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Nicolini P, Malfatto G, Lucchi T. Heart Rate Variability and Cognition: A Narrative Systematic Review of Longitudinal Studies. J Clin Med 2024; 13:280. [PMID: 38202287 PMCID: PMC10780278 DOI: 10.3390/jcm13010280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Heart rate variability (HRV) is a reliable and convenient method to assess autonomic function. Cross-sectional studies have established a link between HRV and cognition. Longitudinal studies are an emerging area of research with important clinical implications in terms of the predictive value of HRV for future cognition and in terms of the potential causal relationship between HRV and cognition. However, they have not yet been the objective of a systematic review. Therefore, the aim of this systematic review was to investigate the association between HRV and cognition in longitudinal studies. METHODS The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Embase, PsycINFO and PubMed databases were searched from the earliest available date to 26 June 2023. Studies were included if they involved adult human subjects and evaluated the longitudinal association between HRV and cognition. The risk of bias was assessed with the Newcastle-Ottawa Scale for Cohort Studies. The results were presented narratively. RESULTS Of 14,359 records screened, 12 studies were included in this systematic review, with a total of 24,390 participants. Two thirds of the studies were published from 2020 onwards. All studies found a longitudinal relationship between HRV and cognition. There was a consistent association between higher parasympathetic nervous system (PNS) activity and better cognition, and some association between higher sympathetic nervous system activity and worse cognition. Also, higher PNS activity persistently predicted better executive functioning, while data on episodic memory and language were more scant and/or controversial. CONCLUSIONS Our results support the role of HRV as a biomarker of future cognition and, potentially, as a therapeutic target to improve cognition. They will need confirmation by further, more comprehensive studies also including unequivocal non-HRV sympathetic measures and meta-analyses.
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Affiliation(s)
- Paola Nicolini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Geriatric Unit, Internal Medicine Department, 20122 Milan, Italy;
| | - Gabriella Malfatto
- Istituto Auxologico Italiano IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, 20149 Milan, Italy;
| | - Tiziano Lucchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Geriatric Unit, Internal Medicine Department, 20122 Milan, Italy;
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2
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Kuang Q, Huang M, Lei Y, Wu L, Jin C, Dai J, Zhou F. Clinical and cognitive correlates tractography analysis in patients with white matter hyperintensity of vascular origin. Front Neurosci 2023; 17:1187979. [PMID: 37397447 PMCID: PMC10311635 DOI: 10.3389/fnins.2023.1187979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose White matter hyperintensity lesions (WMHL) in the brain are a consequence of cerebral small vessel disease and microstructural damage. Patients with WMHL have diverse clinical features, and hypertension, advanced age, obesity, and cognitive decline are often observed. However, whether these clinical features are linked to interrupted structural connectivity in the brain requires further investigation. This study therefore explores the white matter pathways associated with WMHL, with the objective of identifying neural correlates for clinical features in patients with WMHL. Methods Diffusion magnetic resonance imaging (MRI) and several clinical features (MoCA scores, hypertension scores, body mass index (BMI), duration of hypertension, total white matter lesion loads, and education.) highly related to WMHL were obtained in 16 patients with WMHL and 20 health controls. We used diffusion MRI connectometry to explore the relationship between clinical features and specific white matter tracts using DSI software. Results The results showed that the anterior splenium of the corpus callosum, the inferior longitudinal fasciculus, the anterior corpus callosum and the middle cerebellar peduncle were significantly correlated with hypertension scores (false discovery rate (FDR) = 0.044). The anterior splenium of the corpus callosum, the left thalamoparietal tract, the inferior longitudinal fasciculus, and the left cerebellar were significantly correlated with MoCA scores (FDR = 0.016). The anterior splenium of corpus callosum, inferior fronto-occipital fasciculus, cingulum fasciculus, and fornix/fimbria were significantly correlated with body mass index (FDR = 0.001). Conclusion Our findings show that hypertension score, MoCA score, and BMI are important clinical features in patients with WMHL, hypertension degree and higher BMI are associated with whiter matter local disconnection in patients with WMHL, and may contribute to understanding the cognitive impairments observed in patients with WMHL.
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Affiliation(s)
- Qinmei Kuang
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
| | - Muhua Huang
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
| | - Yumeng Lei
- Department of Radiology, Nanchang First Hospital, Nanchang, Jiangxi, China
| | - Lin Wu
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
| | - Chen Jin
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
| | - Jiankun Dai
- GE Healthcare, MR Research China, Beijing, China
| | - Fuqing Zhou
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
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3
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Yue JH, Zhang QH, Yang X, Wang P, Sun XC, Yan SY, Li A, Zhao WW, Cao DN, Wang Y, Wei ZY, Li XL, Zhu LW, Yang G, Mah JZ. Magnetic resonance imaging of white matter in Alzheimer's disease: a global bibliometric analysis from 1990 to 2022. Front Neurosci 2023; 17:1163809. [PMID: 37304017 PMCID: PMC10248146 DOI: 10.3389/fnins.2023.1163809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
Abstract
Background Alzheimer's disease (AD) is a common, progressive, irreversible, and fatal neurodegenerative disorder with rapidly increasing worldwide incidence. Although much research on magnetic resonance imaging (MRI) of the white matter (WM) in AD has been published, no bibliometric analysis study has investigated this issue. Thus, this study aimed to provide an overview of the current status, hotspots, and trends in MRI of WM in AD. Methods We searched for records related to MRI studies of WM in AD from 1990 to 2022 in the Web of Science Core Collection (WOSCC) database. CiteSpace (version 5.1.R8) and VOSviewer (version 1.6.19) software were used for bibliometric analyses. Results A total of 2,199 articles were obtained from this study. From 1990 to 2022, the number of published articles showed exponential growth of y = 4.1374e0.1294x, with an average of 17.9 articles per year. The top country and institutions were the United States and the University of California Davis, accounting for 44.52 and 5.32% of the total studies, respectively. The most productive journal was Neurology, and the most co-cited journal was Lancet Neurology. Decarli C was the most productive author. The current research frontier trend focuses on the association between small vessel disease and AD, the clinical application and exploration of diffusion MRI, and related markers. Conclusion This study provides an in-depth overview of publications on MRI of WM in AD, identifying the current research status, hotspots, and frontier trends in the field.
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Affiliation(s)
- Jin-huan Yue
- Department of Tuina, Acupuncture and Moxibustion, Shenzhen Jiuwei Chinese Medicine Clinic, Shenzhen, China
| | - Qin-hong Zhang
- Department of Tuina, Acupuncture and Moxibustion, Shenzhen Jiuwei Chinese Medicine Clinic, Shenzhen, China
| | - Xu Yang
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Peng Wang
- Department of Oncology, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xu-Chen Sun
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Shi-Yan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ang Li
- Sanofifi-Aventis China Investment Co., Ltd, Beijing, China
| | | | - Dan-Na Cao
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yang Wang
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Ze-Yi Wei
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiao-Ling Li
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Lu-Wen Zhu
- Department of Rehabilitation, Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Guanhu Yang
- Department of Specialty Medicine, Ohio University, Athens, OH, United States
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4
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Low A, Ng KP, Chander RJ, Wong B, Kandiah N. Association of Asymmetrical White Matter Hyperintensities and Apolipoprotein E4 on Cognitive Impairment. J Alzheimers Dis 2020; 70:953-964. [PMID: 31306121 DOI: 10.3233/jad-190159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Asymmetrical patterns of cerebral damage have been widely observed in a range of neurodegenerative diseases, including Alzheimer's disease (AD). OBJECTIVE To elucidate the clinical associations of asymmetrical white matter hyperintensities (WMH) in mild cognitive impairment (MCI) and AD. METHODS Regional WMH asymmetry of 340 participants (90 healthy controls, 132 MCI, 118 AD) was calculated as the difference in normalized hemispheric WMH volume (WMH/ICV) adjusted for structural brain asymmetry of respective lobar regions and total WMH. WMH asymmetry was analyzed in relation to disease classification, cognition, and APOE4 status using ANCOVA and multiple regression analysis, controlling for gender, age, ethnicity, and correcting for multiple comparisons using Bonferroni correction. Moderation analysis examined interaction effects of APOE4 on associations between cognition and WMH asymmetry. RESULTS Greater left-dominant occipital WMH asymmetry was observed in AD, compared to healthy controls and MCI, and was associated with poorer global cognition, memory, language, and executive functions among cognitively impaired participants (MCI and AD). Cognitively impaired APOE4 carriers displayed greater left-dominant WMH asymmetry in the whole brain and frontal lobe, compared to non-carriers. Importantly, effects were independent of structural brain asymmetry, global cerebral atrophy, and overall WMH burden. Moderation analysis demonstrated associations between left-dominant WMH asymmetry and cognition in cognitively impaired APOE4 non-carriers, but not APOE4 carriers. CONCLUSION Leftward asymmetry of WMH may be more pathological in nature, compared to symmetrical WMH. Furthermore, the detrimental effects of WMH asymmetry was more relevant in APOE4-negative cognitive impairment, compared to APOE4-positive which may be driven primarily by AD pathology.
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Affiliation(s)
- Audrey Low
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Russell Jude Chander
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Benjamin Wong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS, Singapore, Singapore
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5
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Haeger A, Mangin JF, Vignaud A, Poupon C, Grigis A, Boumezbeur F, Frouin V, Deverre JR, Sarazin M, Hertz-Pannier L, Bottlaender M. Imaging the aging brain: study design and baseline findings of the SENIOR cohort. ALZHEIMERS RESEARCH & THERAPY 2020; 12:77. [PMID: 32591008 PMCID: PMC7320588 DOI: 10.1186/s13195-020-00642-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/11/2020] [Indexed: 11/13/2022]
Abstract
Background Current demographic trends point towards an aging society entailing increasing occurrence and burden of neurodegenerative diseases. In this context, understanding physiological aging and its turning point into neurodegeneration is essential for the development of possible biomarkers and future therapeutics of brain disease. Methods The SENIOR study represents a longitudinal, observational study including cognitively healthy elderlies aged between 50 and 70 years old at the time of inclusion, being followed annually over 10 years. Our multimodal protocol includes structural, diffusion, functional, and sodium magnetic resonance imaging (MRI) at 3 T and 7 T, positron emission tomography (PET), blood samples, genetics, audiometry, and neuropsychological and neurological examinations as well as assessment of neuronal risk factors. Results One hundred forty-two participants (50% females) were enrolled in the SENIOR cohort with a mean age of 60 (SD 6.3) years at baseline. Baseline results with multiple regression analyses reveal that cerebral white matter lesions can be predicted by cardiovascular and cognitive risk factors and age. Cardiovascular risk factors were strongly associated with juxtacortical and periventricular lesions. Intra-subject across-test variability as a measure of neuropsychological test performance and possible cognitive marker predicts white matter volume and is significantly associated with risk profile. Division of the cohort into subjects with a higher and lower risk profile shows significant differences in intra-subject across-test variability and volumes as well as cortical thickness of brain regions of the temporal lobe. There is no difference between the lower- and higher-risk groups in amyloid load using PET data from a subset of 81 subjects. Conclusions We here describe the study protocol and baseline findings of the SENIOR observational study which aim is the establishment of integrated, multiparametric maps of normal aging and the identification of early biomarkers for neurodegeneration. We show that intra-subject across-test variability as a marker of neuropsychological test performance as well as age, gender, and combined risk factors influence neuronal decline as represented by decrease in brain volume, cortical thickness, and increase in white matter lesions. Baseline findings will be used as underlying basis for the further implications of aging and neuronal degeneration as well as examination of brain aging under different aspects of brain pathology versus physiological aging.
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Affiliation(s)
- Alexa Haeger
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Jean-François Mangin
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France
| | - Alexandre Vignaud
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France
| | - Cyril Poupon
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France
| | - Antoine Grigis
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France
| | - Fawzi Boumezbeur
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France
| | - Vincent Frouin
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France
| | - Jean-Robert Deverre
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France
| | - Marie Sarazin
- Unit of Neurology of Memory and Language, GHU Paris Psychiatry and Neurosciences, Paris University, Paris, France.,Paris-Saclay University, CEA, CNRS, INSERM, BioMaps, Service Hospitalier Frédéric Joliot, F-91400, Orsay, France
| | - Lucie Hertz-Pannier
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France
| | - Michel Bottlaender
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, Paris-Saclay University, Gif-sur-Yvette, France. .,Paris-Saclay University, CEA, CNRS, INSERM, BioMaps, Service Hospitalier Frédéric Joliot, F-91400, Orsay, France.
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6
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Jaarsma-Coes MG, Ghaznawi R, Hendrikse J, Slump C, Witkamp TD, van der Graaf Y, Geerlings MI, de Bresser J. MRI phenotypes of the brain are related to future stroke and mortality in patients with manifest arterial disease: The SMART-MR study. J Cereb Blood Flow Metab 2020; 40:354-364. [PMID: 30547694 PMCID: PMC6985990 DOI: 10.1177/0271678x18818918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neurodegenerative and neurovascular diseases lead to heterogeneous brain abnormalities. A combined analysis of these abnormalities by phenotypes of the brain might give a more accurate representation of the underlying aetiology. We aimed to identify different MRI phenotypes of the brain and assessed the risk of future stroke and mortality within these subgroups. In 1003 patients (59 ± 10 years) from the Second Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) study, different quantitative 1.5T brain MRI markers were used in a hierarchical clustering analysis to identify 11 distinct subgroups with a different distribution in brain MRI markers and cardiovascular risk factors, and a different risk of stroke (Cox regression: from no increased risk compared to the reference group with relatively few brain abnormalities to HR = 10.34; 95% CI 3.80↔28.12 for the multi-burden subgroup) and mortality (from no increased risk compared to the reference group to HR = 4.00; 95% CI 2.50↔6.40 for the multi-burden subgroup). In conclusion, within a group of patients with manifest arterial disease, we showed that different MRI phenotypes of the brain can be identified and that these were associated with different risks of future stroke and mortality. These MRI phenotypes can possibly classify individual patients and assess their risk of future stroke and mortality.
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Affiliation(s)
- Myriam G Jaarsma-Coes
- Department of Radiology, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.,Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rashid Ghaznawi
- Department of Radiology, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, and Utrecht University, Utrecht, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands
| | - Cornelis Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Theo D Witkamp
- Department of Radiology, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, and Utrecht University, Utrecht, the Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, and Utrecht University, Utrecht, the Netherlands
| | - Jeroen de Bresser
- Department of Radiology, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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7
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Ek Olofsson H, Englund E. A cortical microvascular structure in vascular dementia, Alzheimer's disease, frontotemporal lobar degeneration and nondemented controls: a sign of angiogenesis due to brain ischaemia? Neuropathol Appl Neurobiol 2019; 45:557-569. [PMID: 30957900 PMCID: PMC6850314 DOI: 10.1111/nan.12552] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/02/2019] [Indexed: 12/30/2022]
Abstract
Aims We observed a microvascular structure in the cerebral cortex that has not, to our knowledge, been previously described. We have termed the structure a ‘raspberry’, referring to its appearance under a bright‐field microscope. We hypothesized that raspberries form through angiogenesis due to some form of brain ischaemia or hypoperfusion. The aims of this study were to quantify raspberry frequency within the cerebral cortex according to diagnosis (vascular dementia, Alzheimer's disease, frontotemporal lobar degeneration and nondemented controls) and brain regions (frontal, temporal, parietal and occipital cortices, regardless of diagnosis). Materials and methods In each of 10 age‐matched subjects per group, a 20‐mm section of the cerebral cortex was examined in haematoxylin‐and‐eosin‐stained sections of the frontal, temporal and parietal, and/or occipital lobes. Tests were performed to validate the haematoxylin‐and‐eosin‐based identification of relative differences between the groups, and to investigate inter‐rater variability. Results Raspberry frequency was highest in subjects with vascular dementia, followed by those with frontotemporal lobar degeneration, Alzheimer's disease and last, nondemented controls. The frequency of raspberries in subjects with vascular dementia differed from that of all other groups at a statistically significant level. In the cerebral lobes, there was a statistically significant difference between the frontal and occipital cortices. Conclusions We believe the results support the hypothesis that raspberries are a sign of angiogenesis in the adult brain. It is pertinent to discuss possible proangiogenic stimuli, including brain ischaemia (such as mild hypoperfusion due to a combination of small vessel disease and transient hypotension), neuroinflammation and protein pathology.
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Affiliation(s)
- H Ek Olofsson
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - E Englund
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
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8
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Chiti A, Cecchi P, Pesaresi I, Orlandi G, Giannini N, Gialdini G, Terni E, Tognoni G, Volpi L, Pagni C, Ghicopulos I, Siciliano G, Dotti MT, Federico A, Poggesi A, Salvadori E, Pantoni L, Inzitari D, Cosottini M, Bonuccelli U. Functional magnetic resonance imaging with encoding task in patients with mild cognitive impairment and different severity of leukoaraiosis. Psychiatry Res Neuroimaging 2018; 282:126-131. [PMID: 30539733 DOI: 10.1016/j.pscychresns.2018.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 06/15/2018] [Accepted: 06/28/2018] [Indexed: 11/20/2022]
Abstract
Leukoaraiosis is one of the main contributors to mild cognitive impairment due to vascular damage (vascular MCI, VMCI), whose pathophysiology has not been fully elucidated yet. We aimed to shed light on such issue using functional MRI (fMRI). Sixteen patients with VMCI were enrolled and compared with twenty-five patients with MCI but without significant vascular damage (non-vascular MCI, NVMCI) and with fifteen healthy controls (HC). They all underwent fMRI with incidental verbal learning paradigm, using a 3T scanner. Differently from cases with NVMCI (versus HC), VMCI patients presented a higher BOLD activation in the right parieto-occipital cortex and a lower activation in the left superior and middle frontal gyri, anterior cingulum and in left fronto-opercular area when compared to HC. Cortical activation evaluated by fMRI may reflect specific patterns of damage and attempt of compensation in patients with MCI and different severity of leukoaraiosis.
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Affiliation(s)
- Alberto Chiti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy; Unit of Neurology, Ospedale Apuane, Via Mattei 21, Massa 54100, Italy.
| | - Paolo Cecchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, Pisa 56126, Italy
| | - Ilaria Pesaresi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, Pisa 56126, Italy
| | - Giovanni Orlandi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy; Unit of Neurology, Ospedale Apuane, Via Mattei 21, Massa 54100, Italy
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Gino Gialdini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Eva Terni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Gloria Tognoni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Leda Volpi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Cristina Pagni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Irene Ghicopulos
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci 16, Siena 53100, Italy
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci 16, Siena 53100, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Leonardo Pantoni
- "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Via G.B Grassi, 74, Milan 20157, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, Pisa 56126, Italy
| | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
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9
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Chen JJ. Functional MRI of brain physiology in aging and neurodegenerative diseases. Neuroimage 2018; 187:209-225. [PMID: 29793062 DOI: 10.1016/j.neuroimage.2018.05.050] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 05/16/2018] [Accepted: 05/20/2018] [Indexed: 12/14/2022] Open
Abstract
Brain aging and associated neurodegeneration constitute a major societal challenge as well as one for the neuroimaging community. A full understanding of the physiological mechanisms underlying neurodegeneration still eludes medical researchers, fuelling the development of in vivo neuroimaging markers. Hence it is increasingly recognized that our understanding of neurodegenerative processes likely will depend upon the available information provided by imaging techniques. At the same time, the imaging techniques are often developed in response to the desire to observe certain physiological processes. In this context, functional MRI (fMRI), which has for decades provided information on neuronal activity, has evolved into a large family of techniques well suited for in vivo observations of brain physiology. Given the rapid technical advances in fMRI in recent years, this review aims to summarize the physiological basis of fMRI observations in healthy aging as well as in age-related neurodegeneration. This review focuses on in-vivo human brain imaging studies in this review and on disease features that can be imaged using fMRI methods. In addition to providing detailed literature summaries, this review also discusses future directions in the study of brain physiology using fMRI in the clinical setting.
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Affiliation(s)
- J Jean Chen
- Rotman Research Institute at Baycrest Centre, Canada; Department of Medical Biophysics, University of Toronto, Canada.
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10
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White matter hyperintensity shape and location feature analysis on brain MRI; proof of principle study in patients with diabetes. Sci Rep 2018; 8:1893. [PMID: 29382936 PMCID: PMC5789823 DOI: 10.1038/s41598-018-20084-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/08/2018] [Indexed: 02/06/2023] Open
Abstract
Cerebral small vessel disease is a heterogeneous disease in which various underlying etiologies can lead to different types of white matter hyperintensities (WMH). WMH shape features might aid in distinguishing these different types. In this proof of principle study in patients with type 2 diabetes mellitus (T2DM), we present a novel approach to assess WMH using shape features. Our algorithm determines WMH volume and different WMH shape and location features on 3T MRI scans. These features were compared between patients with T2DM (n = 60) and a matched control group (n = 54). Although a more traditional marker (WMH volume) was not significantly different between groups (natural log transformed Beta (95% CI): 0.07 (-0.11↔0.24)), patients with T2DM showed a larger number of non-punctuate WMH (median (10th-90th percentile), patients: 40 lesions per person (16-86); controls: 26 (5-58)) and a different shape (eccentricity) of punctuate deep WMH (Beta (95% CI): 0.40 (0.23↔0.58)) compared to controls. In conclusion, our algorithm identified WMH features that are not part of traditional WMH assessment, but showed to be distinguishing features between patients with T2DM and controls. Future studies could address these features to further unravel the etiology and functional impact of WMH.
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Fornaro M, Solmi M, Veronese N, De Berardis D, Buonaguro EF, Tomasetti C, Perna G, Preti A, Carta MG. The burden of mood-disorder/cerebrovascular disease comorbidity: essential neurobiology, psychopharmacology, and physical activity interventions. Int Rev Psychiatry 2017; 29:425-435. [PMID: 28681620 DOI: 10.1080/09540261.2017.1299695] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardio-vascular diseases (CVDs) and CVD-related disorders (including cerebrovascular diseases; CBVDs) are a major public health concern as they represent the leading cause of mortality and morbidity in developed countries. Patients with CVDs and CBVDs co-morbid with mood disorders, especially bipolar disorder (BD) and major depressive disorder (MDD), suffer reduced quality-of-life and significant disability adjusted for years of life and mortality. The relationship between CVDs/CBVDs and mood disorders is likely to be bidirectional. Evidence for shared genetic risk of pathways involved in stress reaction, serotonin or dopamine signalling, circadian rhythms, and energy balance was reported in genome-wide association studies. There is some evidence of a neuroprotective effect of various antidepressants, which may be boosted by physical exercise, especially by aerobic ones. Patients with CVDs/CBVDs should be routinely attentively evaluated for the presence of mood disorders, with tools aimed at detecting both symptoms of depression and of hypomania/mania. Behavioural lifestyle interventions targeting nutrition and exercise, coping strategies, and attitudes towards health should be routinely provided to patients with mood disorders, to prevent the risk of CVDs/CBVDs. A narrative review of the evidence is herein provided, focusing on pharmacological and physical therapy interventions.
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Affiliation(s)
- Michele Fornaro
- a Department of Neuroscience, Reproductive Science and Odontostomatology , School of Medicine 'Federico II' Naples , Naples , Italy.,b Department of Psychiatry , Columbia University Medical Center, New York State Psychiatric Institute , New York , NY , USA
| | - Marco Solmi
- c Neuroscience Department , University of Padua , Padua , Italy.,d Institute for Clinical Research and Education in Medicine, I.R.E.M , Padua , Italy
| | - Nicola Veronese
- d Institute for Clinical Research and Education in Medicine, I.R.E.M , Padua , Italy.,e Department of Medicine (DIMED), Geriatrics Division , University of Padova , Padova , Italy
| | - Domenico De Berardis
- f Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini' , Teramo , Italy
| | - Elisabetta Filomena Buonaguro
- a Department of Neuroscience, Reproductive Science and Odontostomatology , School of Medicine 'Federico II' Naples , Naples , Italy
| | - Carmine Tomasetti
- a Department of Neuroscience, Reproductive Science and Odontostomatology , School of Medicine 'Federico II' Naples , Naples , Italy
| | - Giampaolo Perna
- g Department of Psychiatry and Neuropsychology , Maastricht University , Maastricht , Netherlands.,h Department of Clinical Neurosciences, FoRiPsi , Hermanas Hospitalarias-Villa San Benedetto Menni Hospital , Albese con Cassano , Como , Italy.,i Department of Psychiatry and Behavioural Sciences, Leonard Miller School of Medicine , University of Miami , Miami , FL , USA
| | - Antonio Preti
- j Center of Liaison Psychiatry and Psychosomatics , University Hospital, University of Cagliari , Monserrato , Cagliari , Italy
| | - Mauro Giovanni Carta
- k Department of Public Health, Clinical and Molecular Medicine , University of Cagliari , Monserrato , Cagliari , Italy
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Love S, Miners JS. Small vessel disease, neurovascular regulation and cognitive impairment: post-mortem studies reveal a complex relationship, still poorly understood. Clin Sci (Lond) 2017; 131:1579-1589. [PMID: 28667060 DOI: 10.1042/cs20170148] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/08/2023]
Abstract
The contribution of vascular disease to cognitive impairment is under-recognized and the pathogenesis is poorly understood. This information gap has multiple causes, including a lack of post-mortem validation of clinical diagnoses of vascular cognitive impairment (VCI) or vascular dementia (VaD), the exclusion of cases with concomitant neurodegenerative disease when diagnosing VCI/VaD, and a lack of standardization of neuropathological assessment protocols for vascular disease. Other contributors include a focus on end-stage destructive lesions to the exclusion of more subtle types of diffuse brain injury, on structural abnormalities of arteries and arterioles to the exclusion of non-structural abnormalities and capillary damage, and the use of post-mortem sampling strategies that are biased towards the identification of neurodegenerative pathologies. Recent studies have demonstrated the value of detailed neuropathology in characterizing vascular contributions to cognitive impairment (e.g. in diabetes), and highlight the importance of diffuse white matter changes, capillary damage and vasoregulatory abnormalities in VCI/VaD. The use of standardized, evidence-based post-mortem assessment protocols and the inclusion of biochemical as well as morphological methods in neuropathological studies should improve the accuracy of determination of the contribution of vascular disease to cognitive impairment and clarify the relative contribution of different pathogenic processes to the tissue damage.
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Affiliation(s)
- Seth Love
- Dementia Research Group, School of Clinical Sciences, University of Bristol, Learning and Research Level 1, Southmead Hospital, Bristol BS10 5NB, U.K.
| | - J Scott Miners
- Dementia Research Group, School of Clinical Sciences, University of Bristol, Learning and Research Level 1, Southmead Hospital, Bristol BS10 5NB, U.K
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Resende EDPF, Costa-Silva L, Carmona KC, Machado TH, Machado JCB, Guimarães HC, Barbosa MT, Teixeira AL, de Souza LC, Caramelli P. Ischemic cerebrovascular burden evaluated by magnetic resonance imaging in an elderly Brazilian community: The Pietà study. eNeurologicalSci 2016; 5:30-34. [PMID: 29430555 PMCID: PMC5803083 DOI: 10.1016/j.ensci.2016.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/08/2016] [Accepted: 11/28/2016] [Indexed: 01/18/2023] Open
Abstract
In developing countries, cardiovascular risk factors are poorly controlled, leading to high prevalence of cerebrovascular diseases. The aim of the study was to evaluate the burden of white matter lesions in magnetic resonance through the Fazekas scale in a population aged 75 + years living in the community, and to investigate possible associations between vascular lesions, cardiovascular risk factors and cognitive status. Subjects were selected from a community-based study on brain aging conducted in Caeté (Minas Gerais state), Brazil. Overall, 177 participants (112 cognitively healthy, 36 with cognitive impairment-no dementia and 29 with dementia), being 108 women, aged 79.3 ± 3.8 years, with 3.1 ± 2.9 years of educational level, underwent a 3 Tesla magnetic resonance scanner with fluid attenuated image recovery acquisition. Severity of white matter lesions was assessed through the Fazekas scale. Severe white matter lesions were present in 31.1% of the whole sample and in 25.0% of the cognitively healthy individuals. A significant association was found between severe white matter lesions and cognitive impairment (OR = 2.20, 95% CI 1.17–6.53; p = 0.021), as well as with hypertension (OR = 1.92, 95% CI 1.03–7.39; p = 0.043). In conclusion, a high prevalence of severe white matter lesions was observed in this elderly Brazilian population sample, and white matter lesions were associated with hypertension and cognitive status. Importantly, the prevalence of white matter lesions was also high in cognitively healthy subjects. The ischemic cerebrovascular burden assessed by MRI in an elderly Brazilian community is very high. MRI white matter lesions were associated with cognitive impairment and hypertension. Even in cognitively healthy individuals the prevalence of ischemic cerebrovascular lesions was high.
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Affiliation(s)
- Elisa de Paula França Resende
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Luciana Costa-Silva
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Karoline Carvalho Carmona
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Thais Helena Machado
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - João Carlos Barbosa Machado
- Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo Horizonte, MG 30130-110, Brazil
| | - Henrique Cerqueira Guimarães
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Maira Tonidandel Barbosa
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Antônio Lúcio Teixeira
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Leonardo Cruz de Souza
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Paulo Caramelli
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
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Lambert C, Benjamin P, Zeestraten E, Lawrence AJ, Barrick TR, Markus HS. Longitudinal patterns of leukoaraiosis and brain atrophy in symptomatic small vessel disease. Brain 2016; 139:1136-51. [PMID: 26936939 PMCID: PMC4806220 DOI: 10.1093/brain/aww009] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/11/2015] [Accepted: 12/19/2015] [Indexed: 12/13/2022] Open
Abstract
Cerebral small vessel disease is a common condition associated with lacunar stroke, cognitive impairment and significant functional morbidity. White matter hyperintensities and brain atrophy, seen on magnetic resonance imaging, are correlated with increasing disease severity. However, how the two are related remains an open question. To better define the relationship between white matter hyperintensity growth and brain atrophy, we applied a semi-automated magnetic resonance imaging segmentation analysis pipeline to a 3-year longitudinal cohort of 99 subjects with symptomatic small vessel disease, who were followed-up for ≥1 years. Using a novel two-stage warping pipeline with tissue repair step, voxel-by-voxel rate of change maps were calculated for each tissue class (grey matter, white matter, white matter hyperintensities and lacunes) for each individual. These maps capture both the distribution of disease and spatial information showing local rates of growth and atrophy. These were analysed to answer three primary questions: first, is there a relationship between whole brain atrophy and magnetic resonance imaging markers of small vessel disease (white matter hyperintensities or lacune volume)? Second, is there regional variation within the cerebral white matter in the rate of white matter hyperintensity progression? Finally, are there regionally specific relationships between the rates of white matter hyperintensity progression and cortical grey matter atrophy? We demonstrate that the rates of white matter hyperintensity expansion and grey matter atrophy are strongly correlated (Pearson's R = -0.69, P < 1 × 10(-7)), and significant grey matter loss and whole brain atrophy occurs annually (P < 0.05). Additionally, the rate of white matter hyperintensity growth was heterogeneous, occurring more rapidly within long association fasciculi. Using voxel-based quantification (family-wise error corrected P < 0.05), we show the rate of white matter hyperintensity progression is associated with increases in cortical grey matter atrophy rates, in the medial-frontal, orbito-frontal, parietal and occipital regions. Conversely, increased rates of global grey matter atrophy are significantly associated with faster white matter hyperintensity growth in the frontal and parietal regions. Together, these results link the progression of white matter hyperintensities with increasing rates of regional grey matter atrophy, and demonstrate that grey matter atrophy is the major contributor to whole brain atrophy in symptomatic cerebral small vessel disease. These measures provide novel insights into the longitudinal pathogenesis of small vessel disease, and imply that therapies aimed at reducing progression of white matter hyperintensities via end-arteriole damage may protect against secondary brain atrophy and consequent functional morbidity.
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Affiliation(s)
- Christian Lambert
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Philip Benjamin
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, SW17 0RE, UK Department of Radiology, Charing Cross Campus, Imperial College NHS Trust, London W6 8RP, UK
| | - Eva Zeestraten
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Andrew J Lawrence
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, CB2 0QQ, UK
| | - Thomas R Barrick
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Hugh S Markus
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, CB2 0QQ, UK
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Bender AR, Völkle MC, Raz N. Differential aging of cerebral white matter in middle-aged and older adults: A seven-year follow-up. Neuroimage 2016; 125:74-83. [PMID: 26481675 PMCID: PMC4691398 DOI: 10.1016/j.neuroimage.2015.10.030] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/30/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
The few extant reports of longitudinal white matter (WM) changes in healthy aging, using diffusion tensor imaging (DTI), reveal substantial differences in change across brain regions and DTI indices. According to the "last-in-first-out" hypothesis of brain aging late-developing WM tracts may be particularly vulnerable to advanced age. To test this hypothesis we compared age-related changes in association, commissural and projection WM fiber regions using a skeletonized, region of interest DTI approach. Using linear mixed effect models, we evaluated the influences of age and vascular risk at baseline on seven-year changes in three indices of WM integrity and organization (axial diffusivity, AD, radial diffusivity, RD, and fractional anisotropy, FA) in healthy middle-aged and older adults (mean age=65.4, SD=9.0years). Association fibers showed the most pronounced declines over time. Advanced age was associated with greater longitudinal changes in RD and FA, independent of fiber type. Furthermore, older age was associated with longitudinal RD increases in late-developing, but not early-developing projection fibers. These findings demonstrate the increased vulnerability of later developing WM regions and support the "last-in-first-out" hypothesis of brain aging.
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Affiliation(s)
- Andrew R Bender
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Germany.
| | - Manuel C Völkle
- Department of Psychology, Humboldt University, Max Planck Institute for Human Development, Germany; Center for Lifespan Psychology, Max Planck Institute for Human Development, Germany
| | - Naftali Raz
- Institute of Gerontology & Department of Psychology, Wayne State University, USA
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Lambert C, Sam Narean J, Benjamin P, Zeestraten E, Barrick TR, Markus HS. Characterising the grey matter correlates of leukoaraiosis in cerebral small vessel disease. Neuroimage Clin 2015; 9:194-205. [PMID: 26448913 PMCID: PMC4564392 DOI: 10.1016/j.nicl.2015.07.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 06/30/2015] [Accepted: 07/03/2015] [Indexed: 01/05/2023]
Abstract
Cerebral small vessel disease (SVD) is a heterogeneous group of pathological disorders that affect the small vessels of the brain and are an important cause of cognitive impairment. The ischaemic consequences of this disease can be detected using MRI, and include white matter hyperintensities (WMH), lacunar infarcts and microhaemorrhages. The relationship between SVD disease severity, as defined by WMH volume, in sporadic age-related SVD and cortical thickness has not been well defined. However, regional cortical thickness change would be expected due to associated phenomena such as underlying ischaemic white matter damage, and the observation that widespread cortical thinning is observed in the related genetic condition CADASIL (Righart et al., 2013). Using MRI data, we have developed a semi-automated processing pipeline for the anatomical analysis of individuals with cerebral small vessel disease and applied it cross-sectionally to 121 subjects diagnosed with this condition. Using a novel combined automated white matter lesion segmentation algorithm and lesion repair step, highly accurate warping to a group average template was achieved. The volume of white matter affected by WMH was calculated, and used as a covariate of interest in a voxel-based morphometry and voxel-based cortical thickness analysis. Additionally, Gaussian Process Regression (GPR) was used to assess if the severity of SVD, measured by WMH volume, could be predicted from the morphometry and cortical thickness measures. We found significant (Family Wise Error corrected p < 0.05) volumetric decline with increasing lesion load predominately in the parietal lobes, anterior insula and caudate nuclei bilaterally. Widespread significant cortical thinning was found bilaterally in the dorsolateral prefrontal, parietal and posterio-superior temporal cortices. These represent distinctive patterns of cortical thinning and volumetric reduction compared to ageing effects in the same cohort, which exhibited greater changes in the occipital and sensorimotor cortices. Using GPR, the absolute WMH volume could be significantly estimated from the grey matter density and cortical thickness maps (Pearson's coefficients 0.80 and 0.75 respectively). We demonstrate that SVD severity is associated with regional cortical thinning. Furthermore a quantitative measure of SVD severity (WMH volume) can be predicted from grey matter measures, supporting an association between white and grey matter damage. The pattern of cortical thinning and volumetric decline is distinctive for SVD severity compared to ageing. These results, taken together, suggest that there is a phenotypic pattern of atrophy associated with SVD severity.
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Affiliation(s)
- Christian Lambert
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Janakan Sam Narean
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Philip Benjamin
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Eva Zeestraten
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Thomas R. Barrick
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Hugh S. Markus
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, United Kingdom
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Abstract
Although cognitive deficits are common in patients with chronic heart failure (CHF), no study to date has investigated whether these deficits extend to the capacity to execute delayed intentions (prospective memory, PM). This is a surprising omission given the critical role PM plays in correctly implementing many important CHF self-care behaviors. The present study aimed to provide the first empirical assessment of PM function in people with CHF. The key dependent measure was a laboratory measure of PM that closely simulates PM tasks in daily life - Virtual Week. A group comparison design was used, with 30 CHF patients compared to 30 demographically matched controls. Background measures assessing executive functions, working memory, and verbal memory were also administered. The CHF group exhibited significant PM impairment, with difficulties generalizing across different types of PM tasks (event, time, regular, irregular). The CHF group also had moderate deficits on several of the background cognitive measures. Given the level of impairment remained consistent even on tasks that imposed minimal demands on memory for task content, CHF-related difficulties most likely reflects problems with the prospective component. However, exploratory analyses suggest that difficulties with retrospective memory and global cognition (but not executive control), also contribute to the PM difficulties seen in this group. The implications of these data are discussed, and in particular, it is argued that problems with PM may help explain why patient engagement in CHF self-care behaviors is often poor.
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Carta MG, Pala AN, Finco G, Musu M, Moro MF. Depression and cerebrovascular disease: could vortioxetine represent a valid treatment option? Clin Pract Epidemiol Ment Health 2015; 11:144-9. [PMID: 25893002 PMCID: PMC4397833 DOI: 10.2174/1745017901511010144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Depression and cerebrovascular atherosclerosis often occur in comorbidity showing neuropsychological impairment and poor response to antidepressant treatment. Objective is to evaluate if new antidepressant vortioxetine may be a potential treatment option. Mechanism of Action : Vortioxetine has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. Efficacy and safety in Major Depressive Disorders and in cognitive impairment : The majority of trials (one of them in older people) showed efficacy for vortioxetine against placebo and no differences against other active treatments. The Adverse Effects ranged from 15.8% more to 10.8% less than placebo. In the elderly, only nausea was found higher than placebo. Effects on arterial blood pressure and cardiac parameters including the ECG-QT segment were similar to placebo. Elderly depressive patients on vortioxetine showed improvement versus placebo and other active comparators in Auditory Verbal Learning Test and Digit Symbol Substitution Test scores. The inclusion criteria admitted cases with middle cerebrovascular disease. Conclusion : The mechanism of action, the efficacy on depression and safety profile and early data on cognitive impairment make Vortioxetine a strong candidate for use in depression associated with cerebrovascular disease. This information must be supported by future randomized controlled trials.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | - Gabriele Finco
- Department of Medical Science, University of Caglairi, Italy
| | - Mario Musu
- Department of Medical Science, University of Caglairi, Italy
| | - Maria Francesca Moro
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
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Cooley SA, Cabeen RP, Laidlaw DH, Conturo TE, Lane EM, Heaps JM, Bolzenius JD, Baker LM, Salminen LE, Scott SE, Paul RH. Posterior brain white matter abnormalities in older adults with probable mild cognitive impairment. J Clin Exp Neuropsychol 2014; 37:61-9. [PMID: 25523313 DOI: 10.1080/13803395.2014.985636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Much of the mild cognitive impairment (MCI) neuroimaging literature has exclusively focused on regions associated with Alzheimer's disease. Little research has examined white matter abnormalities of other brain regions, including those associated with visual processing, despite evidence that other brain abnormalities appear in these regions in early disease stages. METHOD Diffusion tensor imaging (DTI) was utilized to examine participants (n = 44) that completed baseline imaging as part of a longitudinal healthy aging study. Participants were divided into two groups based on scores from the Montreal Cognitive Assessment (MoCA), a brief screening tool for MCI. Participants who scored <26 were defined as "probable MCI" while those who scored ≥26 were labeled cognitively healthy. Two DTI indices were analyzed including fractional anisotropy (FA) and mean diffusivity (MD). DTI values for white matter in the lingual gyrus, cuneus, pericalcarine, fusiform gyrus, and all four lobes were compared using multivariate analysis of variance (MANOVA). Regression analyses examined the relationship between DTI indices and total MoCA score. RESULTS RESULTS revealed significantly lower FA in the probable MCI group in the cuneus, fusiform, pericalcarine, and occipital lobe, and significantly higher MD in the temporal lobe. Fusiform FA and temporal lobe MD were significantly related to total MoCA score after accounting for age and education. CONCLUSIONS RESULTS indicate that there are posterior white matter microstructural changes in individuals with probable MCI. These differences demonstrate that white matter abnormalities are evident among individuals with probable MCI in regions beyond those commonly associated with Alzheimer's disease and anterior brain aging patterns.
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Affiliation(s)
- Sarah A Cooley
- a Department of Psychology , University of Missouri-Saint Louis , Saint Louis , MO , USA
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Attems J, Jellinger KA. The overlap between vascular disease and Alzheimer's disease--lessons from pathology. BMC Med 2014; 12:206. [PMID: 25385447 PMCID: PMC4226890 DOI: 10.1186/s12916-014-0206-2] [Citation(s) in RCA: 475] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/07/2014] [Indexed: 12/15/2022] Open
Abstract
Recent epidemiological and clinico-pathological data indicate considerable overlap between cerebrovascular disease (CVD) and Alzheimer's disease (AD) and suggest additive or synergistic effects of both pathologies on cognitive decline. The most frequent vascular pathologies in the aging brain and in AD are cerebral amyloid angiopathy and small vessel disease. Up to 84% of aged subjects show morphological substrates of CVD in addition to AD pathology. AD brains with minor CVD, similar to pure vascular dementia, show subcortical vascular lesions in about two-thirds, while in mixed type dementia (AD plus vascular dementia), multiple larger infarcts are more frequent. Small infarcts in patients with full-blown AD have no impact on cognitive decline but are overwhelmed by the severity of Alzheimer pathology, while in early stages of AD, cerebrovascular lesions may influence and promote cognitive impairment, lowering the threshold for clinically overt dementia. Further studies are warranted to elucidate the many hitherto unanswered questions regarding the overlap between CVD and AD as well as the impact of both CVD and AD pathologies on the development and progression of dementia.
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Affiliation(s)
- Johannes Attems
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
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Elevated brain lesion volumes in older adults who use calcium supplements: a cross-sectional clinical observational study. Br J Nutr 2014; 112:220-7. [PMID: 24787048 DOI: 10.1017/s0007114514000828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Recent studies have implicated Ca supplements in vascular risk elevation, and therefore these supplements may also be associated with the occurrence of brain lesions (or hyperintensities) in older adults. These lesions represent damage to brain tissue that is caused by ischaemia. In the present cross-sectional clinical observational study, the association between Ca-containing dietary supplement use and lesion volumes was investigated in a sample of 227 older adults (60 years and above). Food and supplemental Ca intakes were assessed with the Block 1998 FFQ; participants with supplemental Ca intake above zero were categorised as supplement users. Lesion volumes were determined from cranial MRI (1.5 tesla) scans using a semi-automated technique; volumes were log-transformed because they were non-normal. ANCOVA models revealed that supplement users had greater lesion volumes than non-users, even after controlling for food Ca intake, age, sex, race, years of education, energy intake, depression and hypertension (Ca supplement use: β = 0.34, SE 0.10, F(1,217)= 10.98, P= 0.0011). The influence of supplemental Ca use on lesion volume was of a magnitude similar to that of the influence of hypertension, a well-established risk factor for lesions. Among the supplement users, the amount of supplemental Ca was not associated with lesion volume (β = - 0.000035, SE 0.00 015, F(1,139)= 0.06, P= 0.81). The present study demonstrates that the use of Ca-containing dietary supplements, even low-dose supplements, by older adults may be associated with greater lesion volumes. Evaluation of randomised controlled trials is warranted to determine whether this relationship is a causal one.
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Dalby RB, Elfving B, Poulsen PHP, Foldager L, Frandsen J, Videbech P, Rosenberg R. Plasma brain-derived neurotrophic factor and prefrontal white matter integrity in late-onset depression and normal aging. Acta Psychiatr Scand 2013; 128:387-96. [PMID: 23350796 DOI: 10.1111/acps.12085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore the relationship between brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF), cerebral deep white matter lesions (DWMLs), and measures of white matter integrity in patients with late-onset depression, with respect to vascular risk factors. METHOD We examined 22 patients with late-onset depression and 22 matched controls. Quantification of plasma BDNF and VEGF levels were performed with enzyme-linked immunosorbent assay (ELISA) kits. Measures of white matter integrity comprised apparent diffusion coefficient (ADC) and fractional anisotropy (FA), obtained by diffusion tensor imaging (DTI). Effects of DWMLs, FA, ADC, and vascular risk factors on BDNF and VEGF were assessed using multiple linear regression. RESULTS The BDNF and VEGF levels did not differ significantly between groups. With pooled data for patients and controls, the BDNF level was positively associated with both number (t = 2.14, P = 0.039) and volume (t = 2.04, P = 0.048) of prefrontal DWMLs and negatively associated with FA in prefrontal normal-appearing white matter (t = -2.40, P = 0.02), adjusted for age and gender. Smoking and hypercholesterolemia was positively associated with the BDNF (t = 2.36, P = 0.023) and VEGF levels (t = 2.28, P = 0.028), respectively. CONCLUSION Our results suggest a role for BDNF in the complex pathophysiologic mechanisms underlying DWMLs in both normal aging and late-onset depression.
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Affiliation(s)
- R B Dalby
- Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark; MINDLab, Aarhus University, Aarhus, Denmark
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Aine CJ, Sanfratello L, Adair JC, Knoefel JE, Qualls C, Lundy SL, Caprihan A, Stone D, Stephen JM. Characterization of a normal control group: are they healthy? Neuroimage 2013; 84:796-809. [PMID: 24060318 DOI: 10.1016/j.neuroimage.2013.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/28/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022] Open
Abstract
We examined the health of a control group (18-81years) in our aging study, which is similar to control groups used in other neuroimaging studies. The current study was motivated by our previous results showing that one third of the elder control group had moderate to severe white matter hyperintensities and/or cortical volume loss which correlated with poor performance on memory tasks. Therefore, we predicted that cardiovascular risk factors (e.g., hypertension, high cholesterol) within the control group would account for significant variance on working memory task performance. Fifty-five participants completed 4 verbal and spatial working memory tasks, neuropsychological exams, diffusion tensor imaging (DTI), and blood tests to assess vascular risk. In addition to using a repeated measures ANOVA design, a cluster analysis was applied to the vascular risk measures as a data reduction step to characterize relationships between conjoint risk factors. The cluster groupings were used to predict working memory performance. The results show that higher levels of systolic blood pressure were associated with: 1) poor spatial working memory accuracy; and 2) lower fractional anisotropy (FA) values in multiple brain regions. In contrast, higher levels of total cholesterol corresponded with increased accuracy in verbal working memory. An association between lower FA values and higher cholesterol levels were identified in different brain regions from those associated with systolic blood pressure. The conjoint risk analysis revealed that Risk Cluster Group 3 (the group with the greatest number of risk factors) displayed: 1) the poorest performance on the spatial working memory tasks; 2) the longest reaction times across both spatial and verbal memory tasks; and 3) the lowest FA values across widespread brain regions. Our results confirm that a considerable range of vascular risk factors are present in a typical control group, even in younger individuals, which have robust effects on brain anatomy and function. These results present a new challenge to neuroimaging studies both for defining a cohort from which to characterize 'normative' brain circuitry and for establishing a control group to compare with other clinical populations.
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Affiliation(s)
- C J Aine
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.
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Zhang Q, Stafford RB, Wang Z, Arnold SE, Wolk DA, Detre JA. Microvascular perfusion based on arterial spin labeled perfusion MRI as a measure of vascular risk in Alzheimer's disease. J Alzheimers Dis 2013; 32:677-87. [PMID: 22886015 DOI: 10.3233/jad-2012-120964] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is growing recognition of an interaction between cerebrovascular disease and Alzheimer's disease, but the mechanisms of this interaction remain poorly understood. While macroscopic stroke can clearly produce cognitive deficits and accelerate Alzheimer's disease, the prevalence and implications of microvascular disease in Alzheimer's disease pathogenesis has been harder to define. At present, white matter (WM) lesions, primarily defined as hyperintensities seen on T2-weighted magnetic resonance imaging (MRI), provide the best biomarker of cerebrovascular disease at the microvascular level. However, T2 hyperintensities in WM can also be caused by other mechanisms such as inflammation. Arterial spin labeled (ASL) perfusion MRI provides a noninvasive approach for quantifying cerebral blood flow (CBF). We explored CBF measurements with ASL in AD patients, mild cognitive impairment patients, and an age-matched control group to determine if CBF in gray matter or WM could be correlated with WM lesions, or to stratify patients by microvascular disease severity. In a retrospective sample, we were able to obtain credible measures of WM CBF using ASL MRI and observed trends suggesting that WM CBF may provide a useful biomarker of microvascular disease. Future prospective studies in larger cohorts with optimized ASL MRI protocols will be needed to validate these observations.
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Affiliation(s)
- Quan Zhang
- Center for Functional Neuroimaging, University of Pennsylvania, Philadelphia, PA, USA Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
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25
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Mortamais M, Reynes C, Brickman AM, Provenzano FA, Muraskin J, Portet F, Berr C, Touchon J, Bonafé A, le Bars E, Maller JJ, Meslin C, Sabatier R, Ritchie K, Artero S. Spatial distribution of cerebral white matter lesions predicts progression to mild cognitive impairment and dementia. PLoS One 2013; 8:e56972. [PMID: 23457645 PMCID: PMC3572965 DOI: 10.1371/journal.pone.0056972] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 01/17/2013] [Indexed: 11/18/2022] Open
Abstract
CONTEXT White matter lesions (WML) increase the risk of dementia. The relevance of WML location is less clear. We sought to determine whether a particular WML profile, based on the density and location of lesions, could be associated with an increased risk of mild cognitive impairment (MCI) or dementia over the following 7 years. METHODS In 426 healthy subjects from a cohort of community-dwelling people aged 65 years and over (ESPRIT Project), standardized cognitive and neurological evaluations were repeated after 2, 4 and 7 years. Patterns of WML were computed with a supervised data mining approach (decision trees) using the regional WML volumes (frontal, parietal, temporal, and occipital regions) and the total WML volume estimated at baseline. Cox proportional hazard models were then constructed to study the association between WML patterns and risk of MCI/dementia. RESULTS Total WML volume and percentage of WML in the temporal region proved to be the best predictors of progression to MCI and dementia. Specifically, severe total WML load with a high proportion of lesions in the temporal region was significantly associated with the risk of developing MCI or dementia. CONCLUSIONS Above a certain threshold of damage, a pattern of WML clustering in the temporal region identifies individuals at increased risk of MCI or dementia. As this WML pattern is observed before the onset of clinical symptoms, it may facilitate the detection of patients at risk of MCI/dementia.
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Affiliation(s)
- Marion Mortamais
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
| | - Christelle Reynes
- University of Montpellier 1, Montpellier, France
- EA 2415, Faculté de Pharmacie, Montpellier, France
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, College of Physicians and Surgeons, New York, New York, United States of America
| | - Frank A. Provenzano
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, College of Physicians and Surgeons, New York, New York, United States of America
| | - Jordan Muraskin
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, College of Physicians and Surgeons, New York, New York, United States of America
| | - Florence Portet
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- Unité Transversale des Troubles Neurologiques du Sujet Âgé, CHU Caremeau, Centre Ruffi, Pôle de Gériatrie, CHU Nîmes, Nîmes, France
- Montpellier University Hospital, University Department of Adult Psychiatry, La Colombière Hospital, CHU de Montpellier, Montpellier, France
| | - Claudine Berr
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
| | - Jacques Touchon
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
| | - Alain Bonafé
- University of Montpellier 1, Montpellier, France
- CHRU Montpellier, Montpellier, France
| | - Emmanuelle le Bars
- University of Montpellier 1, Montpellier, France
- CHRU Montpellier, Montpellier, France
| | - Jerome J. Maller
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - Chantal Meslin
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Robert Sabatier
- University of Montpellier 1, Montpellier, France
- EA 2415, Faculté de Pharmacie, Montpellier, France
| | - Karen Ritchie
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
- Faculty of Medicine, Imperial College, London, United Kingdom
| | - Sylvaine Artero
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
- * E-mail:
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Mortamais M, Artero S, Ritchie K. Cerebral white matter hyperintensities in the prediction of cognitive decline and incident dementia. Int Rev Psychiatry 2013; 25:686-98. [PMID: 24423222 PMCID: PMC5104835 DOI: 10.3109/09540261.2013.838151] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cerebral white matter hyperintensities (WMH), detected in vivo with magnetic resonance imaging (MRI), are commonly used to assess cerebrovascular burden in cognitive impairment. However, the association between WMH and cognition is not consistent across the literature. The present review examines evidence from published longitudinal studies. We reviewed the PubMed data base from January 1990 to March 2013 and included studies investigating the association of WMH with (1) the risk of dementia in the general population, (2) the risk of conversion to dementia in the mild cognitive impairment (MCI) population, and (3) cognitive decline in the general population. WMH were associated with all types of dementia in the general population, but not in MCI patients. Results are discrepant for global decline. WMH appear to be early predictors of the risk of dementia, but this association appears to be modulated by cognitive reserve, age and the spatial distribution of lesions. There are, however, some limits in the use of WMH as a marker of vascular burden. In addition to their ischaemic origin, WMH may be the result of co-occurring morbidity. Further research is needed to elucidate to what extent WMH actually reflect vascular risk to evaluate the likely efficacy of interventions specifically targeting WMH reduction.
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Affiliation(s)
- Marion Mortamais
- Neuropsychiatrie : Recherche Epidémiologique et Clinique
Institut National de la Santé et de la Recherche Médicale - U1061Université Montpellier 1 - Hôpital La Colombière 39 avenue Charles Flahault BP 34493 -pavillon 42 Calixte Cavalier 34093 Cedex 5 Montpellier,* Correspondence should be addressed to Marion Mortamais
| | - Sylvaine Artero
- Neuropsychiatrie : Recherche Epidémiologique et Clinique
Institut National de la Santé et de la Recherche Médicale - U1061Université Montpellier 1 - Hôpital La Colombière 39 avenue Charles Flahault BP 34493 -pavillon 42 Calixte Cavalier 34093 Cedex 5 Montpellier
| | - Karen Ritchie
- Neuropsychiatrie : Recherche Epidémiologique et Clinique
Institut National de la Santé et de la Recherche Médicale - U1061Université Montpellier 1 - Hôpital La Colombière 39 avenue Charles Flahault BP 34493 -pavillon 42 Calixte Cavalier 34093 Cedex 5 Montpellier,Faculty of Medicine
Imperial College London - W12 0NN, Londres
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Abstract
Mild cognitive impairment (MCI) refers to cognitive impairment that is assumed to be due to pathological central nervous system processes, but which interacts with normal aging-related changes. Epidemiological studies conducted in the general population have been able to examine more heterogeneous forms of this disorder than clinical studies, and have also been able to provide early estimations of population incidence and prevalence. Large differences in case identification procedures and sampling methods have led to considerable divergence in the rates of prevalence reported, which ranged from 1% to 29%. Suggested improvements in the definition of MCI have led to an upward adjustment of prevalence rates in most studies, giving between 5% and 29%. Incidence is estimated as 8 to 58 new cases per thousand persons per year, and the probability of conversion from MCI to dementia is estimated at around 15%. The principal risk factors that have been identified so far for MCI using regression models applied to general population data are age, education, race, medicated hypertension, infarcts, white matter lesions, depression, and apolipoprotein E4 (AP0E-4J allele. An etiological model derived from these studies indicates possible intervention points for future therapeutic strategies at the level of both clinical intervention and environmental exposure. There is, however, a clear need for epidemiological studies that take into account a broader range of risk factors than those studied to date, which have focused principally on known risk factors for dementia.
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Affiliation(s)
- Karen Ritchie
- Institut National de la Santé et de la Recherche Médicale (INSERM), E361 Epidemiology of Nervous System Pathologies, La Colombière Hospital, Montpellier, France
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Tendolkar I, Enajat M, Zwiers MP, van Wingen G, de Leeuw FE, van Kuilenburg J, Bouwels L, Pop G, Pop-Purceleanu M. One-year cholesterol lowering treatment reduces medial temporal lobe atrophy and memory decline in stroke-free elderly with atrial fibrillation: evidence from a parallel group randomized trial. Int J Geriatr Psychiatry 2012; 27:49-58. [PMID: 21308791 DOI: 10.1002/gps.2688] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 12/09/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVES In elderly patients with atrial fibrillation (AF), medial temporal lobe (MTL) atrophy and white matter lesions (WML) may account for the cognitive decline. Though a combination therapy of statins with cholesterol lowering agents like ezetimibe may be beneficial in patients with AF, its effects on MTL structure and WML remains unknown. METHODS A parallel group double-blinded randomized trial was performed during 1 year whereby elderly stroke-free AF patients either received placebo or atorvastatin and ezetimibe on top oral anticoagulation therapy. Neuropsychological performance and inflammatory markers in the blood were assessed at baseline and 1 year later together with amygdala and hippocampal volume as well as WML. RESULTS Sixty-three patients were assessed for eligibility, but 29 patients had to be excluded so that 34 patients were randomized to both groups. In the treatment group, the systemic level of inflammation was significantly decreased after 1 year and an improvement in cognitive speed as well as short- and long-term memory was observed. While there was no significant difference in MTL volume at baseline, the placebo group exhibited more atrophy for right amygdala and left hippocampus at follow-up. Finally, descriptive data showed a slight decline of WML volume in the treatment group. CONCLUSIONS In spite of limitations due to small sample size, our data suggest that intensive cholesterol lowering therapy in AF patients may slow cognitive decline and atrophy of the MTL. Though these results have to be replicated in a larger sample, they offer potential for future interventions.
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Affiliation(s)
- Indira Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands.
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Culang-Reinlieb ME, Johnert LC, Brickman AM, Steffens DC, Garcon E, Sneed JR. MRI-defined vascular depression: a review of the construct. Int J Geriatr Psychiatry 2011; 26:1101-8. [PMID: 21192018 DOI: 10.1002/gps.2668] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 11/01/2010] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To review the construct of MRI-defined vascular depression and to examine the substantive and methodological issues that bear on its validity as a distinct subtype of depression in late life. DESIGN Literature review. RESULTS We identified three areas that are critical to establishing the validity of MRI-defined vascular depression: (1) understanding and delineating the relationship between MRI hyperintensities, executive dysfunction, and antidepressant treatment outcome; (2) understanding the relationship between, and establishing the validity of, qualitative and quantitative approaches to the measurement of MRI hyperintensities (the primary feature of the proposed subtype); (3) establishing the clinical presentation and course of the subtype in the context of other late-life disorders. CONCLUSIONS Despite considerable data supporting the validity of MRI-defined vascular depression, there are a number of critical issues that remain, including establishing a causal relationship between cerebrovascular disease and late-life depression, establishing consistent diagnostic criteria, determining the importance of lesion type and location, and understanding the course of the disorder.
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30
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Jacobs HIL, Leritz EC, Williams VJ, Van Boxtel MPJ, van der Elst W, Jolles J, Verhey FRJ, McGlinchey RE, Milberg WP, Salat DH. Association between white matter microstructure, executive functions, and processing speed in older adults: the impact of vascular health. Hum Brain Mapp 2011; 34:77-95. [PMID: 21954054 DOI: 10.1002/hbm.21412] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 06/08/2011] [Accepted: 07/01/2011] [Indexed: 11/12/2022] Open
Abstract
Cerebral white matter damage is not only a commonly reported consequence of healthy aging, but is also associated with cognitive decline and dementia. The aetiology of this damage is unclear; however, individuals with hypertension have a greater burden of white matter signal abnormalities (WMSA) on MR imaging than those without hypertension. It is therefore possible that elevated blood pressure (BP) impacts white matter tissue structure which in turn has a negative impact on cognition. However, little information exists about whether vascular health indexed by BP mediates the relationship between cognition and white matter tissue structure. We used diffusion tensor imaging to examine the impact of vascular health on regional associations between white matter integrity and cognition in healthy older adults spanning the normotensive to moderate-severe hypertensive BP range (43-87 years; N = 128). We examined how white matter structure was associated with performance on tests of two cognitive domains, executive functioning (EF) and processing speed (PS), and how patterns of regional associations were modified by BP and WMSA. Multiple linear regression and structural equation models demonstrated associations between tissue structure, EF and PS in frontal, temporal, parietal, and occipital white matter regions. Radial diffusivity was more prominently associated with performance than axial diffusivity. BP only minimally influenced the relationship between white matter integrity, EF and PS. However, WMSA volume had a major impact on neurocognitive associations. This suggests that, although BP and WMSA are causally related, these differential metrics of vascular health may act via independent pathways to influence brain structure, EF and PS.
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Affiliation(s)
- Heidi I L Jacobs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, University Maastricht, 6200 MD Maastricht, The Netherlands.
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31
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Pavlović AM, Pekmezović T, Zidverc-Trajković J, Jovanović Z, Mijajlovic M, Pavlović D, Tomić G, Sternić N. What are the differences between younger and older patients with symptomatic small vessel disease? Clin Neurol Neurosurg 2011; 113:762-7. [PMID: 21890262 DOI: 10.1016/j.clineuro.2011.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 07/25/2011] [Accepted: 08/09/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although typically linked to aging, small vessel disease (SVD) is also observed in younger adult patients, with common vascular risk factors (RF). We aimed to investigate features of SVD occurrence at an early adult age. PATIENTS AND METHODS Vascular RF, functional and cognitive status and severity of lesions on MRI expressed as total score on Age-Related White Matter Changes (ARWMC) scale were analyzed in 200 consecutive patients with cerebral SVD admitted to a tertiary neurological hospital. Variables were compared between younger (35-55 years) and older (>56 years) patients. RESULTS In this study, 63 (31.5%) of patients were 55 years or younger. Both age groups had comparable RF profiles, but smoking emerged as an independent predictor for SVD at a younger age (OR 2.9; 95% CI 1.5-5.5; p=0.002). Younger patients had better functional (OR 1.8; 95% CI 1.3-2.5; p=0.0001) and cognitive (χ(2) 13.94; p=0.0009) status compared to older patients. However, two thirds of younger patients had some degree of cognitive deficit. Total score on ARWMC scale was lower in younger patients (mean 12.3 in younger versus 15.2 in older, OR 1.11; 95% CI 1.0-1.18; p=0.001). There was a strong correlation in both groups between functional score, cognitive status and ARWMC score (p<0.0001). CONCLUSION In our dataset, younger patients with SVD shared common vascular RF with older patients. In the group aged ≤55, better functional and cognitive status and less severe MRI changes were noted. However, a substantial number of younger SVD patients presenting with TIA or ischemic stroke had various deficits.
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Affiliation(s)
- Aleksandra M Pavlović
- Clinic for Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Raz N, Yang Y, Dahle CL, Land S. Volume of white matter hyperintensities in healthy adults: contribution of age, vascular risk factors, and inflammation-related genetic variants. Biochim Biophys Acta Mol Basis Dis 2011; 1822:361-9. [PMID: 21889590 DOI: 10.1016/j.bbadis.2011.08.007] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 08/16/2011] [Accepted: 08/17/2011] [Indexed: 12/01/2022]
Abstract
Aging is associated with appearance of white matter hyperintensities (WMH) on MRI scans. Vascular risk and inflammation, which increase with age, may contribute to white matter deterioration and proliferation of WMH. We investigated whether circulating biomarkers and genetic variants associated with elevated vascular risk and inflammation are associated with WMH volume in healthy adults (144 volunteers, 44-77 years of age). We examined association of WMH volume with age, sex, hypertension, circulating levels of total plasma homocysteine (tHcy), cholesterol (low-density lipoprotein), and C-reactive protein (CRP), and four polymorphisms related to vascular risk and inflammation: Apolipoprotein ε (ApoE ε2,3,4), Angiotensin-Converting Enzyme insertion/deletion (ACE I/D), methylenetetrahydrofolate reductase (MTHFR) C677T, C-reactive protein (CRP)-286C>A>T, and interleukin-1β (IL-1β) C-511T. We found that larger WMH volume was associated with advanced age, hypertension, and elevated levels of homocysteine and CRP but not with low-density lipoprotein levels. Homozygotes for IL-1β-511T allele and carriers of CRP-286T allele that are associated with increased inflammatory response had larger WMH than the other allelic combinations. Carriers of the APOE ε2 allele had larger frontal WMH than ε3 homozygotes and ε4 carriers did. Thus, in healthy adults, who are free of neurological and vascular disease, genetic variants that promote inflammation and elevated levels of vascular risk biomarkers can contribute to brain abnormalities. This article is part of a Special Issue entitled: Imaging Brain Aging and Neurodegenerative disease.
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Affiliation(s)
- Naftali Raz
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, MI 48202, USA.
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Kim JH, Hwang KJ, Kim JH, Lee YH, Rhee HY, Park KC. Regional white matter hyperintensities in normal aging, single domain amnestic mild cognitive impairment, and mild Alzheimer's disease. J Clin Neurosci 2011; 18:1101-6. [PMID: 21723730 DOI: 10.1016/j.jocn.2011.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 12/29/2010] [Accepted: 01/09/2011] [Indexed: 11/30/2022]
Abstract
Few studies have examined white matter hyperintensities (WMH) along the cognitive continuum between single-domain amnestic mild cognitive impairment (sd-aMCI) and Alzheimer's disease (AD). The aims of our study were to explore relationships between the extent and location of WMH and disease severity along the cognitive continuum and to determine whether differences in the distribution of WMH could be predictive of specific patterns of cognitive impairment. We compared cognitive function, vascular risk factors, and regional (frontal lobe, parieto-occipital [PO] lobe, temporal lobe, periventricular [PV] white matter and deep white matter) WMH volume in 37 patients with mild AD, 23 patients with sd-aMCI, and 24 age-matched and education-matched normal controls. A quantitative volumetric method was applied to measure WMH burden. Total and regional WMH burdens, except for those in the temporal lobe, were significantly correlated with age (p<0.01). We found a trend toward increasing WMH volume with disease severity, higher in AD than in sd-aMCI and lowest in the controls. Total WMH volume was associated with the global cognitive test score. In multiple linear regression analysis, PV WMH volume, but not deep WMH volume, strongly predicted performances on the Controlled Oral Word Association test and the Color Word Stroop test after adjusting for important demographic variables. Only PO WMH volume was a significant predictor of a cognitive test score when frontal and temporal WMH volumes were simultaneously entered into the regression model. The extent and distribution of WMH, especially in the PV and PO regions, were associated with disease severity and reduced cognition.
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Affiliation(s)
- Jung Hwa Kim
- Department of Neurology, Kyung Hee Medical Center, School of Medicine Kyung Hee University, 1 Hoegi-dong, Dongdaemoon-ku, Seoul 130-702, Republic of Korea
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Aine CJ, Sanfratello L, Adair JC, Knoefel JE, Caprihan A, Stephen JM. Development and decline of memory functions in normal, pathological and healthy successful aging. Brain Topogr 2011; 24:323-39. [PMID: 21452018 DOI: 10.1007/s10548-011-0178-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 03/16/2011] [Indexed: 11/28/2022]
Abstract
Many neuroimaging studies of age-related memory decline interpret resultant differences in brain activation patterns in the elderly as reflecting a type of compensatory response or regression to a simpler state of brain organization. Here we review a series of our own studies which lead us to an alternative interpretation, and highlights a couple of potential confounds in the aging literature that may act to increase the variability of results within age groups and across laboratories. From our perspective, level of cognitive functioning achieved by a group of elderly is largely determined by the health of individuals within this group. Individuals with a history of hypertension, for example, are likely to have multiple white matter insults which compromise cognitive functioning, independent of aging processes. The health of the elderly group has not been well-documented in most previous studies and elderly participants are rarely excluded, or placed into a separate group, due to health-related problems. In addition, recent results show that white matter tracts within the frontal and temporal lobes, regions critical for higher cognitive functions, continue to mature well into the 4th decade of life. This suggests that a young age group may not be the best control group for understanding aging effects on the brain since development is ongoing within this age range. Therefore, we have added a middle-age group to our studies in order to better understand normal development across the lifespan as well as effects of pathology on cognitive functioning in the aging brain.
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Affiliation(s)
- C J Aine
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA.
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35
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Abstract
Since being proposed as a unique subtype of late-life depression (LLD), the vascular depression hypothesis has received considerable research attention. Although this effort has generated considerable empirical support for the validity of the subtype, fundamental questions remain including how the illness is defined, whether cerebrovascular disease and executive dysfunction (ED) define two separate entities or one underlying subtype, and whether ED is responsible for poor response to antidepressant treatment. In this guest editorial, we explore these and other issues (i.e., the role of personality and social support, psychosocial treatments targeting cognitive abilities frequently impaired in LLD) using a number of important papers that are either directly or indirectly related to the vascular depression hypothesis. In so doing we highlight a range of critical problems facing the vascular depression hypothesis and the effort to establish the illness as a unique diagnostic entity in late-life.
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Ziegler DA, Piguet O, Salat DH, Prince K, Connally E, Corkin S. Cognition in healthy aging is related to regional white matter integrity, but not cortical thickness. Neurobiol Aging 2010; 31:1912-26. [PMID: 19091444 PMCID: PMC2996721 DOI: 10.1016/j.neurobiolaging.2008.10.015] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 10/09/2008] [Accepted: 10/22/2008] [Indexed: 11/23/2022]
Abstract
It is well established that healthy aging is accompanied by structural changes in many brain regions and functional decline in a number of cognitive domains. The goal of this study was to determine (1) whether the regional distribution of age-related brain changes is similar in gray matter (GM) and white matter (WM) regions, or whether these two tissue types are affected differently by aging, and (2) whether measures of cognitive performance are more closely linked to alterations in the cerebral cortex or in the underlying WM in older adults (OA). To address these questions, we collected high-resolution magnetic resonance imaging (MRI) data from a large sample of healthy young adults (YA; aged 18-28) and OA (aged 61-86 years). In addition, the OA completed a series of tasks selected to assess cognition in three domains: cognitive control, episodic memory, and semantic memory. Using advanced techniques for measuring cortical thickness and WM integrity, we found that healthy aging was accompanied by deterioration of both GM and WM, but with distinct patterns of change: Cortical thinning occurred primarily in primary sensory and motor cortices, whereas WM changes were localized to regions underlying association cortices. Further, in OA, we found a striking pattern of region-specific correlations between measures of cognitive performance and WM integrity, but not cortical thickness. Specifically, cognitive control correlated with integrity of frontal lobe WM, whereas episodic memory was related to integrity of temporal and parietal lobe WM. Thus, age-related impairments in specific cognitive capacities may arise from degenerative processes that affect the underlying connections of their respective neural networks.
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Affiliation(s)
- David A Ziegler
- Department of Brain & Cognitive Sciences, Massachusetts Institute of Technology 46-5121, Cambridge, MA 02139, United States.
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Ayaz M, Boikov AS, Haacke EM, Kido DK, Kirsch WM. Imaging cerebral microbleeds using susceptibility weighted imaging: one step toward detecting vascular dementia. J Magn Reson Imaging 2010; 31:142-8. [PMID: 20027582 DOI: 10.1002/jmri.22001] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To monitor changes in the number of cerebral microbleeds (CMBs) in a longitudinal study of healthy controls (HC) and mild-cognitively impaired (MCI) patients using susceptibility weighted imaging (SWI). MATERIALS AND METHODS SWI was used to image 28 HC and 75 MCI patients annually at 1.5 Tesla over a 4-year period. Magnitude and phase data were used to visualize CMBs for the first and last scans of 103 subjects. RESULTS Preliminary analysis revealed that none of the 28 HC had more than three CMBs. In the 75 MCI patients, five subjects had more than three CMBs in both first and last scans, while one subject had more than three bleeds only in the last scan. In five of these six MCI patients, the number of CMBs increased over time and all six went on to develop progressive cognitive impairment (PCI). Of the 130 total CMBs seen in the last scans of the six MCI cases, most were less than 4 mm in diameter. CONCLUSION SWI can reveal small CMBs on the order of 1 mm in diameter and this technique can be used to follow their development longitudinally. Monitoring CMBs may be a means by which to evaluate patients for the presence of microvascular disease that leads to PCI.
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Affiliation(s)
- Muhammad Ayaz
- The MRI Institute for Biomedical Research, Detroit, Michigan, USA
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38
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Vance DE, Struzick T, Childs G. Challenges of depression and suicidal ideation associated with aging with HIV/AIDS: implications for social work. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2010; 53:159-175. [PMID: 20094935 DOI: 10.1080/01634370903415692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
As the number of older adults with HIV/AIDS increases, new challenges are emerging that threaten their ability to age with this disease. Threats of particular concern are depression and suicidal ideation. Studies show that those aging with HIV/AIDS have a number of stressors that tax their coping mechanisms, increasing vulnerability to depression and suicidal ideation. These stressors can be categorized into three areas. First, there are psychosocial stressors that can contribute to depression. Second, there are health and biochemical stressors that can contribute to depression, as well as compromise cognitive abilities needed to adapt to such stressors. Third, cognitive stressors may create predispositions to depression. In particular, certain cognitive abilities needed to cope with depression and suicidal ideation may be compromised by aging with HIV/AIDS. A model of these stressors is provided for didactic purposes, as well as to suggest implications for social work practice and research.
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Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Kirsch W, McAuley G, Holshouser B, Petersen F, Ayaz M, Vinters HV, Dickson C, Haacke EM, Britt W, Larseng J, Kim I, Mueller C, Schrag M, Kido D. Serial susceptibility weighted MRI measures brain iron and microbleeds in dementia. J Alzheimers Dis 2009; 17:599-609. [PMID: 19433895 DOI: 10.3233/jad-2009-1073] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A new iron sensitive MR sequence (susceptibility weighted imaging - SWI) enabling the simultaneous quantitation of regional brain iron levels and brain microbleeds (BMB) has been acquired serially to study dementia. Cohorts of mildly cognitively impaired (MCI) elderly (n = 73) and cognitively normal participants (n = 33) have been serially evaluated for up to 50 months. SWI phase values (putative iron levels) in 14 brain regions were measured and the number of BMB were counted for each SWI study. SWI phase values showed a left putaminal mean increase of iron (decrease of phase values) over the study duration in 27 participants who progressed to dementia compared to Normals (p = 0.035) and stable MCI (p = 0.01). BMB were detected in 9 out of 26 (38%) MCI participants who progressed to dementia and are a significant risk factor for cognitive failure in MCI participants [risk ratio = 2.06 (95% confidence interval 1.37-3.12)]. SWI is useful to measure regional iron changes and presence of BMB, both of which may be important MR-based biomarkers for neurodegenerative diseases.
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Affiliation(s)
- Wolff Kirsch
- Neurosurgery Center for Research, Training, and Education, Loma Linda University, 11175 Campus Street, Suite 11113, Loma Linda, CA 92350, USA.
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40
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Aine CJ, Bryant JE, Knoefel JE, Adair JC, Hart B, Donahue CH, Montaño R, Hayek R, Qualls C, Ranken D, Stephen JM. Different strategies for auditory word recognition in healthy versus normal aging. Neuroimage 2009; 49:3319-30. [PMID: 19962439 DOI: 10.1016/j.neuroimage.2009.11.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 11/20/2009] [Accepted: 11/23/2009] [Indexed: 10/20/2022] Open
Abstract
To explore the effects of commonly encountered pathology on auditory recognition strategies in elderly participants, magnetoencephalographic (MEG) brain activation patterns and performance were examined in 30 elderly [18 controls and 12 elderly with mild cognitive impairment (MCI) or probable Alzheimer's disease (AD)]. It was predicted that participants with known pathology would reveal different networks of brain activation, compared to healthy elderly, which should correlate with poorer performance. Participants heard a list of words representing common objects, twice. After 20 minutes a list of new and old words was presented and participants judged whether each word was heard earlier. MEG responses were analyzed using a semiautomated source modeling procedure. A cluster analysis using all subjects' MEG sources revealed three dominant patterns of activity which correlated with IQ and task performance. The highest performing group revealed activity in premotor, anterior temporal, and superior parietal lobes with little contribution from prefrontal cortex. Performance and brain activation patterns were also compared for individuals with or without abnormalities such as white matter hyperintensities and/or volume reduction evidenced on their MRIs. Memory performance and activation patterns for individuals with white matter hyperintensities resembled the group of MCI/AD patients. These results emphasize the following: (1) general pathology correlates with cognitive decline and (2) full characterization of the health of elderly participants is important in studies of normal aging since random samples from the elderly population are apt to include individuals with subclinical pathology that can affect cognitive performance.
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Affiliation(s)
- C J Aine
- Department of Radiology, University of New Mexico School of Medicine, MSC10-5530, Albuquerque, NM 87131, USA
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41
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Burgmans S, van Boxtel MPJ, Gronenschild EHBM, Vuurman EFPM, Hofman P, Uylings HBM, Jolles J, Raz N. Multiple indicators of age-related differences in cerebral white matter and the modifying effects of hypertension. Neuroimage 2009; 49:2083-93. [PMID: 19850136 DOI: 10.1016/j.neuroimage.2009.10.035] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 10/07/2009] [Accepted: 10/12/2009] [Indexed: 11/18/2022] Open
Abstract
We investigated differences associated with age and hypertension, a common risk factor for vascular disease, in three aspects of white matter integrity--gross regional volumes of the white matter, volume of the white matter hyperintensities (WMH) and diffusion properties. We acquired MRI scans on 93 adult volunteers (age 50-77 years; 36 with diagnosis of hypertension or elevated blood pressure), and obtained all measures in seven brain regions: frontal, temporal, parietal and occipital white matter, and the genu, body and splenium of the corpus callosum. The results demonstrated robust age-related differences in diffusion-based indices of cerebral white matter integrity and age-related increase in the WMH volume, but no age differences in the gross regional volumes of the white matter. Hypertension was associated with decline in fractional anisotropy, and exacerbated age differences in fractional anisotropy more than those in the volume of WMH. These findings indicate that of all examined measures, diffusion-based indices of white matter integrity may be the most sensitive indicators of global and regional declines and vascular damage in the aging brain.
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Affiliation(s)
- S Burgmans
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
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42
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Kennedy KM, Raz N. Pattern of normal age-related regional differences in white matter microstructure is modified by vascular risk. Brain Res 2009; 1297:41-56. [PMID: 19712671 DOI: 10.1016/j.brainres.2009.08.058] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 08/10/2009] [Accepted: 08/13/2009] [Indexed: 11/29/2022]
Abstract
Even successful aging is associated with regional brain shrinkage and deterioration of the cerebral white matter. Aging also brings about an increase in vascular risk, and vascular impairment may be a potential mechanism behind the observed patterns of aging. The goals of this study were to characterize the normal age differences in white matter integrity in several brain regions across the adult life span and to assess the modifying effect of vascular risk on the observed pattern of regional white matter integrity. We estimated fractional anisotropy and diffusivity of white matter in nine cerebral regions of interest in 77 healthy adults (19-84 years old). There was a widespread reduction of white matter anisotropy with age, and prefrontal and occipital regions evidenced the greatest age-related differences. Diffusivity increased with age, and the magnitude of age differences increased beginning with the middle of the fifth decade. Vascular risk factors modified age differences in white matter integrity. Clinically diagnosed and treated arterial hypertension was associated with reduced white matter anisotropy and increased diffusivity beyond the effects of age. In the normotensive participants, elevation of arterial pulse pressure (a surrogate of arterial stiffness) was linked to deterioration of the white matter integrity in the frontal regions. Although the causal role of vascular risk in brain aging is unclear, the observed pattern of effects suggests that vascular risk may drive the expansion of age-related white matter damage from anterior to posterior regions.
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Affiliation(s)
- Kristen M Kennedy
- Center for Brain Health, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
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43
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Abstract
OBJECTIVE Dementia is prevalent in older adults and the population is ageing. Many factors have been associated with dementia and anything that may aid the prevention of dementia is of importance. METHOD The literature in this area was evaluated and information relating to the various factors that may impact upon the prevention of dementia is presented below. RESULTS Factors that have been associated with a possible increased risk of developing dementia include high blood pressure, (at least in midlife), high body mass index, smoking and possibly diabetes although the evidence is mixed. There is currently no clear evidence with regard to cholesterol and metabolic syndrome although both may be implicated. Having education and maintaining a Mediterranean diet, including vegetable, fruit and fish intake, have been linked to a lower incidence of dementia as has low to moderate alcohol intake. Although care must be taken with the latter given the different characteristics of the studies reporting on alcohol and dementia. CONCLUSION It may be that risk and protective factors vary with age, however, in the absence of prophylactic treatment it seems likely that the maintenance of a healthy lifestyle may represent the best option with regard to the prevention of dementia.
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Affiliation(s)
- Ruth Peters
- Imperial College Faculty of Medicine, Hammersmith Campus, London, UK.
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Targosz-Gajniak M, Siuda J, Ochudło S, Opala G. Cerebral white matter lesions in patients with dementia - from MCI to severe Alzheimer's disease. J Neurol Sci 2009; 283:79-82. [PMID: 19268974 DOI: 10.1016/j.jns.2009.02.314] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Brain images of patients with Alzheimer's disease (AD) on magnetic resonance imaging (MRI) show white matter lesions (WML), which are attributed to degenerative changes of small vessels. These lesions are supposed to be among the factors supporting the diagnosis of probable AD; however their correlation with the severity of dementia requires further studies. METHODS We examined four groups of patients with cognitive impairment: Ten patients with amnestic-MCI (Mild Cognitive Impairment), 11 with mild AD (21-24 points in MMSE), 17 with moderate AD (11-20 points in MMSE) and 15 with severe AD (3-10 points in MMSE). The T2 and FLAIR MRI sequences of the brain of each patient were assessed using the White Matter Lesions Semiquantitive Rating Scale, taking into consideration the amount, size and distribution of WML. RESULTS WML of the brain were seen in almost all patients with AD and MCI on T2 and FLAIR sequences. The positive correlation between the patients' age and the amount and size of WML, in subcortical (T2: p<0.01, r=0.39; FLAIR: p<0.05, r=0.31) and in the periventricular region (T2: p<0.05, r=0.28; FLAIR: p<0.05, r=0.35) has been shown on both sequences. There was no correlation between the size or distribution of lesions and either hypertension or homocysteine blood level. The analysis revealed also that in both sequences, the severity of lesions in the periventricular region increased with the progression of the disease (T2: p=0.038; FLAIR: p=0.02). CONCLUSIONS A significant factor correlating with the location of WML in patients with MCI and AD is the age of patient. The amount and size of WML in the periventricular and subcortical regions of the brain correlates with the severity of dementia. Hypertension and hyperhomocysteinemia have no influence on the presence of described lesions.
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Affiliation(s)
- Magdalena Targosz-Gajniak
- Department of Neurology, Aging, Vascular and Neurodegenerative Diseases, Central University Hospital, ul. Medyków 14, 40-752 Katowice, Poland.
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45
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Piguet O, Double KL, Kril JJ, Harasty J, Macdonald V, McRitchie DA, Halliday GM. White matter loss in healthy ageing: a postmortem analysis. Neurobiol Aging 2008; 30:1288-95. [PMID: 18077060 DOI: 10.1016/j.neurobiolaging.2007.10.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 10/23/2007] [Accepted: 10/27/2007] [Indexed: 10/22/2022]
Abstract
Age-related brain changes are widely documented. Because of differences in measurement methods and case selection, the reported effects of age on regional grey and white matter brain volumes, however, are much more pronounced and widespread in neuroimaging than in postmortem studies. Consequently, the magnitude of the effect that is specific to chronological age remains unresolved. We present postmortem volume measurements for 26 cortical, subcortical and white matter regions, in 24 human brains aged 46-92 years, free of neuropathological abnormalities. Significant age-related loss was observed in anterior and posterior white matter but not in total grey matter volumes. Further analyses on five cortical subregions previously reported to exhibit large age-related loss on MRI yielded negative results. These analyses demonstrate smaller changes with age than those reported in imaging studies. Although this discrepancy between postmortem and imaging studies may partly be explained by the increase in noise of the neuroimaging data with age, our results suggest that healthy brain ageing is a process affecting predominantly white matter not grey matter.
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Affiliation(s)
- O Piguet
- Prince of Wales Medical Research Institute and the University of New South Wales, NSW, Australia.
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46
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Kraut MA, Beason-Held LL, Elkins WD, Resnick SM. The impact of magnetic resonance imaging-detected white matter hyperintensities on longitudinal changes in regional cerebral blood flow. J Cereb Blood Flow Metab 2008; 28:190-7. [PMID: 17534385 DOI: 10.1038/sj.jcbfm.9600512] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
White matter hyperintensities are frequently detected on cranial magnetic resonance imaging (MRI) scans of older adults. Given the presumed ischemic contribution to the etiology of these lesions and the posited import of resting brain activity on cognitive function, we hypothesized that longitudinal changes in MRI-detected white matter disease, and its severity at a given time point, would be associated with changes in regional cerebral blood flow (rCBF) over time. We evaluated MRI scans and resting H(2)(15)O positron emission tomographic rCBF at baseline and after an average of 7.7-year follow-up in Baltimore Longitudinal Study of Aging participants without dementia. Differences in patterns of rCBF were evident at baseline and at follow-up between the group of subjects showing increased white matter disease over the 8-year interval compared with the group with stable white matter ratings. Furthermore, longitudinal changes over time in rCBF also differed between the two groups. Specifically, the group with progressive white matter abnormalities showed greater increase in the right inferior temporal gyrus/fusiform gyrus, right anterior cingulate, and the rostral aspect of the left superior temporal gyrus. Regions of greater longitudinal decrease in this group were evident in the right inferior parietal lobule and at the right occipital pole. Changes in white matter disease over time and its severity at any given time are associated significantly with both cross-sectional and longitudinal patterns of rCBF. The longitudinal increases may reflect cortical compensation mechanisms for reduced efficacy of interregional neural communications that result from white matter deterioration.
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Affiliation(s)
- Michael A Kraut
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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47
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Abstract
Mixed dementia (MD) refers to a combination of definite Alzheimer disease (AD) and vascular encephalopathy, but the distinction between both disorders is controversial. For the diagnosis of MD the clinical/neuroimaging criteria of possible AD plus cerebrovascular disease (CVD) as separate entities are used, but causal relations between vascular brain lesions and dementia are unclear. We proposed the combination of autopsy-proven AD with multiple vascular or ischemic lesions with about 30-50 ml of infarcted/damaged brain tissue. The population-based prevalence of MD is unknown. In retrospective and prospective autopsy studies, it ranges from 2 to 58% with reasonable means of 6-12%. In a consecutive autopsy series of 1500 demented elderly subjects, 830 of which with clinically probable AD, in Vienna, Austria, 41.5 to 52.0% showed "pure" AD, 7% atypical AD, 16-20% AD plus cerebrovascular lesions, and 9% AD plus Lewy body pathology; MD was diagnosed in 4.6 and 2.4%, and "pure" vascular dementia (VaD) in 11 and 2.0%, respectively, while 16.3/6.1% were other dementing disorders, and 1% showed no specific pathology. Like the MRC-CFAS and other studies, this indicates frequent coexistence of AD with multiple cerebrovascular lesions in cognitively impaired patients. In both AD and VaD, vascular lesions frequently involved subcortical regions (basal ganglia, thalamus, hippocampus, and white matter) or were multiple microinfarcts, whereas in MD, large/hemispheral infarcts and multiple microinfarcts were more frequent, suggesting different pathogenic mechanisms. In early/mild AD, critically located small vascular lesions may induce/promote cognitive decline, but in full-blown AD they appear of minor importance. Discussion of the major pathogenic factors inducing AD, VaD and MD suggests synergistic relations between these disorders. However, currently available morphological criteria for AD and VaD are of limited value for the diagnosis of MD and generally accepted and validated histopathological criteria for the diagnosis of VaD and MD are currently not available. Therefore, more distinct and critically evaluated clinico-pathological criteria are warranted.
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Affiliation(s)
- K A Jellinger
- Institute of Clinical Neurobiology, 18, Kenyongasse, A-1070 Vienna, Austria.
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48
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Jellinger KA. The enigma of vascular cognitive disorder and vascular dementia. Acta Neuropathol 2007; 113:349-88. [PMID: 17285295 DOI: 10.1007/s00401-006-0185-2] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 12/08/2006] [Accepted: 12/08/2006] [Indexed: 12/20/2022]
Abstract
The prevalence, morphology and pathogenesis of vascular dementia (VaD), recently termed vascular cognitive impairment, are a matter of discussion, and currently used clinical diagnostic criteria show moderate sensitivity (average 50%) and variable specificity (range 64-98%). In Western clinic-based series, VaD is suggested in 8-10% of cognitively impaired aged subjects. Its prevalence in autopsy series varies from 0.03 to 58%, with reasonable values of 8-15%, while in Japan it is seen in 22-35%. Neuropathologic changes associated with cognitive impairment include multifocal and/or diffuse disease and focal lesions: multi-infarct encephalopathy, white matter lesions or arteriosclerotic subcortical (leuko)encephalopathy, multilacunar state, mixed cortico-subcortical type, borderline/watershed lesions, rare granular cortical atrophy, post-ischemic encephalopathy and hippocampal sclerosis. They result from systemic, cardiac and local large or small vessel disease. Recent data indicate that cognitive decline is commonly associated with widespread small ischemic/vascular lesions (microinfarcts, lacunes) throughout the brain with predominant involvement of subcortical and functionally important brain areas. Their pathogenesis is multifactorial, and their pathophysiology affects neuronal networks involved in cognition, memory, behavior and executive functioning. Vascular lesions often coexist with Alzheimer disease (AD) and other pathologies. Minor cerebrovascular lesions, except for severe amyloid angiopathy, appear not essential for cognitive decline in full-blown AD, while both mild Alzheimer pathology and small vessel disease may interact synergistically. The lesion pattern of "pure" VaD, related to arteriosclerosis and microangiopathies, differs from that in mixed-type dementia (AD with vascular encephalopathy), more often showing large infarcts, which suggests different pathogenesis of both types of lesions. Due to the high variability of cerebrovascular pathology and its causative factors, no validated neuropathologic criteria for VaD are available, and a large variability across laboratories still exists in the procedures for morphologic examination and histology techniques.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, 1070, Vienna, Austria.
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49
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Jellinger KA. The enigma of mixed dementia. Alzheimers Dement 2007; 3:40-53. [DOI: 10.1016/j.jalz.2006.09.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 09/22/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Kurt A. Jellinger
- Institute of Clinical Neurobiology; Kenyongasse 18, A-1070 Vienna Austria
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50
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Vance DE, Burrage JW. Promoting successful cognitive aging in adults with HIV: strategies for intervention. J Gerontol Nurs 2006; 32:34-41. [PMID: 17112136 DOI: 10.3928/00989134-20061101-06] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Aging individuals with HIV may be at risk for developing more age-related cognitive decline, mild cognitive impairment, or even dementia. The incidence of HIV-related dementia was reduced sharply with the introduction of HAART. Positive mediators, such as good nutrition or cognitive remediation therapy, can potentially mitigate some of the negative cognitive consequences of aging with HIV.
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Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham 35294-2110, USA
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