MRS experiment (preprocessing, analysis and quantification) and provide recommendations for best practices at each step.
Collapse
Affiliation(s)
- Jamie Near
- Douglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Canada
| | - Ashley D. Harris
- Department of Radiology, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
| | - Christoph Juchem
- Department of Biomedical Engineering, Columbia University, New York NY, USA
| | - Roland Kreis
- Departments of Radiology and Biomedical Research, University Bern, Switzerland
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis MN, USA
| | - Gülin Öz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis MN, USA
| | - Johannes Slotboom
- Support Center for Advanced Neuroimaging (SCAN), Neuroradiology, University Hospital Inselspital, Bern, Switzerland
| | - Martin Wilson
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, England
| | | |
Collapse
|
11
|
Lin H, Jin T, Chen L, Dai Y, Jia W, He X, Yang M, Li J, Liang S, Wu J, Huang J, Chen L, Liu W, Tao J. Longitudinal tracing of neurochemical metabolic disorders in working memory neural circuit and optogenetics modulation in rats with vascular cognitive impairment. Brain Res Bull 2021; 170:174-186. [PMID: 33600886 DOI: 10.1016/j.brainresbull.2021.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
Chronic cerebral ischemia leads to vascular cognitive impairment (VCI) that exacerbates along with ischemia time and eventually develops into dementia. Recent advances in molecular neuroimaging contribute to understand its pathological characteristics. We previously traced the anisotropic diffusion of water molecules suggests that chronic cerebral ischemia leads to irreversible progressive damage to white matter integrity. However, the abnormalities of gray matter activity following chronic cerebral ischemia remains not entirely understood. In this study, in vivo hydrogen proton magnetic resonance spectroscopy (1H-MRS) was applied to longitudinally track the neurochemical metabolic disorder of gray matter associated with working memory, and optogenetics modulation of neurochemical metabolism was performed for targeted treatment of VCI. The results showed that the concentration of N-acetylaspartate (NAA) in the right hippocampus, left hippocampus, right medial prefrontal cortex (mPFC) and mediodorsal thalamus was decreased as early as 7 days after chronic cerebral ischemia, subsequently gamma-aminobutyric acid (GABA) declined whereas myo-inositol (mI) and glutamate (Glu) increased at 14 days, as well as choline (Cho) lost at 28 days, concurrently the change of Glu and GABA in the mPFC and hippocampus was ischemia time-dependent manner within 1 month. Behaviorally, working memory and object recognition memory were impaired at 14 days, 28 days that significantly correlated with neurochemical metabolic disorders. Interestingly, using optogenetics modulation of PV neurons in the mPFC, the metabolic abnormalities of NAA and GABA in working memory neural circuit could be repaired after chronic cerebral ischemia, together with behavior improvements. These findings suggested that as early as 1∼4 weeks after chronic cerebral ischemia, the metabolism of NAA, Glu, mI and Cho was synchronously impaired in neural circuit of hippocampus-mediodorsal thalamus-mPFC, and the loss of GABA delayed in the hippocampus, and optogenetics modulation of parvalbumin (PV) neurons in the mPFC can improve the neurochemical metabolism of working memory neural circuit and enhance working memory.
Collapse
Affiliation(s)
- Huawei Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Tingting Jin
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology & Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Lewen Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Yaling Dai
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Weiwei Jia
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Xiaojun He
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Minguang Yang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology & Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Jianhong Li
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology & Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Shengxiang Liang
- Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Jinsong Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Lidian Chen
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology & Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China
| | - Weilin Liu
- Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China.
| | - Jing Tao
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology & Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China; Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, PR China.
| |
Collapse
|
12
|
Chelala L, O'Connor EE, Barker PB, Zeffiro TA. Meta-analysis of brain metabolite differences in HIV infection. NEUROIMAGE-CLINICAL 2020; 28:102436. [PMID: 33383609 PMCID: PMC7596344 DOI: 10.1016/j.nicl.2020.102436] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Numerous studies have used magnetic resonance spectroscopy (MRS) neurometabolite measurements to study HIV infection effects. While many have reported differences in total N-Acetylaspartate (tNAA), myo-Inositol (mI), and total Choline (tCho), there have been no meta-analyses performed to evaluate concordance across studies. PURPOSE To evaluate the consistency of HIV serostatus effects on brain metabolites. STUDY SELECTION The sample included studies conducted between 1993 and 2019 reporting HIV infection effects measured using proton MRS. tNAA/tCr ratios (21 papers), tCho/tCr ratios (21 papers), mI/tCr ratios (17 papers) and quantitative tCr (9 papers), sampling from basal ganglia (BG), gray matter (GM), and white matter (WM) were included. DATA ANALYSIS Random effects meta-analysis using inverse variance weighting and bias corrected standardized mean differences (SMDs) was used. Meta-regression examined effects of publication year and data acquisition technique differences. DATA SYNTHESIS BG SMDs related to positive serostatus were -0.10 [-0.39; 0.18] tNAA/tCr, 0.27 [0.05; 0.49] tCho/tCr, 0.60 [0.31; 0.90] mI/tCr, and -0.26 [-0.59; 0.06] tCr. GM SMDs related to serostatus were -0.29 [-0.49; -0.09] tNAA/tCr, 0.37 [0.19; 0.54] tCho/tCr, 0.41 [0.15; 0.68] mI/tCr, and -0.24 [-0.45; -0.03] tCr. WM SMDs related to serostatus were -0.52 [-0.79; -0.25] tNAA/tCr, 0.41 [0.21; 0.61] tCho/tCr, 0.59 [0.24; 0.94] mI/tCr, and -0.03 [-0.25; 0.19] tCr. WM regions showed larger serostatus effect sizes than BG and GM. I2 ranged from 52 to 88% for the metabolite ratios. Both GM and WM tNAA/tCr SMDs were lower with increasing calendar year. LIMITATIONS Many studies pooled participants with varying treatment, infection, and comorbidity durations. CONCLUSIONS HIV neurometabolite studies showed consistently lower tNAA/tCr, higher tCho/tCr and higher mI/tCr ratios associated with chronic HIV infection. Substantial between-study variation may have resulted from measurement technique variations, study population differences and HIV treatment changes over time. Higher WM tCho/tCr and mI/tCr may reflect reactive gliosis or myelin turnover. Neurometabolite measurements can reliably detect chronic HIV infection effects and may be useful in understanding the pathophysiology of cognitive and sensorimotor decline following HIV infection. CLASSIFICATION OF EVIDENCE This study provides Class II evidence of neurometabolite differences in chronic HIV infection.
Collapse
Affiliation(s)
- Lydia Chelala
- University of Maryland, School of Medicine, Baltimore, MD, United States
| | - Erin E O'Connor
- University of Maryland, School of Medicine, Baltimore, MD, United States.
| | - Peter B Barker
- Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Thomas A Zeffiro
- University of Maryland, School of Medicine, Baltimore, MD, United States.
| |
Collapse
|
13
|
Tong T, Lu H, Zong J, Lv Q, Chu X. Chemotherapy-related cognitive impairment in patients with breast cancer based on MRS and DTI analysis. Breast Cancer 2020; 27:893-902. [PMID: 32301096 DOI: 10.1007/s12282-020-01094-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
Abstract
The purpose of this study is to investigate chemotherapy-related cognitive impairment (CRCI) in breast cancer patients, analyze absolute concentration and structural changes of metabolites in different brain regions by multimodal neuroimaging technology, and explore correlation between them. Breast cancer patients with chemotherapy treatment group (Ctx+, N = 24) and control group without treatment (Ctx-, N = 20) underwent neuropsychological tests, multivoxel magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI) before and after chemotherapy. Regions of interest (ROls) in magnetic resonance scan include bilateral posterior cingulate gyrus (PCG), bilateral dorsal thalamus (DT), bilateral lenticular nucleus (LN), bilateral posterior horn of the lateral ventricle paratrigonal white matter (PWM). In MRS, absolute concentrations of N-acetylaspartate (NAA), myo-inositol (MI), choline-containing compounds (Cho), total creatine (tCr), glutamine + glutamate (Glx) were quantified using LC Model and SAGE software. In DTI, we used fractional anisotropy (FA) and mean diffusivity (MD) to reflect white matter integrity. In Ctx+ patients, scores of functional assessment of cancer treatment cognition test (FACT-Cog), perceived cognitive impairments (PCI), impact of perceived impairments on quality of life (QOL), perceived cognitive abilities (PCA), auditory-verbal learning test (AVLT) recognition and clock drawing test (CDT) were lower than those before chemotherapy (p < 0.05). In MRS, Ctx+ patients had significantly lower NAA values in bilateral PCG, DT, respectively. The concentrations of tCr were observed to decline in bilateral PCG and right DT. Glx values decreased in right DT. Cho values decreased significantly in bilateral DT. In DTI, Ctx+ patients had lower FA values in bilateral PCG compared with patients before chemotherapy. Among imaging metrics and cognitive scores, positive correlations were observed between changes in AVLT recognition scores and changes in NAA values in bilateral PCG (left PCG: r = 0.470, p < 0.01; right PCG: r = 0.500, p < 0.01). Positive correlations were also found between changes in AVLT recognition and changes in FA values in bilateral PCG (left PCG: r = 0.513, p < 0.01; right PCG: r = 0.563, p < 0.01). Chemotherapy can lead to a decrease in memory function, accompanied by changes in brain metabolite concentration and white matter integrity in some parts of brain.
Collapse
Affiliation(s)
- Taishan Tong
- Department of Psychology and Psychiatry, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, 214000, Jiangsu, China
| | - Heng Lu
- Department of Psychology and Psychiatry, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, 214000, Jiangsu, China
| | - Jian Zong
- Department of Magnetic Resonance Imaging, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Qing Lv
- Department of Breast Surgery, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Xing Chu
- Department of Psychology and Psychiatry, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, 214000, Jiangsu, China.
| |
Collapse
|
14
|
Vinciguerra L, Lanza G, Puglisi V, Fisicaro F, Pennisi M, Bella R, Cantone M. Update on the Neurobiology of Vascular Cognitive Impairment: From Lab to Clinic. Int J Mol Sci 2020; 21:E2977. [PMID: 32340195 PMCID: PMC7215552 DOI: 10.3390/ijms21082977] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
In the last years, there has been a significant growth in the literature exploring the pathophysiology of vascular cognitive impairment (VCI). As an "umbrella term" encompassing any degree of vascular-related cognitive decline, VCI is deemed to be the most common cognitive disorder in the elderly, with a significant impact on social and healthcare expenses. Interestingly, some of the molecular, biochemical, and electrophysiological abnormalities detected in VCI seem to correlate with disease process and progression, eventually promoting an adaptive plasticity in some patients and a maladaptive, dysfunctional response in others. However, the exact relationships between vascular lesion, cognition, and neuroplasticity are not completely understood. Recent findings point out also the possibility to identify a panel of markers able to predict cognitive deterioration in the so-called "brain at risk" for vascular or mixed dementia. This will be of pivotal importance when designing trials of disease-modifying drugs or non-pharmacological approaches, including non-invasive neuromodulatory techniques. Taken together, these advances could make VCI a potentially preventable cause of both vascular and degenerative dementia in late life. This review provides a timely update on the recent serological, cerebrospinal fluid, histopathological, imaging, and neurophysiological studies on this "cutting-edge" topic, including the limitations, future perspectives and translational implications in the diagnosis and management of VCI patients.
Collapse
Affiliation(s)
- Luisa Vinciguerra
- Department of Neurology and Stroke Unit, ASST Cremona, 26100 Cremona, Italy; (L.V.); (V.P.)
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy
- Department of Neurology IC, Oasi Research Institute – IRCCS, 94018 Troina, Italy
| | - Valentina Puglisi
- Department of Neurology and Stroke Unit, ASST Cremona, 26100 Cremona, Italy; (L.V.); (V.P.)
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (F.F.); (M.P.)
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (F.F.); (M.P.)
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, 95123 Catania, Italy;
| | - Mariagiovanna Cantone
- Department of Neurology, Sant’Elia Hospital, ASP Caltanissetta, 93100 Caltanissetta, Italy;
| |
Collapse
|
15
|
Update on the Neurobiology of Vascular Cognitive Impairment: From Lab to Clinic. Int J Mol Sci 2020. [PMID: 32340195 DOI: 10.3390/ijms21082977.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the last years, there has been a significant growth in the literature exploring the pathophysiology of vascular cognitive impairment (VCI). As an "umbrella term" encompassing any degree of vascular-related cognitive decline, VCI is deemed to be the most common cognitive disorder in the elderly, with a significant impact on social and healthcare expenses. Interestingly, some of the molecular, biochemical, and electrophysiological abnormalities detected in VCI seem to correlate with disease process and progression, eventually promoting an adaptive plasticity in some patients and a maladaptive, dysfunctional response in others. However, the exact relationships between vascular lesion, cognition, and neuroplasticity are not completely understood. Recent findings point out also the possibility to identify a panel of markers able to predict cognitive deterioration in the so-called "brain at risk" for vascular or mixed dementia. This will be of pivotal importance when designing trials of disease-modifying drugs or non-pharmacological approaches, including non-invasive neuromodulatory techniques. Taken together, these advances could make VCI a potentially preventable cause of both vascular and degenerative dementia in late life. This review provides a timely update on the recent serological, cerebrospinal fluid, histopathological, imaging, and neurophysiological studies on this "cutting-edge" topic, including the limitations, future perspectives and translational implications in the diagnosis and management of VCI patients.
Collapse
|
16
|
Barry Erhardt E, Pesko JC, Prestopnik J, Thompson J, Caprihan A, Rosenberg GA. Biomarkers identify the Binswanger type of vascular cognitive impairment. J Cereb Blood Flow Metab 2019; 39:1602-1612. [PMID: 29513153 PMCID: PMC6681525 DOI: 10.1177/0271678x18762655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
Abstract
Binswanger's disease is a form of subcortical ischemic vascular disease (SIVD-BD) with extensive white matter changes. To test the hypothesis that biomarkers could improve classification of SIVD-BD, we recruited 62 vascular cognitive impairment and dementia (VCID) patients. Multimodal biomarkers were collected at entry into the study based on clinical and neuropsychological testing, multimodal magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis. The patients' diagnoses were confirmed by long-term follow-up, and they formed a "training set" to test classification methods, including (1) subcortical ischemic vascular disease score (SIVDS), (2) exploratory factor analysis (EFA), (3) logistic regression (LR), and (4) random forest (RF). A subsequently recruited cohort of 43 VCID patients with provisional diagnoses were used as a "test" set to calculate the probability of SIVD-BD based on biomarkers obtained at entry. We found that N-acetylaspartate (NAA) on proton magnetic resonance spectroscopy (1H-MRS) was the best variable for classification, followed by matrix metalloproteinase-2 in CSF and blood-brain barrier permeability on MRI. Both LR and RF performed better in diagnosing SIVD-BD than either EFA or SIVDS. Two-year follow-up of provisional diagnosis patients confirmed the accuracy of statistically derived classifications. We propose that biomarker-based classification methods could diagnose SIVD-BD patients earlier, facilitating clinical trials.
Collapse
Affiliation(s)
- Erik Barry Erhardt
- Departments of Mathematics and
Statistics,
University
of New Mexico, Albuquerque, NM, USA
- MIND
Research Network, Albuquerque, NM, USA
| | - John C Pesko
- Departments of Mathematics and
Statistics,
University
of New Mexico, Albuquerque, NM, USA
| | - Jillian Prestopnik
- Department of Neurology,
University
of New Mexico Health Sciences Center,
Albuquerque, NM, USA
| | - Jeffrey Thompson
- Department of Neurology,
University
of New Mexico Health Sciences Center,
Albuquerque, NM, USA
| | | | - Gary A Rosenberg
- Department of Neurology,
University
of New Mexico Health Sciences Center,
Albuquerque, NM, USA
| |
Collapse
|
17
|
Raja R, Rosenberg G, Caprihan A. Review of diffusion MRI studies in chronic white matter diseases. Neurosci Lett 2019; 694:198-207. [PMID: 30528980 PMCID: PMC6380179 DOI: 10.1016/j.neulet.2018.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
Abstract
Diffusion MRI studies characterizing the changes in white matter (WM) due to vascular cognitive impairment, which includes all forms of small vessel disease are reviewed. We reviewed the usefulness of diffusion methods in discriminating the affected WM regions and its relation to cognitive impairment. These studies were categorized based on the diffusion MRI techniques used. The most common method was the diffusion tensor imaging, whereas other methods included diffusion weighted imaging, diffusion kurtosis imaging, intravoxel incoherent motion, and studies based on diffusion tractography. The diffusion measures showed correlation with cognitive scores and disease progression, with mean diffusivity being the most robust parameter. Future studies should focus on incorporating multi-compartment and higher order diffusion models, which can handle the presence of multiple and crossing fibers inside a voxel.
Collapse
Affiliation(s)
- Rajikha Raja
- The MIND Research Network, Albuquerque, NM, United States.
| | - Gary Rosenberg
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | | |
Collapse
|
18
|
Nelson SE, Ament Z, Wolcott Z, Gerszten RE, Kimberly WT. Succinate links atrial dysfunction and cardioembolic stroke. Neurology 2019; 92:e802-e810. [PMID: 30674589 DOI: 10.1212/wnl.0000000000006957] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To determine whether altered metabolic profiles represent a link between atrial dysfunction and cardioembolic (CE) stroke, and thus whether underlying dysfunctional atrial substrate may contribute to thromboembolism risk in CE stroke. METHODS A total of 144 metabolites were measured using liquid chromatography-tandem mass spectrometry in plasma samples collected within 9 hours of stroke onset in 367 acute stroke patients. Stroke subtype was assigned using the Causative Classification of Stroke System, and CE stroke (n = 181) was compared to non-CE stroke (n = 186). Markers of left atrial dysfunction included abnormal atrial function (P-wave terminal force in lead V1, PTFV1 >4,000 μV·ms), left atrial enlargement on echocardiography, and frank atrial fibrillation on ECG. Stroke recurrence risk was assessed using CHADS2 and CHA2DS2-VASc scores. Associations between metabolites and CE stroke, atrial dysfunction, and stroke recurrence risk were evaluated using logistic regression models. RESULTS Three tricarboxylic acid metabolites-succinate (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.36-2.15, p = 1.37 × 10-6), α-ketoglutarate (OR 1.62, 95% CI 1.29-2.04, p = 1.62 × 10-5), and malate (OR 1.58, 95% CI 1.26-1.97, p = 2.57 × 10-5)-were associated with CE stroke. Succinate (OR 1.36, 95% CI 1.31-1.98, p = 1.22 × 10-6), α-ketoglutarate (OR 2.14, 95% CI 1.60-2.87, p = 2.08 × 10-8), and malate (OR 2.02, 95% CI 1.53-2.66, p = 1.60 × 10-7) were among metabolites also associated with subclinical atrial dysfunction. Of these, succinate was also associated with left atrial enlargement (OR 1.54, 95% CI 1.23-1.94, p = 1.06 × 10-4) and stroke recurrence based on dichotomized CHADS2 (OR 2.63, 95% CI 1.68-4.13, p = 3.00 × 10-6) and CHA2DS2-VASc (OR 2.43, 95% CI 1.60-3.68, p = 4.25 × 10-6) scores. CONCLUSIONS Metabolite profiling identified changes in succinate associated with CE stroke, atrial dysfunction, and stroke recurrence, revealing a putative underlying link between CE stroke and energy metabolism.
Collapse
Affiliation(s)
- Sarah E Nelson
- From the Departments of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins Hospital, Baltimore, MD; Center for Genomic Medicine (Z.A., Z.W., W.T.K.) and Division of Neurocritical Care and Emergency Neurology, Department of Neurology (Z.A., Z.W., W.T.K.), Massachusetts General Hospital, Harvard Medical School; and Division of Cardiovascular Medicine (R.E.G.), Beth Israel Deaconess Hospital, Boston, MA
| | - Zsuzsanna Ament
- From the Departments of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins Hospital, Baltimore, MD; Center for Genomic Medicine (Z.A., Z.W., W.T.K.) and Division of Neurocritical Care and Emergency Neurology, Department of Neurology (Z.A., Z.W., W.T.K.), Massachusetts General Hospital, Harvard Medical School; and Division of Cardiovascular Medicine (R.E.G.), Beth Israel Deaconess Hospital, Boston, MA
| | - Zoe Wolcott
- From the Departments of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins Hospital, Baltimore, MD; Center for Genomic Medicine (Z.A., Z.W., W.T.K.) and Division of Neurocritical Care and Emergency Neurology, Department of Neurology (Z.A., Z.W., W.T.K.), Massachusetts General Hospital, Harvard Medical School; and Division of Cardiovascular Medicine (R.E.G.), Beth Israel Deaconess Hospital, Boston, MA
| | - Robert E Gerszten
- From the Departments of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins Hospital, Baltimore, MD; Center for Genomic Medicine (Z.A., Z.W., W.T.K.) and Division of Neurocritical Care and Emergency Neurology, Department of Neurology (Z.A., Z.W., W.T.K.), Massachusetts General Hospital, Harvard Medical School; and Division of Cardiovascular Medicine (R.E.G.), Beth Israel Deaconess Hospital, Boston, MA
| | - W Taylor Kimberly
- From the Departments of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins Hospital, Baltimore, MD; Center for Genomic Medicine (Z.A., Z.W., W.T.K.) and Division of Neurocritical Care and Emergency Neurology, Department of Neurology (Z.A., Z.W., W.T.K.), Massachusetts General Hospital, Harvard Medical School; and Division of Cardiovascular Medicine (R.E.G.), Beth Israel Deaconess Hospital, Boston, MA.
| |
Collapse
|
19
|
Yuan J, Feng L, Hu W, Zhang Y. Use of Multimodal Magnetic Resonance Imaging Techniques to Explore Cognitive Impairment in Leukoaraiosis. Med Sci Monit 2018; 24:8910-8915. [PMID: 30531675 PMCID: PMC6296345 DOI: 10.12659/msm.912153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Leukoaraiosis, also referred to as white-matter hyperintensities (WMHs) or age-related white matter changes, is the most frequently seen lesion on brain magnetic resonance images (MRI) in the elderly. LA is a subject of intense research interest, and is correlated with stroke, cognitive impairment or dementia, disturbances, affective disorders, and poor prognoses. Rapid advances in neuroimaging have enabled greater understanding of LA associated with aging-related cognitive decline or dementia. Recently, the techniques of multimodal MRI, such as structural MRI (sMRI), resting-state functional MRI (rs-MRI), cerebrovascular reactivity (CVR), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), and dynamic contrast-enhanced MRI (DCE-MRI), have been used to explore the underlying mechanism of cognitive impairment in patients with LA. These multimodal MRI techniques may provide further insights into the structural and functional changes of LA with cognitive dysfunction.
Collapse
Affiliation(s)
- Junliang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Li Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (mainland)
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yumei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (mainland)
| |
Collapse
|
20
|
Chen HJ, Gao YQ, Che CH, Lin H, Ruan XL. Diffusion Tensor Imaging With Tract-Based Spatial Statistics Reveals White Matter Abnormalities in Patients With Vascular Cognitive Impairment. Front Neuroanat 2018; 12:53. [PMID: 29997482 PMCID: PMC6028522 DOI: 10.3389/fnana.2018.00053] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose: The aim of this study was to evaluate microstructural changes of major white matter (WM) tracts in patients with vascular cognitive impairment (VCI). Method: Diffusion tensor imaging (DTI) data were obtained from 24 subjects with subcortical ischemic vascular disease (SIVD), including 13 subjects with VCI-no dementia (VCIND) and 11 subjects with normal cognition (as a control group). A tract-based spatial statistics approach was performed to investigate WM microstructure in VCIND by integrating multiple indices including fractional anisotropy (FA) and mean diffusivity (MD), which are intra-voxel metrics, and local diffusion homogeneity (LDH), which is an inter-voxel metric. Results: The VCIND group had decreased FA and increased MD values throughout widespread WM areas predominately in the corpus callosum, bilateral internal capsule/corona radiata/posterior thalamic radiation/inferior fronto-occipital fasciculus and right inferior/superior longitudinal fasciculus. There was a slight discrepancy between the distribution of areas with decreased FA and LDH. The FA, MD and LDH values were significantly correlated with cognitive test results. According to a WM tract atlas, 10 major tracts were identified as tracts of interest in which three diffusion metrics simultaneously differed between groups, including bilateral anterior thalamic radiation, forceps minor, right corticospinal tract, bilateral inferior fronto-occipital fasciculus, left inferior and superior longitudinal fasciculus, and bilateral uncinate fasciculus. Receiver operating characteristic (ROC) analysis demonstrated the feasibility of using diffusion metrics along the forceps minor and left anterior thalamic radiation for separating two groups. Conclusion: The results suggest WM microstructural abnormalities contribute to cognitive impairments in SIVD patients. DTI parameters may be potential biomarkers for detecting VCIND from SIVD.
Collapse
Affiliation(s)
- Hua-Jun Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yong-Qing Gao
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China.,Department of Radiology, Fuqing City Hospital, Fuqing, China
| | - Chun-Hui Che
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hailong Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xin-Lin Ruan
- Department of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| |
Collapse
|
21
|
Rosenberg GA. Binswanger's disease: biomarkers in the inflammatory form of vascular cognitive impairment and dementia. J Neurochem 2018; 144:634-643. [PMID: 28902409 PMCID: PMC5849485 DOI: 10.1111/jnc.14218] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/17/2017] [Accepted: 08/30/2017] [Indexed: 12/13/2022]
Abstract
Vascular cognitive impairment and dementia (VCID) is a major public health concern because of the increased incidence of vascular disease in the aging population and the impact of vascular disease on Alzheimer's disease. VCID is a heterogeneous group of diseases for which there are no proven treatments. Biomarkers can be used to select more homogeneous populations. Small vessel disease is the most prevalent form of VCID and is the optimal form for treatment trials because there is a progressive course with characteristic pathological changes. Subcortical ischemic vascular disease of the Binswanger type (SIVD-BD) has a characteristic set of features that can be used both to identify patients and to follow treatment. SIVD-BD patients have clinical, neuropsychological, cerebrospinal fluid (CSF) and imaging features that can be used as biomarkers. No one feature is diagnostic, but a multimodal approach defines the SIVD-BD spectrum disorder. The most important features are large white matter lesions with axonal damage, blood-brain barrier disruption as shown by magnetic resonance imaging and CSF, and neuropsychological evidence of executive dysfunction. We have used these features to create a Binswanger Disease Scale and a probability of SIVD-BD, using a machine-learning algorithm. The patients discussed in this review are derived from published studies. Biomarkers not only aid in early diagnosis before the disease process has progressed too far for treatment, but also can indicate response to treatment. Refining the use of biomarkers will allow dementia treatment to enter the era of precision medicine. This article is part of the Special Issue "Vascular Dementia".
Collapse
Affiliation(s)
- Gary A Rosenberg
- Professor of Neurology, Neurosciences, and Cell Biology, UNM Memory and Aging Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| |
Collapse
|
22
|
Lang B, Kindy MS, Kozel FA, Schultz SK, Taheri S. Multi-Parametric Classification of Vascular Cognitive Impairment and Dementia: The Impact of Diverse Cerebrovascular Injury Biomarkers. J Alzheimers Dis 2018; 62:39-60. [DOI: 10.3233/jad-170733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Brittany Lang
- Clinical Psychology Program, University of South Florida, Tampa, FL, USA
| | - Mark S. Kindy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida Tampa, FL, USA
- James A. Haley VA Medical Center, Tampa, FL, USA
| | - F. Andrew Kozel
- James A. Haley VA Medical Center, Tampa, FL, USA
- Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Susan K. Schultz
- James A. Haley VA Medical Center, Tampa, FL, USA
- Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Saeid Taheri
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida Tampa, FL, USA
- Byrd Alzheimer’s Institute, Tampa, FL, USA
| |
Collapse
|
23
|
The Neurochemical and Microstructural Changes in the Brain of Systemic Lupus Erythematosus Patients: A Multimodal MRI Study. Sci Rep 2016; 6:19026. [PMID: 26758023 PMCID: PMC4725825 DOI: 10.1038/srep19026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/17/2015] [Indexed: 12/24/2022] Open
Abstract
The diagnosis and pathology of neuropsychiatric systemic lupus erythematosus (NPSLE) remains challenging. Herein, we used multimodal imaging to assess anatomical and functional changes in brains of SLE patients instead of a single MRI approach generally used in previous studies. Twenty-two NPSLE patients, 21 non-NPSLE patients and 20 healthy controls (HCs) underwent 3.0 T MRI with multivoxel magnetic resonance spectroscopy, T1-weighted volumetric images for voxel based morphometry (VBM) and diffusional kurtosis imaging (DKI) scans. While there were findings in other basal ganglia regions, the most consistent findings were observed in the posterior cingulate gyrus (PCG). The reduction of multiple metabolite concentration was observed in the PCG in the two patient groups, and the NPSLE patients were more prominent. The two patient groups displayed lower diffusional kurtosis (MK) values in the bilateral PCG compared with HCs (p < 0.01) as assessed by DKI. Grey matter reduction in the PCG was observed in the NPSLE group using VBM. Positive correlations among cognitive function scores and imaging metrics in bilateral PCG were detected. Multimodal imaging is useful for evaluating SLE subjects and potentially determining disease pathology. Impairments of cognitive function in SLE patients may be interpreted by metabolic and microstructural changes in the PCG.
Collapse
|
24
|
Abstract
Vascular cognitive impairment (VCI) is the diagnostic term used to describe a heterogeneous group of sporadic and hereditary diseases of the large and small blood vessels. Subcortical small vessel disease (SVD) leads to lacunar infarcts and progressive damage to the white matter. Patients with progressive damage to the white matter, referred to as Binswanger's disease (BD), constitute a spectrum from pure vascular disease to a mixture with neurodegenerative changes. Binswanger's disease patients are a relatively homogeneous subgroup with hypoxic hypoperfusion, lacunar infarcts, and inflammation that act synergistically to disrupt the blood-brain barrier (BBB) and break down myelin. Identification of this subgroup can be facilitated by multimodal disease markers obtained from clinical, cerebrospinal fluid, neuropsychological, and imaging studies. This consensus statement identifies a potential set of biomarkers based on underlying pathologic changes that could facilitate diagnosis and aid patient selection for future collaborative treatment trials.
Collapse
|
25
|
Tomimoto H. White matter integrity and cognitive dysfunction: Radiological and neuropsychological correlations. Geriatr Gerontol Int 2015; 15 Suppl 1:3-9. [DOI: 10.1111/ggi.12661] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Hidekazu Tomimoto
- Department of Neurology; Graduate School of Medicine; Mie University; Mie Japan
| |
Collapse
|
26
|
Rosenberg GA, Prestopnik J, Adair JC, Huisa BN, Knoefel J, Caprihan A, Gasparovic C, Thompson J, Erhardt EB, Schrader R. Validation of biomarkers in subcortical ischaemic vascular disease of the Binswanger type: approach to targeted treatment trials. J Neurol Neurosurg Psychiatry 2015; 86:1324-30. [PMID: 25618903 PMCID: PMC4527945 DOI: 10.1136/jnnp-2014-309421] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/04/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Vascular cognitive impairment (VCI) is a heterogeneous group of cerebrovascular diseases secondary to large and small vessel disease. We hypothesised that biomarkers obtained early in the disease could identify a homogeneous subpopulation with small vessel disease. METHODS We obtained disease markers in 62 patients with VCI that included neurological findings, neuropsychological tests, multimodal MR and cerebrospinal fluid measurements of albumin ratio, matrix metalloproteinases (MMPs), amyloid-β1-42 and phosphorylated-τ181. Proton MR spectroscopic imaging showed ischaemic white matter and permeability of the blood-brain barrier (BBB) was measured with dynamic contrast-enhanced MRI. We constructed a 10-point Binswanger disease score (BDS) with subjective and objective disease markers. In addition, an objective set of biomarkers was used for an exploratory factor analysis (EFA) to select patients with BD. Patients were followed for an average of 2 years to obtain clinical consensus diagnoses. RESULTS An initial BDS of 6 or greater was significantly correlated with a final diagnosis of BD (p<0.05; area under the curve (AUC)=0.79). EFA reduced nine objective biomarkers to four factors. The most predictive of BD was the factor containing the inflammatory biomarkers of increased BBB permeability, elevated albumin index and reduced MMP-2 index (factor 2; AUC=0.78). Both measures independently predicted a diagnosis of BD, and combining them improved the diagnostic accuracy. CONCLUSIONS Biomarkers predicted the diagnosis of the BD type of subcortical ischaemic vascular disease. Using pathophysiological biomarkers to select homogeneous groups of patients needs to be tested in targeted treatment trials.
Collapse
Affiliation(s)
- Gary A Rosenberg
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA Department of Neurosciences, University of New Mexico, Albuquerque, New Mexico, USA Department of Cell Biology and Physiology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jillian Prestopnik
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - John C Adair
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Branko N Huisa
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Janice Knoefel
- Department of Geriatrics, University of New Mexico, Albuquerque, New Mexico, USA
| | | | | | - Jeffrey Thompson
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Erik B Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Ronald Schrader
- Clinical and Translational Science Center, Albuquerque, New Mexico, USA
| |
Collapse
|
27
|
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]
|
28
|
Abstract
Binswanger's disease (BD) is a progressive form of cerebral small vessel disease affecting the white matter and other subcortical structures. Clinical and imaging characteristics, neuropsychological profile and cerebrospinal fluid analysis aid in making the diagnosis. BD shares features of other small vessel diseases and degenerative neurological conditions, which makes diagnosis difficult. However, with recent developments in MRI methods and serum/cerebrospinal fluid biomarkers, we have gained a greater understanding of the complex pathophysiology of the disease that will guide us to a more certain diagnosis. There is growing evidence that the white matter injury in BD is related to endothelial dysfunction with a secondary inflammatory response leading to breakdown of the neurovascular unit. This review summarizes current and future research directions, including pathophysiological mechanisms and potential therapeutic approaches.
Collapse
Affiliation(s)
- Branko N Huisa
- Department of Neurology, University of New Mexico Health Sciences Center, MSC10 5620, Albuquerque, NM 87131, USA
| | | |
Collapse
|
29
|
Li J, Hu W. Glucose metabolism measured by positron emission tomography is reduced in patients with white matter presumably ischemic lesions. Med Sci Monit 2014; 20:1525-30. [PMID: 25159539 PMCID: PMC4156339 DOI: 10.12659/msm.892137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The severity and progression of white matter ischemic lesion (WMIL) are closely linked to vascular dementia. The function of neural tissue is closely linked to glucose consumption as the most important energy-supplying metabolic process. At present, [18]fluorine-fluorodeoxy glucose ([18]FDG) positron emission tomography (PET) can provide regional and 3-dimensional quantification of glucose metabolism in the human brain. Although MMSE and MoCA are commonly used screens in cognitive impairment, no research team has yet validated their performance in WMIL. The purpose of our study was to compare MMSE and MoCA in screening for cognitive impairment and to explore the correlations between CMRglu values and executive function. MATERIAL AND METHODS All the participants underwent comprehensive clinical, MoCA, MMSE, MRI, and PET examinations. Patients in the WMIL group were subdivided into 3 severity subgroups according to the Fazekas scale. RESULTS The MoCA scores were lower in the WMIL group. Our research indicates that MoCA is a more sensitive screening tool than the commonly used MMSE in detecting cognitive impairment in patients with WMIL. CMRglu values of gray matter were decreased in the WMIL group. Reductions of CMRglu in parietal lobe, frontal lobe, and white matter centrum semiovale were observed to different degrees in the WMIL groups according to the modified Fazekas scale. A significant negative correlation was found between executive function and CMRglu in the frontal lobe. CONCLUSIONS MoCA appears to be a more sensitive screening tool than the commonly used MMSE in detecting cognitive impairment in patients with WMIL. CMRglu can potentially be used as a biomarker for predicting the severity of WMIL.
Collapse
Affiliation(s)
- Jian Li
- Department of Neurology, Beijing Chaoyang Hospital (Xi District), Capital Medical University, Beijing, China (mainland)
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital (Xi District), Capital Medical University, Beijing, China (mainland)
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Brain metabolite alterations in children with primary nocturnal enuresis using proton magnetic resonance spectroscopy. Neurochem Res 2014; 39:1355-62. [PMID: 24792733 DOI: 10.1007/s11064-014-1320-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 03/09/2014] [Accepted: 04/25/2014] [Indexed: 12/18/2022]
Abstract
Nocturnal enuresis is a common developmental disorder in children; primary monosymptomatic nocturnal enuresis (PMNE) is the dominant subtype. Previous literature has suggested that the prefrontal cortex and the pons are both involved in micturition control. This study aimed to investigate the metabolic levels of the left prefrontal cortex and the pons in children with PMNE by proton magnetic resonance spectroscopy (1H-MRS). Twenty-five children with PMNE and 25 healthy children took part in our experiments. Magnetic resonance examinations were performed on a Siemens 3T Trio Tim scanner. For each subject, localized 1H-MRS was acquired from the left prefrontal cortex (mainly in brodmann area 9) and the pons with a point-resolved spectroscopy sequence with repetition time 2,000 ms, echo time 30 ms and 64 averages. The LCModel software package was used to analyze the MRS raw data, and two-sample t tests were used to determine significant differences between the two groups. The results revealed a significant reduction in metabolite to total creatine ratios of N-acetylaspartate (NAA/tCr) in the left prefrontal cortex and the pons for children with PMNE compared to healthy children. Our study suggests that metabolism is disturbed in the prefrontal cortex and the pons in children with PMNE, which may be associated with the symptoms of enuresis.
Collapse
|
32
|
Rosenberg GA, Bjerke M, Wallin A. Multimodal markers of inflammation in the subcortical ischemic vascular disease type of vascular cognitive impairment. Stroke 2014; 45:1531-8. [PMID: 24692476 PMCID: PMC4025998 DOI: 10.1161/strokeaha.113.004534] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/21/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Gary A Rosenberg
- From the Departments of Neurology, Neurosciences, Cell Biology and Physiology, and Mathematics and Statistics, University of New Mexico Health Sciences Center, Albuquerque (G.A.R.); and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (M.B., A.W.)
| | | | | |
Collapse
|
33
|
|