1
|
Golenia A, Olejnik P, Żołek N, Wojtaszek E, Małyszko J. Cognitive Impairment and Anxiety Are Prevalent in Kidney Transplant Recipients. Kidney Blood Press Res 2023; 48:587-595. [PMID: 37619550 PMCID: PMC10614445 DOI: 10.1159/000533755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Cognitive impairment (CI) is common in end-stage kidney disease (ESKD), including kidney transplant recipients. Patients with cognitive problems may find it difficult to comply with medical recommendations after kidney transplantation (KT), which can be the cause of many complications, poorer prognosis, and increased hospitalization rates after transplantation. Additionally, some patients after KT may experience depression and anxiety, which are prevalent comorbidities in patients with ESKD. METHODS In this single-center, cross-sectional study, we included 56 consecutive adult patients after KT. Cognitive function was assessed using the Addenbrooke Cognitive Test III (ACE III). In addition, all patients were screened for depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). The impact of immunosuppressive therapy and other disease-related variables on cognitive function was also assessed. RESULTS A total of 56 KT patients, with a mean age of 50.3 ± 11.7 years, transplanted ≤35 months ago were included in the study. The prevalence of CI was 30%. Compared with cognitively unimpaired patients, patients with CI scored significantly lower in all cognitive domains. Furthermore, better cognitive functioning after KT was significantly associated with more years of schooling. We found no significant correlation between CI and age at assessment, duration of dialysis before KT, creatinine levels, creatinine clearance, uric acid levels, hemoglobin levels, comorbid cardiovascular diseases, and immunosuppressive therapy. In addition, the prevalence of depression and anxiety in screening tests was 12.5% and 27%, respectively, and patients receiving higher daily dose of prednisone had higher HADS scores on both the depression and anxiety subscales (not statistically significant). DISCUSSION Cognitive disorders are a relevant issue in kidney transplant recipients. There might be many factors, both before and after KT, that have a negative impact on cognition. Therefore, further research is needed to increase knowledge about the course and profile of cognitive function after KT.
Collapse
Affiliation(s)
| | | | - Norbert Żołek
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Ewa Wojtaszek
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
2
|
Wang Y, Zhang H, Liu L, Li Z, Zhou Y, Wei J, Xu Y, Zhou Y, Tang Y. Cognitive function and cardiovascular health in the elderly: network analysis based on hypertension, diabetes, cerebrovascular disease, and coronary heart disease. Front Aging Neurosci 2023; 15:1229559. [PMID: 37600511 PMCID: PMC10436622 DOI: 10.3389/fnagi.2023.1229559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Cognitive decline in the elderly population is a growing concern, and vascular factors, such as hypertension, diabetes, cerebrovascular disease, and coronary heart disease, have been associated with cognitive impairments. This study aims to provide deeper insights into the structure of cognitive function networks under these different vascular factors and explore their potential associations with specific cognitive domains. Methods Cognitive function was assessed using a modified Chinese version of the mini-mental state examination (MMSE) scale, and intensity centrality and side weights were estimated by network modeling. The network structure of cognitive function was compared across subgroups by including vascular factors as subgroup variables while controlling for comorbidities and confounders. Results The results revealed that cerebrovascular disease and coronary heart disease had a more significant impact on cognitive function. Cerebrovascular disease was associated with weaker centrality in memory and spatial orientation, and a sparser cognitive network structure. Coronary heart disease was associated with weaker centrality in memory, repetition, executive function, recall, attention, and calculation, as well as a sparser cognitive network structure. The NCT analyses further highlighted significant differences between the cerebrovascular disease and coronary heart disease groups compared to controls in terms of overall network structure and connection strength. Conclusion Our findings suggest that specific cognitive domains may be more vulnerable to impairments in patients with cerebrovascular disease and coronary heart disease. These insights could be used to improve the accuracy and sensitivity of cognitive screening in these patient populations, inform personalized cognitive intervention strategies, and provide a better understanding of the potential mechanisms underlying cognitive decline in patients with vascular diseases.
Collapse
Affiliation(s)
- Yucheng Wang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
- School of Public Health, China Medical University, Shenyang, China
| | - Huanrui Zhang
- Department of Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Linzi Liu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
| | - Zijia Li
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
| | - Yang Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
- School of Basic Medicine of Peking Union Medical College, Beijing, China
| | - Jiayan Wei
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
| | - Yixiao Xu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
| | - Yifang Zhou
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Yanqing Tang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
- Department of Geriatrics, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
3
|
Massett R, Maher A, Imms P, Amgalan A, Chaudhari N, Chowdhury N, Irimia A. Regional Neuroanatomic Effects on Brain Age Inferred Using Magnetic Resonance Imaging and Ridge Regression. J Gerontol A Biol Sci Med Sci 2023; 78:872-881. [PMID: 36183259 PMCID: PMC10235198 DOI: 10.1093/gerona/glac209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Indexed: 11/14/2022] Open
Abstract
The biological age of the brain differs from its chronological age (CA) and can be used as biomarker of neural/cognitive disease processes and as predictor of mortality. Brain age (BA) is often estimated from magnetic resonance images (MRIs) using machine learning (ML) that rarely indicates how regional brain features contribute to BA. Leveraging an aggregate training sample of 3 418 healthy controls (HCs), we describe a ridge regression model that quantifies each region's contribution to BA. After model testing on an independent sample of 651 HCs, we compute the coefficient of partial determination R¯p2 for each regional brain volume to quantify its contribution to BA. Model performance is also evaluated using the correlation r between chronological and biological ages, the mean absolute error (MAE ) and mean squared error (MSE) of BA estimates. On training data, r=0.92, MSE=70.94 years, MAE=6.57 years, and R¯2=0.81; on test data, r=0.90, MSE=81.96 years, MAE=7.00 years, and R¯2=0.79. The regions whose volumes contribute most to BA are the nucleus accumbens (R¯p2=7.27%), inferior temporal gyrus (R¯p2=4.03%), thalamus (R¯p2=3.61%), brainstem (R¯p2=3.29%), posterior lateral sulcus (R¯p2=3.22%), caudate nucleus (R¯p2=3.05%), orbital gyrus (R¯p2=2.96%), and precentral gyrus (R¯p2=2.80%). Our ridge regression, although outperformed by the most sophisticated ML approaches, identifies the importance and relative contribution of each brain structure to overall BA. Aside from its interpretability and quasi-mechanistic insights, our model can be used to validate future ML approaches for BA estimation.
Collapse
Affiliation(s)
- Roy J Massett
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Alexander S Maher
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Phoebe E Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Anar Amgalan
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Nikhil N Chaudhari
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Nahian F Chowdhury
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | | |
Collapse
|
4
|
Xiong Y, Khlif MS, Egorova-Brumley N, Brodtmann A, Stark BC. Neural correlates of verbal fluency revealed by longitudinal T1, T2 and FLAIR imaging in stroke. Neuroimage Clin 2023; 38:103406. [PMID: 37104929 PMCID: PMC10165164 DOI: 10.1016/j.nicl.2023.103406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Diffusion-weighted imaging has been widely used in the research on post-stroke verbal fluency but acquiring diffusion data is not always clinically feasible. Achieving comparable reliability for detecting brain variables associated with verbal fluency impairments, based on more readily available anatomical, non-diffusion images (T1, T2 and FLAIR), enables clinical practitioners to have complementary neurophysiological information at hand to facilitate diagnosis and treatment of language impairment. Meanwhile, although the predominant focus in the stroke recovery literature has been on cortical contributions to verbal fluency, it remains unclear how subcortical regions and white matter disconnection are related to verbal fluency. Our study thus utilized anatomical scans of ischaemic stroke survivors (n = 121) to identify longitudinal relationships between subcortical volume, white matter tract disconnection, and verbal fluency performance at 3- and 12-months post-stroke. Subcortical grey matter volume was derived from FreeSurfer. We used an indirect probabilistic approach to quantify white matter disconnection in terms of disconnection severity, the proportion of lesioned voxel volume to the total volume of a tract, and disconnection probability, the probability of the overlap between the stroke lesion and a tract. These disconnection variables of each subject were identified based on the disconnectome map of the BCBToolkit. Using a linear mixed multiple regression method with 5-fold cross-validations, we correlated the semantic and phonemic fluency scores with longitudinal measurements of subcortical grey matter volume and 22 bilateral white matter tracts, while controlling for demographic variables (age, sex, handedness and education), total brain volume, lesion volume, and cortical thickness. The results showed that the right subcortical grey matter volume was positively correlated with phonemic fluency averaged over 3 months and 12 months. The finding generalized well on the test data. The disconnection probability of left superior longitudinal fasciculus II and left posterior arcuate fasciculus was negatively associated with semantic fluency only on the training data, but the result aligned with our previous study using diffusion scans in the same clinical population. In sum, our results presented evidence that routinely acquired anatomical scans can serve as a reliable source for deriving neural variables of post-stroke verbal fluency performance. The use of this method might provide an ecologically valid and more readily implementable analysis tool.
Collapse
Affiliation(s)
- Yanyu Xiong
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington IN 47408, USA.
| | - Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Natalia Egorova-Brumley
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Brielle C Stark
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington IN 47408, USA
| |
Collapse
|
5
|
Song Z, Wu Z, Zhou Z, Feng M, Liu Y, Ma M, Chang Y, Xing H, Shen L, Wang Y, Dai H. Altered static and dynamic indices of intrinsic brain activity in patients with subcortical ischemic vascular disease: a resting-state functional magnetic resonance imaging analysis. Neuroradiology 2023; 65:923-931. [PMID: 36892613 DOI: 10.1007/s00234-023-03135-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/17/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE To explore the static and dynamic characteristics of intrinsic brain activity (IBA) in subcortical ischemic vascular disease (SIVD) patients with or without cognitive impairment. METHODS In total, 90 participants were recruited, including 32 SIVD patients with cognitive impairment (SIVD-CI, N = 32), 26 SIVD patients with no cognitive impairment (SIVD-NCI, N = 26), and 32 healthy controls (HC, N = 32) matched for age, gender, and education. All subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning and neuropsychological tests. Amplitude of low-frequency fluctuation (ALFF) was calculated to reflect static alterations of regional IBA. Sliding window analysis was conducted in order to explore the dynamic characteristics. RESULTS Both SIVD-CI and SIVD-NCI group showed significantly decreased ALFF in left angular gyrus (ANG), whereas SIVD-CI group showed increased ALFF in right superior frontal gyrus (SFG), compared with HCs. Furthermore, SIVD-CI group showed significantly decreased ALFF dynamics (dALFF) in right precuneus (PreCu) and left dorsal anterior cingulate cortex (dACC), compared with HC and SIVD-NCI groups (Gaussian random field-corrected, voxel-level P < 0.001, cluster-level P < 0.05). No dynamic changes were detected between SIVD-NCI group and HC group. The mean ALFF value in left ANG of SIVD-CI group was correlated with the score of delayed memory scale. CONCLUSION ANG may be a vulnerable brain region in SIVD patients. Temporal dynamic analysis could serve as a sensitive and promising method to investigate IBA alterations in SIVD patients.
Collapse
Affiliation(s)
- Ziyang Song
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhiwei Wu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zheping Zhou
- Department of Geratology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengmeng Feng
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuanqing Liu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengya Ma
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yue Chang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hanqi Xing
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lan Shen
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Yueju Wang
- Department of Geratology, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
- Institute of Medical Imaging, Soochow University, Suzhou, China.
- Suzhou Key Laboratory of Intelligent Medicine and Equipment, Suzhou, China.
| |
Collapse
|
6
|
Gomes Gonçalves N, Vidal Ferreira N, Khandpur N, Martinez Steele E, Bertazzi Levy R, Andrade Lotufo P, Bensenor IM, Caramelli P, Alvim de Matos SM, Marchioni DM, Suemoto CK. Association Between Consumption of Ultraprocessed Foods and Cognitive Decline. JAMA Neurol 2023; 80:142-150. [PMID: 36469335 PMCID: PMC9857155 DOI: 10.1001/jamaneurol.2022.4397] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/07/2022] [Indexed: 12/12/2022]
Abstract
Importance Although consumption of ultraprocessed food has been linked to higher risk of cardiovascular disease, metabolic syndrome, and obesity, little is known about the association of consumption of ultraprocessed foods with cognitive decline. Objective To investigate the association between ultraprocessed food consumption and cognitive decline in the Brazilian Longitudinal Study of Adult Health. Design, Setting, and Participants This was a multicenter, prospective cohort study with 3 waves, approximately 4 years apart, from 2008 to 2017. Data were analyzed from December 2021 to May 2022. Participants were public servants aged 35 to 74 years old recruited in 6 Brazilian cities. Participants who, at baseline, had incomplete food frequency questionnaire, cognitive, or covariate data were excluded. Participants who reported extreme calorie intake (<600 kcal/day or >6000 kcal/day) and those taking medication that could negatively interfere with cognitive performance were also excluded. Exposures Daily ultraprocessed food consumption as a percentage of total energy divided into quartiles. Main Outcomes and Measures Changes in cognitive performance over time evaluated by the immediate and delayed word recall, word recognition, phonemic and semantic verbal fluency tests, and Trail-Making Test B version. Results A total of 15 105 individuals were recruited and 4330 were excluded, leaving 10 775 participants whose data were analyzed. The mean (SD) age at the baseline was 51.6 (8.9) years, 5880 participants (54.6%) were women, 5723 (53.1%) were White, and 6106 (56.6%) had at least a college degree. During a median (range) follow-up of 8 (6-10) years, individuals with ultraprocessed food consumption above the first quartile showed a 28% faster rate of global cognitive decline (β = -0.004; 95% CI, -0.006 to -0.001; P = .003) and a 25% faster rate of executive function decline (β = -0.003, 95% CI, -0.005 to 0.000; P = .01) compared with those in the first quartile. Conclusions and Relevance A higher percentage of daily energy consumption of ultraprocessed foods was associated with cognitive decline among adults from an ethnically diverse sample. These findings support current public health recommendations on limiting ultraprocessed food consumption because of their potential harm to cognitive function.
Collapse
Affiliation(s)
| | - Naomi Vidal Ferreira
- Adventist University of São Paulo, Engenheiro Coelho, Brazil
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Neha Khandpur
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Renata Bertazzi Levy
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Isabela M. Bensenor
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Dirce M. Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | |
Collapse
|
7
|
Zhang W, Li M, Zhou X, Huang C, Wan K, Li C, Yin J, Zhao W, Zhang C, Zhu X, Sun Z. Altered serum amyloid beta and cerebral perfusion and their associations with cognitive function in patients with subcortical ischemic vascular disease. Front Neurosci 2022; 16:993767. [PMID: 36312019 PMCID: PMC9608371 DOI: 10.3389/fnins.2022.993767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/08/2022] [Indexed: 01/07/2024] Open
Abstract
Subcortical ischemic vascular disease (SIVD) is one of the important causes of cognitive dysfunction, altered amyloid-beta (Aβ) and cerebral perfusion may be involved in the pathophysiological mechanism of SIVD and are closely related to cognitive function. We aimed to investigate altered serum Aβ and cerebral perfusion in patients with SIVD and their correlation with cognitive function. Seventy-four healthy controls (HCs) and 74 SIVD patients, including 38 SIVD patients with no cognitive impairment (SIVD-NCI) and 36 SIVD patients with mild cognitive impairment (SIVD-MCI) underwent the measurement of serum Aβ40 and Aβ42 levels, pseudo-continuous arterial spin labeling MRI scanning, and cognitive evaluation. Compared to the healthy controls (HCs), the level of serum Aβ40 and Aβ40/42 ratio increased and Aβ42 decreased in SIVD patients. The serum Aβ40 level and Aβ40/42 ratio in patients with SIVD-MCI were significantly higher than those in the HCs and SIVD-NCI, and the level of Aβ42 in the SIVD-MCI was lower than the HCs. In addition, the serum Aβ40/42 ratio provided high diagnostic accuracy for SIVD and SIVD-MCI, it was further identified as an independent risk factor for cognitive impairment. Patients with SIVD-NCI and SIVD-MCI exhibited both increased and decreased cerebral blood flow (CBF) in regional. The Aβ40/42 ratio was associated with global CBF, while altered global and regional CBF was associated with cognitive deficits. In addition, white matter hyperintensities volume (WMHV) correlated with Aβ40/42 ratio, CBF, and cognition. The relationship between Aβ40/42 ratio and cognition was partially mediated by altered CBF. Based on these results, we conclude that the serum Aβ40/42 ratio may be a potential biomarker that can complement current methods for the prediction and diagnosis of cognitive impairment in SIVD patients. In addition, serum Aβ may play a role in cognitive function by regulating CBF, which provides new insights into the intervention, treatment, and prevention of cognitive impairment in SIVD.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mingxu Li
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xia Zhou
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chaojuan Huang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ke Wan
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chenchen Li
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiabin Yin
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenming Zhao
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cun Zhang
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoqun Zhu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhongwu Sun
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
8
|
Ayers MR, Bushnell J, Gao S, Unverzagt F, Gaizo JD, Wadley VG, Kennedy R, Clark DG. Verbal fluency response times predict incident cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12277. [PMID: 35571962 PMCID: PMC9074715 DOI: 10.1002/dad2.12277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 01/09/2023]
Abstract
Introduction In recent decades, researchers have defined novel methods for scoring verbal fluency tasks. In this work, we evaluate novel scores based on speed of word responses. Methods We transcribed verbal fluency recordings from 641 cases of incident cognitive impairment (ICI) and matched controls, all participants in a large national epidemiological study. Timing measurements of utterances were used to calculate a speed score for each recording. Traditional raw and speed scores were entered into Cox proportional hazards (CPH) regression models predicting time to ICI. Results Concordance of the CPH model with speed scores was 0.599, an improvement of 3.4% over a model with only raw scores and demographics. Scores with significant effects included animals raw and speed scores, and letter F speed score. Discussion Novel verbal fluency scores based on response times could enable use of remotely administered fluency tasks for early detection of cognitive decline. Highlights The current work evaluates prognostication with verbal fluency speed scores. These speed scores improve survival models predicting cognitive decline. Cases with progressive decline have some characteristics suggestive of Alzheimer's disease. The subset of acute decliners is probably pathologically heterogeneous.
Collapse
Affiliation(s)
- Matthew R. Ayers
- Department of PsychiatryRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA
| | - Justin Bushnell
- Department of NeurologyIndiana UniversityIndianapolisIndianaUSA
| | - Sujuan Gao
- Department of BiostatisticsIndiana UniversityIndianapolisIndianaUSA
| | | | - John Del Gaizo
- Biomedical Informatics CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Virginia G. Wadley
- Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Richard Kennedy
- Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | |
Collapse
|
9
|
Shen W, Fan X, Wang L, Zhang Y. Traditional Chinese Medicine for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:816333. [PMID: 35237166 PMCID: PMC8883343 DOI: 10.3389/fphar.2022.816333] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/18/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Post-stroke cognitive impairment (PSCI) affects more than one-third of stroke patients, and causes much greater harm to long-term function than the initial brain damage. No conventional Western medications have shown convincing clinical effectiveness for treating PSCI. Research shows that Traditional Chinese medicine (TCM) can improve cognitive function in patients. However, the clinical efficacy and safety remain controversial. The aim of this study was to examine the effectiveness and harmful effects of TCMs in the treatment of PSCI. Method: We searched seven databases and two clinical registration websites for randomized controlled trials (RCTs). The revised Cochrane risk of bias tool (RoB 2.0) was used to evaluate the methodological quality and RevMan 5.4 was used for data analysis. This study has been submitted to PROSPERO with registration number is CRD42020149299. Results: We included 34 studies in this review. The results of this study showed that TCM adjuvant therapy improved scores on the MoCA [MD = 2.55, 95% CI (1.56, 3.53), p < 0.00001; MD = 3.07, 95% CI (1.98, 4.17), p < 0.00001 at treatment duration of <3 and 3 months, respectively], MMSE [MD = 2.55, 95% CI (1.99, 3.10), p < 0.00001; MD = 2.53, 95% CI (1.59, 3.47), p < 0.00001; MD = 2.91, 95% CI (1.26, 4.56), p = 0.0006; MD = 3.11, 95% CI (-0.04, 6.27), p = 0.05 at treatment duration of <3, 3, 4, and 6 months, respectively], and BI [MD = 7.34, 95% CI (3.83, 10.85), p < 0.0001; MD = 8.98, 95% CI (4.76, 13.21), p < 0.0001 at treatment duration of <3 and 3 months, respectively] and reduced scores on the ADL (MD = -8.64, 95% CI (-9.83, -7.45), p < 0.00001; MD = -2.00, 95% CI (-2.94, -1.06), p < 0.0001 at treatment duration of 3 and 4 months, respectively], NIHSS [MD = -2.48, 95% CI (-4.97, 0.00), p = 0.05; MD = -3.81, 95% CI (-6.21, -1.40), p = 0.002 at treatment duration of <3 and 3 months, respectively], and CSS [MD = -2.47, 95% CI (-3.49, -1.45), p < 0.00001 at a treatment duration of 3 months]. No serious adverse reactions were observed. Conclusion: Despite the significant positive results, the present evidence supports, to a limited extent because of the methodological flaws and herbal heterogeneity, that TCM adjuvant therapy can be used for patients with PSCI. While, further rigorous RCTs are warranted to confirm the efficacy and safety of TCM. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42020149299.
Collapse
Affiliation(s)
- Wei Shen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xueming Fan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liuding Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yunling Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
10
|
Petersen M, Frey BM, Mayer C, Kühn S, Gallinat J, Hanning U, Fiehler J, Borof K, Jagodzinski A, Gerloff C, Thomalla G, Cheng B. Fixel based analysis of white matter alterations in early stage cerebral small vessel disease. Sci Rep 2022; 12:1581. [PMID: 35091684 PMCID: PMC8799636 DOI: 10.1038/s41598-022-05665-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common cause of morbidity and cognitive decline in the elderly population. However, characterizing the disease pathophysiology and its association with potential clinical sequelae in early stages is less well explored. We applied fixel-based analysis (FBA), a novel framework of investigating microstructural white matter integrity by diffusion-weighted imaging, to data of 921 participants of the Hamburg City Health Study, comprising middle-aged individuals with increased cerebrovascular risk in early stages of CSVD. In individuals in the highest quartile of white matter hyperintensity loads (n = 232, median age 63 years; IQR 15.3 years), FBA detected significantly reduced axonal density and increased atrophy of transcallosal fiber tracts, the bilateral superior longitudinal fasciculus, and corticospinal tracts compared to participants in the lowest quartile of white matter hyperintensities (n = 228, mean age 55 years; IQR 10 years). Analysis of all participants (N = 921) demonstrated a significant association between reduced fiber density and worse executive functions operationalized by the Trail Making Test. Findings were confirmed by complementary analysis of diffusion tensor metrics.
Collapse
Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Borof
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Jagodzinski
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| |
Collapse
|
11
|
von Deneen KM. Correlations between cognitive function and gray matter alterations in patients with acute lacunar stroke. BRAIN SCIENCE ADVANCES 2021. [DOI: 10.26599/bsa.2021.9050012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Researchers emphasized acute lacunar stroke (ALS) patients suffer from poor social/physical outcomes, cognitive decline, and decreased quality of life. We hypothesized brain abnormalities may occur in ALS during this particular stage and may be associated with cognitive deficits upon evaluation. We investigated structural abnormalities in ALS using magnetic resonance imaging and voxel-based morphometry conducted on 28 healthy controls (HC) and 29 patients with ALS and proximal anterior circulation occlusion within 12 hours of symptom onset. Mini-Mental State Examination (MMSE) scores were used to evaluate cognitive dysfunction. Decreased gray matter (GM) in ALS vs. HC was predominantly in the superior frontal gyrus, inferior frontal gyrus, insula, superior temporal gyrus (STG), heschl gyrus, middle temporal gyrus (MTG), posterior cingulate cortex (PCC), hippocampus (HIP), and others. Positive correlation was found between GM density and MMSE scores in STG ( r = 0.59, p = 0.0007), MTG ( r = 0.46, p = 0.01), PCC ( r = 0.42, p = 0.02), HIP ( r = 0.4, p = 0.03), and medial prefrontal cortex ( r = 0.5, p = 0.005). This study provided further information on pathophysiological/morphological mechanisms related to cognitive impairment in ALS and is the basis for further studies in aging-related diseases.
Collapse
Affiliation(s)
- Karen M. von Deneen
- School of Life Science and Technology, Xidian University, Xi’an 710126, Shaanxi, China
| |
Collapse
|
12
|
Barha CK, Dao E, Marcotte L, Hsiung GYR, Tam R, Liu-Ambrose T. Cardiovascular risk moderates the effect of aerobic exercise on executive functions in older adults with subcortical ischemic vascular cognitive impairment. Sci Rep 2021; 11:19974. [PMID: 34620933 PMCID: PMC8497597 DOI: 10.1038/s41598-021-99249-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022] Open
Abstract
Aerobic training (AT) can promote cognitive function in adults with Subcortical Ischemic Vascular Cognitive Impairment (SIVCI) by modifying cardiovascular risk factors. However, pre-existing cardiovascular health may attenuate the benefits of AT on cognitive outcomes in SIVCI. We examined whether baseline cardiovascular risk moderates the effect of a 6-month progressive AT program on executive functions with a secondary analysis of a randomized controlled trial in 71 adults, who were randomized to either: (1) 3×/week progressive AT; or (2) education program (CON). Three executive processes were measured: (1) response inhibition by Stroop Test; (2) working memory by digits backward test; and (3) set shifting by the Trail Making Test. Baseline cardiovascular risk was calculated using the Framingham cardiovascular disease (CVD) Risk Score (FCRS), and participants were classified as either low risk (< 20% FCRS score; LCVR) or high risk (≥ 20% FCRS score; HCVR). A complete case analysis (n = 58) was conducted using an analysis of covariance (ANCOVA) to evaluate between-group differences in the three executive processes. A significant interaction was found between cardiovascular risk group and intervention group (AT or CON) for the digit span backward and the Trail Making Test. AT improved performance compared with CON in those with LCVR, while in those with HCVR, AT did not improve performance compared with CON. Baseline cardiovascular risk significantly moderates the efficacy of AT on cognition. Our findings highlight the importance of intervening early in the disease course of SIVCI, when cardiovascular risk may be lower, to reap maximum benefits of aerobic exercise.
Collapse
Affiliation(s)
- Cindy K Barha
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Elizabeth Dao
- Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.,Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Lauren Marcotte
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Ging-Yuek Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.,Division of Neurology, University of British Columbia, Vancouver, Canada.,Vancouver Coastal Health Research Institute and University of British Columbia Hospital Clinic for Alzheimer Disease and Related Disorders, Vancouver, Canada
| | - Roger Tam
- Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.,Department of Radiology, University of British Columbia, Vancouver, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, Canada. .,Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada. .,Centre for Hip Health and Mobility, Vancouver, Canada.
| |
Collapse
|
13
|
Lugtmeijer S, Lammers NA, de Haan EHF, de Leeuw FE, Kessels RPC. Post-Stroke Working Memory Dysfunction: A Meta-Analysis and Systematic Review. Neuropsychol Rev 2020; 31:202-219. [PMID: 33230717 PMCID: PMC7889582 DOI: 10.1007/s11065-020-09462-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/07/2020] [Indexed: 12/16/2022]
Abstract
This review investigates the severity and nature of post-stroke working memory deficits with reference to the multi-component model of working memory. We conducted a systematic search in PubMed up to March 2019 with search terms for stroke and memory. Studies on adult stroke patients, that included a control group, and assessed working memory function, were selected. Effect sizes (Hedges' g) were extracted from 50 studies (in total 3,084 stroke patients) based on the sample size, mean and standard deviation of patients and controls. Performance of stroke patients was compared to healthy controls on low-load (i.e. capacity) and high-load (executively demanding) working memory tasks, grouped by modality (verbal, non-verbal). A separate analysis compared patients in the sub-acute and the chronic stage. Longitudinal studies and effects of lesion location were systematically reviewed. Stroke patients demonstrated significant deficits in working memory with a moderate effect size for both low-load (Hedges' g = -.58 [-.82 to -.43]) and high-load (Hedges' g = -.59 [-.73 to -.45]) tasks. The effect sizes were comparable for verbal and non-verbal material. Systematically reviewing the literature showed that working memory deficits remain prominent in the chronic stage of stroke. Lesions in a widespread fronto-parietal network are associated with working memory deficits. Stroke patients show decrements of moderate magnitude in all subsystems of working memory. This review clearly demonstrates the global nature of the impairment in working memory post-stroke.
Collapse
Affiliation(s)
- Selma Lugtmeijer
- University of Amsterdam, Amsterdam, the Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.
| | | | | | - Frank-Erik de Leeuw
- Radboud University Medical Center, Department of Neurology, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
14
|
Bai X, Wang WX, Fu RJ, Yue SJ, Gao H, Chen YY, Tang YP. Therapeutic Potential of Hydroxysafflor Yellow A on Cardio-Cerebrovascular Diseases. Front Pharmacol 2020; 11:01265. [PMID: 33117148 PMCID: PMC7550755 DOI: 10.3389/fphar.2020.01265] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022] Open
Abstract
The incidence rate of cardio-cerebrovascular diseases (CCVDs) is increasing worldwide, causing an increasingly serious public health burden. The pursuit of new promising treatment options is thus becoming a pressing issue. Hydroxysafflor yellow A (HSYA) is one of the main active quinochalcone C-glycosides in the florets of Carthamus tinctorius L., a medical and edible dual-purpose plant. HSYA has attracted much interest for its pharmacological actions in treating and/or managing CCVDs, such as myocardial and cerebral ischemia, hypertension, atherosclerosis, vascular dementia, and traumatic brain injury, in massive preclinical studies. In this review, we briefly summarized the mode and mechanism of action of HSYA on CCVDs based on these preclinical studies. The therapeutic effects of HSYA against CCVDs were presumed to reside mostly in its antioxidant, anti-inflammatory, and neuroprotective roles by acting on complex signaling pathways.
Collapse
Affiliation(s)
- Xue Bai
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Wen-Xiao Wang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Rui-Jia Fu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Shi-Jun Yue
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Huan Gao
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Yan-Yan Chen
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Yu-Ping Tang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, China
| |
Collapse
|
15
|
Sur S, Lin Z, Li Y, Yasar S, Rosenberg P, Moghekar A, Hou X, Kalyani R, Hazel K, Pottanat G, Xu C, van Zijl P, Pillai J, Liu P, Albert M, Lu H. Association of cerebrovascular reactivity and Alzheimer pathologic markers with cognitive performance. Neurology 2020; 95:e962-e972. [PMID: 32661101 DOI: 10.1212/wnl.0000000000010133] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/17/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine whether MRI-based cerebrovascular reactivity (CVR) can predict cognitive performance independently of Alzheimer pathologic markers, we studied the relationship between cognition, CVR, and CSF-derived β-amyloid42 (Aβ42) and tau in a group of elderly individuals with mixed Alzheimer and vascular cognitive impairment and dementia. METHODS This was a cross-sectional study of 72 participants 69 ± 8 years of age consisting of individuals with normal cognition (n = 28) and cognitive impairment (n = 44) (including 36 with mild cognitive impairment [MCI] and 8 with mild dementia). CVR was measured with hypercapnia-MRI. Whole-brain CVR (percent blood oxygen level-dependent per 1 mm Hg Etco2) was used to estimate vasodilatory capacity. Montreal Cognitive Assessment (MoCA) scores, cognitive domains scores, and a global composite cognitive score were obtained. AD biomarkers included CSF assays of Aβ42 and tau. RESULTS Whole-brain CVR was lower in the impaired (mean ± SE, 0.132 ± 0.006%/mm Hg) compared to the normal (0.151 ± 0.007%/mm Hg) group (β = -0.02%/mm Hg; 95% confidence interval [CI] -0.038 to -0.001). After adjustment for CSF Aβ42 and tau, higher whole-brain CVR was associated with better performance on the MoCA (β = 29.64, 95% CI 9.94-49.34) and with a global composite cognitive score (β = 4.32, 95% CI 0.05-8.58). When the CVR marker was compared with the Fazekas score based on white matter hyperintensities and vascular risk-score in a single regression model predicting the MoCA score, only CVR revealed a significant effect (β = 28.09, 95% CI 6.14-50.04), while the other 2 measures were not significant. CONCLUSIONS CVR was significantly associated with cognitive performance independently of AD pathology. Whole-brain CVR may be a useful biomarker for evaluating cognitive impairment related to vascular disease in older individuals. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that CVR was significantly associated with cognitive performance independent of AD pathology.
Collapse
Affiliation(s)
- Sandeepa Sur
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Zixuan Lin
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Yang Li
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Sevil Yasar
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Paul Rosenberg
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Abhay Moghekar
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Xirui Hou
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Rita Kalyani
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Kaisha Hazel
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - George Pottanat
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Cuimei Xu
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Peter van Zijl
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Jay Pillai
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Peiying Liu
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Marilyn Albert
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD
| | - Hanzhang Lu
- From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD.
| |
Collapse
|
16
|
Nolze-Charron G, Dufort-Rouleau R, Houde JC, Dumont M, Castellano CA, Cunnane S, Lorrain D, Fülöp T, Descoteaux M, Bocti C. Tractography of the external capsule and cognition: A diffusion MRI study of cholinergic fibers. Exp Gerontol 2019; 130:110792. [PMID: 31778753 DOI: 10.1016/j.exger.2019.110792] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/23/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION White matter changes (WMC) in the cholinergic tracts contribute to executive dysfunction in the context of cognitive aging. WMC in the external capsule have been associated with executive dysfunction. The objectives of this study were to: 1) Characterize the lateral cholinergic tracts (LCT) and the superior longitudinal fasciculus (SLF). 2) Evaluate the association between diffusion measures within those tracts and cognitive performance. METHODS Neuropsychological testing and high angular resolution diffusion imaging (HARDI) of 34 healthy elderly participants was done, followed by anatomically constrained probabilistic tractography reconstruction robust to crossing fibers. The external capsule was manually segmented on a mean T1 image then merged with an atlas, allowing extraction of the LCT. Diffusion tensor imaging (DTI) and HARDI-based measures were obtained. RESULTS Correlations between diffusion measures in the LCT and the time of completion of Stroop (left LCT radial and medial diffusivity), the Symbol Search score (right LCT apparent fiber density) and the motor part of Trail-B (left LCT axial and radial diffusivity) were observed. Correlations were also found with diffusion measures in the SLF. WMC burden was low, and no correlation was found with diffusion measures or cognitive performance. DISCUSSION DTI and HARDI, with isolation of strategic white matter tracts for cognitive functions, represent complimentary tools to better understand the complex process of brain aging.
Collapse
Affiliation(s)
- Geneviève Nolze-Charron
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada; Division of Neurology, Department of Medicine, Hôpital de Rouyn-Noranda - CISSS de l'Abitibi-Témiscamingue, 4, 9e Rue, Rouyn-Noranda, Quebec J9X 2B2, Canada.
| | - Raphaël Dufort-Rouleau
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
| | - Jean-Christophe Houde
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, Quebec J1K 0A5, Canada.
| | - Matthieu Dumont
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, Quebec J1K 0A5, Canada.
| | - Christian-Alexandre Castellano
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada; Research Centre on Aging, CIUSSS de l'Estrie-CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada.
| | - Stephen Cunnane
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada; Research Centre on Aging, CIUSSS de l'Estrie-CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada.
| | - Dominique Lorrain
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada.
| | - Tamàs Fülöp
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada; Research Centre on Aging, CIUSSS de l'Estrie-CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada.
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, Quebec J1K 0A5, Canada.
| | - Christian Bocti
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada; Research Centre on Aging, CIUSSS de l'Estrie-CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; Division of Neurology, Department of Medicine, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
| |
Collapse
|
17
|
Perri R, Monaco M, Fadda L, Caltagirone C, Carlesimo GA. Influence of controlled encoding and retrieval facilitation on memory performance of patients with subcortical ischemic vascular dementia and Alzheimer's disease. J Neurol 2019; 266:2447-2456. [PMID: 31214768 DOI: 10.1007/s00415-019-09411-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/09/2019] [Accepted: 05/30/2019] [Indexed: 11/25/2022]
Abstract
Patients with subcortical ischemic vascular dementia (SIVD) perform better than Alzheimer's disease patients (AD) on the Free and Cued Recall Selective Reminding test (FCSRT). In this test, SIVD are able to overcome their strategic retrieval deficit, whereas AD patients, whose memory impairment is due to a hippocampal storage deficit, are not. However, the FCSRT does not assess the advantage passing from free to assisted learning, which is expected to be different in frontal and hippocampal damage. We compared SIVD, AD and healthy subjects on the free recall of a 15-word list not assisted at encoding and on the free and cued recall of the FCRST. Indexes of Encoding, Cueing and Total (measuring the advantage passing from the 15-word list free recall to the free and cued recall of the FCRST) were computed. The two groups performed comparably poorly on the free recall of the 15-word list, but SIVD outperformed AD patients in the free and cued recall of the FCSRT and took greater advantage than AD patients on both learning and recall when passing from the unassisted to the assisted paradigms. All indexes significantly predicted diagnostic group membership, but the Total Index showed the larger classification accuracy with 80% of AD and 71% of SIVD correctly classified. These results confirm that the FCRST is able to differentiate AD and SIVD patients with a good level of accuracy. However, the evaluation of memory performance variation as a function of support to encoding provides additional data able to increase diagnostic reliability.
Collapse
Affiliation(s)
- Roberta Perri
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179, Rome, Italy.
| | - Marco Monaco
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179, Rome, Italy
| | - Lucia Fadda
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Carlo Caltagirone
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni A Carlesimo
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| |
Collapse
|
18
|
Paul R, Salminen L. Vascular Cognitive Impairment. HANDBOOK ON THE NEUROPSYCHOLOGY OF AGING AND DEMENTIA 2019. [DOI: 10.1007/978-3-319-93497-6_30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
19
|
Chahine LM, Dos Santos C, Fullard M, Scordia C, Weintraub D, Erus G, Rosenthal L, Davatzikos C, McMillan CT. Modifiable vascular risk factors, white matter disease and cognition in early Parkinson's disease. Eur J Neurol 2018; 26:246-e18. [PMID: 30169897 DOI: 10.1111/ene.13797] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Dementia in Parkinson's disease (PD) is common and disabling. Identification of modifiable risk factors for it is essential. Vascular risk factors (VRFs) may be associated with cognitive decline in early PD. Biomarkers that serve as surrogates of the long-term effect of VRFs on PD are needed. To that end, we aimed to quantitate white matter hyperintensities (WMH) in early PD, measure associations with VRFs and examine relationships between WMH and longitudinal cognition. METHODS Participants in the Parkinson's Progression Markers Initiative study (141 patients with PD, 63 healthy controls) with adequate baseline structural brain magnetic resonance imaging data were included. Hypertension and diabetes history, and body mass index were combined to create a vascular risk score. WMH were quantitated via automated methods. Cognition was assessed annually with a comprehensive test battery. RESULTS In the PD group, vascular risk score was associated with WMH for total brain (β = 0.210; P = 0.021), total white matter (β = 0.214; P = 0.013), frontal (β = 0.220; P = 0.002) and temporal (β = 0.212; P = 0.002) regions. Annual rate of change in global cognition was greater in those with higher vascular risk score (β = -0.040; P = 0.007) and greater WMH (β = -0.029; P = 0.049). Higher temporal WMH burden was associated with great decline over time in verbal memory (β = -0.034; P = 0.031). CONCLUSIONS In early PD, modifiable VRFs are associated with WMH on brain magnetic resonance imaging. Temporal WMH burden predicts decline in verbal memory. WMH may serve as a surrogate marker for the effect of VRFs on cognitive abilities in PD.
Collapse
Affiliation(s)
- L M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA
| | - C Dos Santos
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - M Fullard
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - C Scordia
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - D Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia, PA.,Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - G Erus
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA
| | - L Rosenthal
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - C Davatzikos
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA
| | - C T McMillan
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
20
|
Paul M, War F, Sharma V, Kushwaha S. Magnetic resonance imaging and neuropsychological correlates of subcortical vascular dementia. Asian J Neurosurg 2018; 13:631-635. [PMID: 30283516 PMCID: PMC6159047 DOI: 10.4103/ajns.ajns_159_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Common understanding of dementia is mostly based on the Alzheimer's disease model. However, in subcortical vascular dementia (SVaD), several other cognitive and behavioral dysfunctions predominate over what is commonly noticed in Alzheimer's disease. There are inconsistencies in literature regarding the profile of cognitive impairments in vascular dementia.
Collapse
Affiliation(s)
- Mohd Paul
- Department of Psychiatry, Institute of Mental Health and Neurosciences, Kashmir, Jammu and Kashmir
| | - Firdous War
- Department of Humanities and Social Sciences, Indian Institute of Technology, Kanpur, Uttar Pradesh
| | - Vibha Sharma
- Department of Clinical Psychology, Institute of Human Behaviour and Allied Sciences, New Delhi
| | - Suman Kushwaha
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi
| |
Collapse
|
21
|
Education, Socioeconomic Status, and Intelligence in Childhood and Stroke Risk in Later Life: A Meta-analysis. Epidemiology 2018; 28:608-618. [PMID: 28410350 DOI: 10.1097/ede.0000000000000675] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Stroke is the second most common cause of death, and a common cause of dependency and dementia. Adult vascular risk factors and socioeconomic status (SES) are associated with increased risk, but less is known about early life risk factors, such as education, childhood SES, or intelligence (IQ). METHODS We comprehensively searched Medline, PsycINFO, and EMBASE from inception to November 2015. We included all studies reporting data on >50 strokes examining childhood/premorbid IQ, SES, and education. Two reviewers independently screened full texts and extracted and cross-checked data, including available risk factor adjustments. We meta-analyzed stroke risk using hazard ratios (HR), odds ratios (OR), and mean differences (MD). We tested effects of study and participant characteristics in sensitivity analyses and meta-regression, and assessed heterogeneity and publication bias. RESULTS We identified 90 studies examining stroke risk and education (79), SES (10), or IQ (nine) including approximately 164,683 stroke and over 5 million stroke-free participants. Stroke risk increased with lower education (OR = 1.35, 95% CI = 1.24, 1.48), SES (OR = 1.28, 95% CI = 1.12, 1.46), and IQ (HR = 1.17, 95% CI = 1.00, 1.37) in studies reporting point estimates, with similar associations for MD. We found minimal publication bias. Between-study heterogeneity was partly explained by participant age and case ascertainment method. CONCLUSIONS Education, childhood SES, and intelligence have modest but important associations with lifetime stroke, and hence dementia, risks. Future studies distinguishing between the individual and combined effects of education, childhood SES and intelligence are needed to determine the independent contribution of each factor to stroke risk. See video abstract at, http://links.lww.com/EDE/B210.
Collapse
|
22
|
Doiron M, Langlois M, Dupré N, Simard M. The influence of vascular risk factors on cognitive function in early Parkinson's disease. Int J Geriatr Psychiatry 2018; 33:288-297. [PMID: 28509343 DOI: 10.1002/gps.4735] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 04/10/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Hypertension, dyslipidemia, diabetes, and obesity are well-established risk factors for cognitive impairment and dementia in older adults. In contrast, previous studies that have assessed the impact of vascular risk factors (VRFs) on cognition in Parkinson's disease (PD) have had methodological limitations and reported conflicting findings. We address this question in a large well-characterized cohort of de novo PD patients. METHODS A total of 367 untreated and non-demented patients aged 50 years and older with early PD (H&Y = 1.0-2.0) underwent a comprehensive clinical and neuropsychological assessment at baseline and 24 months later. A series of linear mixed models were used to determine the effects of VRFs on cognition while controlling for patient and disease characteristics. The outcomes included norm-referenced Z-scores of global cognition, visuospatial skills, verbal episodic memory, semantic verbal fluency, attention, and working memory tests. RESULTS A longer history of hypertension and a higher pulse pressure were significant predictors of lower Z-scores on immediate and delayed free recall, recognition, and verbal fluency tests. On average, every 10 mmHg increase in pulse pressure was associated with a 0.08 reduction on the cognitive Z-scores. The effects were independent of age, education, disease duration, motor impairment, medication, and depressive symptoms. Other VRFs were not associated with cognitive outcomes. CONCLUSIONS Our results are consistent with previous studies suggesting that hypertension exerts a detrimental effect on memory and verbal fluency in early PD. Management of blood pressure and cardiovascular health may be important to reduce risk of cognitive decline in PD. Copyright © 2017 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Maxime Doiron
- School of Psychology, Laval University, Quebec City, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Quebec City, Canada.,Faculty of Medicine, Laval University, Quebec City, Canada
| | - Mélanie Langlois
- Faculty of Medicine, Laval University, Quebec City, Canada.,Department of Neurological Sciences, CHU de Québec (Enfant-Jésus), Quebec City, Canada
| | - Nicolas Dupré
- Faculty of Medicine, Laval University, Quebec City, Canada.,Department of Neurological Sciences, CHU de Québec (Enfant-Jésus), Quebec City, Canada
| | - Martine Simard
- School of Psychology, Laval University, Quebec City, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Quebec City, Canada
| |
Collapse
|
23
|
Oh H, Park J, Seo W. A 2-year prospective follow-up study of temporal changes associated with post-stroke cognitive impairment. Int J Nurs Pract 2018; 24:e12618. [PMID: 29291599 DOI: 10.1111/ijn.12618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 11/03/2017] [Accepted: 11/11/2017] [Indexed: 12/15/2022]
Abstract
AIMS To explore temporal patterns of change in cognitive impairments during the 2 years following stroke and to identify factors that affect these temporal changes. BACKGROUND Despite the prognostic importance, temporal changes in post-stroke cognitive impairment have not been systematically investigated. DESIGN A non-experimental, prospective, longitudinal descriptive study design. METHODS Fifty-two stroke patients were enrolled. Data were collected from April 2015 to September 2017. Cognitive function was evaluated at 5 different times (immediately, and at 3, 6, 12, and 24 months post-stroke). RESULTS Significant changes in cognitive function following stroke exhibited an "s-shaped" curve, and the most rapid changes were observed between 3 and 6 months after stroke. The incidence of post-stroke cognitive impairment ranged from 23.1% to 42.3% and was highest at 3 months and lowest at 6 months. Gender, educational level, pre-stroke cognitive and functional abilities, haematoma, and brain surgery were associated with incidence of post-stroke cognitive impairment. CONCLUSIONS The ongoing changes exhibited by patterns of cognitive impairment provide evidence that consistent efforts are required to achieve positive changes in post-stroke cognitive function. Our findings may be helpful to develop nursing care strategies aimed at improving cognitive ability and consequently the quality of life of stroke patients.
Collapse
Affiliation(s)
- HyunSoo Oh
- Department of Nursing, Inha University, Incheon, Republic of Korea
| | - JongSuk Park
- Department of Nursing, Inha University; and Nurse, Inha University Hospital, Incheon, Republic of Korea
| | - WhaSook Seo
- Department of Nursing, Inha University, Incheon, Republic of Korea
| |
Collapse
|
24
|
Liang Y, Deng M, Chen Y, Mok V, Wang D, Ungvari GS, Chu CW, Berge E, Tang W. Enlarged perivascular spaces are associated with health-related quality of life in patients with acute ischemic stroke. CNS Neurosci Ther 2017; 23:973-979. [PMID: 29052954 PMCID: PMC6492717 DOI: 10.1111/cns.12766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 01/30/2023] Open
Abstract
AIMS This study explored the association between enlarged perivascular spaces (EPVS) and the health-related quality of life (HRQoL) in patients with acute ischemic stroke. METHODS This was an observational study of consecutively screened patients with acute ischemic stroke from March 2010 to March 2015. EPVS were rated in the basal ganglia and the centrum semiovale with a validated scale. The HRQoL was assessed 3 months after the stroke onset using the Stroke-Specific Quality of Life (SSQoL). Linear regression models were used to study the association between EPVS and HRQoL. RESULTS The study included 648 patients (mean age 65.8 years; 40.0% women) with mild to moderately severe stroke (median NIHSS score 2), of whom 640 (98.8%) exhibited signs of small vessel disease. The median EPVS scores in the basal ganglia and the centrum semiovale were 1 each. In linear regression analysis, EPVS in the basal ganglia were associated with a lower total SSQoL score (P = 0.02) and lower mobility (P = 0.01), mood (P = 0.03), and self-care (P < 0.01). EPVS in the centrum semiovale were associated only with a lower SSQoL work/productivity subscore (P = 0.002). CONCLUSIONS EPVS are associated with lower HRQoL in patients with mild to moderate acute ischemic stroke. Early identification and intervention of EPVS may improve HRQoL in stroke survivors.
Collapse
Affiliation(s)
- Yan Liang
- Department of Psychiatrythe Chinese University of Hong KongHong KongChina
| | - Min Deng
- Department of Imaging and Interventional Radiologythe Chinese University of Hong KongHong KongChina
| | - Yang‐Kun Chen
- Department of NeurologyDongguan People's HospitalDongguanGuangdongChina
| | - Vincent Mok
- Department of Medicine and Therapeuticsthe Chinese University of Hong KongHong KongChina
| | - De‐Feng Wang
- Department of Imaging and Interventional Radiologythe Chinese University of Hong KongHong KongChina
| | - Gabor S. Ungvari
- Australia / Graylands HospitalUniversity of Notre DamePerthWAAustralia
| | - Chiu‐Wing Winnie Chu
- Department of Imaging and Interventional Radiologythe Chinese University of Hong KongHong KongChina
| | - Eivind Berge
- Departments of Internal Medicine and CardiologyOslo University HospitalOsloNorway
| | - Wai‐Kwong Tang
- Department of Psychiatrythe Chinese University of Hong KongHong KongChina
- Shenzhen Research Institutethe Chinese University of Hong KongShenzhenGuangdongChina
| |
Collapse
|
25
|
Jaul E, Meiron O. Systemic and Disease-Specific Risk Factors in Vascular Dementia: Diagnosis and Prevention. Front Aging Neurosci 2017; 9:333. [PMID: 29089884 PMCID: PMC5650993 DOI: 10.3389/fnagi.2017.00333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/29/2017] [Indexed: 12/04/2022] Open
Abstract
In order to prevent the onset of vascular dementia (VaD) in aging individuals, it is critical to detect clinically relevant vascular and systemic pathophysiological changes to signal the onset of its preceding prodromal stages. Identifying behavioral and neurobiological markers that are highly sensitive to VaD classification vs. other dementias is likely to assist in developing novel preventive treatment strategies that could delay the onset of disruptive psychomotor symptoms, decrease hospitalizations, and increase the quality of life in clinically-high-risk aging individuals. In light of empirical diagnostic and clinical findings associated with VaD pathophysiology, the current investigation will suggest a few clinically-validated biomarker measures of prodromal VaD cognitive impairments that are correlated with vascular symptomology, and VaD endophenotypes in non-demented aging people. In prodromal VaD individuals, distinguishing VaD from other dementias (e.g., Alzheimer's disease) could facilitate specific early preventive interventions that significantly delay more severe cognitive deterioration or indirectly suppress the onset of dementia with vascular etiology. Importantly, the authors conclude that primary prevention strategies should examine aging individuals by employing comprehensive geriatric assessment approach, taking into account their medical history, and longitudinally noting their vascular, systemic, cognitive, behavioral, and clinical functional status. Secondary prevention strategies may include monitoring chronic medication as well as promoting programs that facilitate social interaction and every-day activities.
Collapse
Affiliation(s)
- Efraim Jaul
- Geriatric Skilled Nursing Department, Herzog Hospital, Hebrew University, Jerusalem, Israel
| | - Oded Meiron
- Clinical Research Center for Brain Sciences, Herzog Hospital, Hebrew University, Jerusalem, Israel
| |
Collapse
|
26
|
Bucks RS, Olaithe M, Rosenzweig I, Morrell MJ. Reviewing the relationship between OSA and cognition: Where do we go from here? Respirology 2017; 22:1253-1261. [PMID: 28779504 DOI: 10.1111/resp.13140] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/07/2017] [Accepted: 05/29/2017] [Indexed: 12/14/2022]
Abstract
Obstructive sleep apnoea (OSA) is a disorder of breathing during sleep resulting in temporary reduction in cerebral oxygenation and sleep disruption. A growing body of research reveals a relatively consistent pattern of deficits in cognition, particularly in attention, episodic memory, and executive function, which are partially remediated by treatment. This is where the consensus ends. Despite a number of competing explanations regarding how OSA affects cognition, reliable evidence is hard to find, which may relate to the many, common conditions co-morbid with OSA or to the methodological challenges in this field. This paper reviews the evidence for cognitive impairment in OSA, the proposed models of cognitive harm, the impact of co-morbidities and the many methodological and theoretical challenges of exploring the effect of OSA on cognition. To overcome some of these challenges, we end by proposing a number of future directions for the field, including suggesting some core design elements for future studies.
Collapse
Affiliation(s)
- Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, London, UK
| | - Mary J Morrell
- Academic Unit of Sleep and Ventilation, National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
| |
Collapse
|
27
|
Levit A, Regis AM, Garabon JR, Oh SH, Desai SJ, Rajakumar N, Hachinski V, Agca Y, Agca C, Whitehead SN, Allman BL. Behavioural inflexibility in a comorbid rat model of striatal ischemic injury and mutant hAPP overexpression. Behav Brain Res 2017; 333:267-275. [PMID: 28693862 DOI: 10.1016/j.bbr.2017.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/22/2017] [Accepted: 07/06/2017] [Indexed: 01/04/2023]
Abstract
Alzheimer disease (AD) and stroke coexist and interact; yet how they interact is not sufficiently understood. Both AD and basal ganglia stroke can impair behavioural flexibility, which can be reliably modeled in rats using an established operant based set-shifting test. Transgenic Fischer 344-APP21 rats (TgF344) overexpress pathogenic human amyloid precursor protein (hAPP) but do not spontaneously develop overt pathology, hence TgF344 rats can be used to model the effect of vascular injury in the prodromal stages of Alzheimer disease. We demonstrate that the injection of endothelin-1 (ET1) into the dorsal striatum of TgF344 rats (Tg-ET1) produced an exacerbation of behavioural inflexibility with a behavioural phenotype that was distinct from saline-injected wildtype & TgF344 rats as well as ET1-injected wildtype rats (Wt-ET1). In addition to profiling the types of errors made, interpolative modeling using logistic exposure-response regression provided an informative analysis of the timing and efficiency of behavioural flexibility. During set-shifting, Tg-ET1 committed fewer perseverative errors than Wt-ET1. However, Tg-ET1 committed significantly more regressive errors and had a less efficient strategy change than all other groups. Thus, behavioural flexibility was more vulnerable to striatal ischemic injury in TgF344 rats.
Collapse
Affiliation(s)
- Alexander Levit
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London ON, Canada
| | - Aaron M Regis
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London ON, Canada
| | - Jessica R Garabon
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London ON, Canada
| | - Seung-Hun Oh
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London ON, Canada
| | - Sagar J Desai
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London ON, Canada
| | - Nagalingam Rajakumar
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London ON, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, University Hospital, Western University, London, ON, Canada
| | - Yuksel Agca
- Department of Veterinary Pathobiology, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Cansu Agca
- Department of Veterinary Pathobiology, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Shawn N Whitehead
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London ON, Canada; Department of Clinical Neurological Sciences, University Hospital, Western University, London, ON, Canada.
| | - Brian L Allman
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London ON, Canada.
| |
Collapse
|
28
|
Barker MS, Young B, Robinson GA. Cohesive and coherent connected speech deficits in mild stroke. BRAIN AND LANGUAGE 2017; 168:23-36. [PMID: 28113106 DOI: 10.1016/j.bandl.2017.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 12/22/2016] [Accepted: 01/13/2017] [Indexed: 06/06/2023]
Abstract
Spoken language production theories and lesion studies highlight several important prelinguistic conceptual preparation processes involved in the production of cohesive and coherent connected speech. Cohesion and coherence broadly connect sentences with preceding ideas and the overall topic. Broader cognitive mechanisms may mediate these processes. This study aims to investigate (1) whether stroke patients without aphasia exhibit impairments in cohesion and coherence in connected speech, and (2) the role of attention and executive functions in the production of connected speech. Eighteen stroke patients (8 right hemisphere stroke [RHS]; 6 left [LHS]) and 21 healthy controls completed two self-generated narrative tasks to elicit connected speech. A multi-level analysis of within and between-sentence processing ability was conducted. Cohesion and coherence impairments were found in the stroke group, particularly RHS patients, relative to controls. In the whole stroke group, better performance on the Hayling Test of executive function, which taps verbal initiation/suppression, was related to fewer propositional repetitions and global coherence errors. Better performance on attention tasks was related to fewer propositional repetitions, and decreased global coherence errors. In the RHS group, aspects of cohesive and coherent speech were associated with better performance on attention tasks. Better Hayling Test scores were related to more cohesive and coherent speech in RHS patients, and more coherent speech in LHS patients. Thus, we documented connected speech deficits in a heterogeneous stroke group without prominent aphasia. Our results suggest that broader cognitive processes may play a role in producing connected speech at the early conceptual preparation stage.
Collapse
Affiliation(s)
- Megan S Barker
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, Australia
| | - Breanne Young
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, Australia
| | - Gail A Robinson
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, Australia.
| |
Collapse
|
29
|
Development of an Evidence-Based Intervention Program for Patients With Mild Cognitive Impairment After Stroke. TOPICS IN GERIATRIC REHABILITATION 2017. [DOI: 10.1097/tgr.0000000000000149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
30
|
Davis JC, Hsiung GYR, Bryan S, Best JR, Eng JJ, Munkacsy M, Cheung W, Chiu B, Jacova C, Lee P, Liu-Ambrose T. Economic evaluation of aerobic exercise training in older adults with vascular cognitive impairment: PROMoTE trial. BMJ Open 2017; 7:e014387. [PMID: 28360247 PMCID: PMC5372066 DOI: 10.1136/bmjopen-2016-014387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/OBJECTIVES Evidence suggests that aerobic exercise may slow the progression of subcortical ischaemic vascular cognitive impairment (SIVCI) by modifying cardiovascular risk factors. Yet the economic consequences relating to aerobic training (AT) remain unknown. Therefore, our primary objective was to estimate the incremental cost per quality-adjusted life years (QALYs) gained of a thrice weekly AT intervention compared with usual care. DESIGN Cost-utility analysis alongside a randomised trial. SETTING Vancouver, British Columbia, Canada. PARTICIPANTS 70 adults (mean age of 74 years, 51% women) who meet the diagnostic criteria for mild SIVCI. INTERVENTION A 6-month, thrice weekly, progressive aerobic exercise training programme compared with usual care (CON; comparator) with a follow-up assessment 6 months after formal cessation of aerobic exercise training. MEASUREMENTS Healthcare resource usage was estimated over the 6-month intervention and 6-month follow-up period. Health status (using the EQ-5D-3L) at baseline and trial completion and 6-month follow-up was used to calculate QALYs. The incremental cost-utility ratio (cost per QALY gained) was calculated. RESULTS QALYs were both modestly greater, indicating a health gain. Total healthcare costs (ie, 1791±1369 {2015 $CAD} at 6 months) were greater, indicating a greater cost for the thrice weekly AT group compared with CON. From the Canadian healthcare system perspective, the incremental cost-utility ratios for thrice weekly AT were cost-effective compared with CON, when using a willingness to pay threshold of $CAD 20 000 per QALY gained or higher. CONCLUSIONS AT represents an attractive and potentially cost-effective strategy for older adults with mild SIVCI. TRIAL REGISTRATION NUMBER NCT01027858.
Collapse
Affiliation(s)
- Jennifer C Davis
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
| | - Ging-Yuek Robin Hsiung
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Best
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Munkacsy
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
| | - Winnie Cheung
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
| | - Bryan Chiu
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
| | - Claudia Jacova
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philip Lee
- Department of Medicine, Division of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
31
|
Liu Q, Zhu Z, Teipel SJ, Yang J, Xing Y, Tang Y, Jia J. White Matter Damage in the Cholinergic System Contributes to Cognitive Impairment in Subcortical Vascular Cognitive Impairment, No Dementia. Front Aging Neurosci 2017; 9:47. [PMID: 28289381 PMCID: PMC5326769 DOI: 10.3389/fnagi.2017.00047] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/20/2017] [Indexed: 11/30/2022] Open
Abstract
Cholinergic deficiency has been implicated in the pathogenesis of vascular cognitive impairment (VCI), but the extent of involvement and underlying mechanism remain unclear. In this study, targeting the early stage of VCI, we determined regional atrophy within the basal forebrain and deficiency in cholinergic pathways in 25 patients with vascular cognitive impairment no dementia (VCIND) compared to 24 healthy elderly subjects. By applying stereotaxic cytoarchitectonic maps of the nucleus basalis of Meynert (NbM), no significant atrophy was identified in VCIND. Using probabilistic tractography analysis, our study tracked the two major white matter tracks which map to cholinergic pathways. We identified significantly lower fractional anisotropy (FA) in VCIND. Mediation analysis demonstrated that FA in the tracked pathways could fully account for the executive dysfunction, and partly mediate the memory and global cognition impairment. Our study suggests that the fibers mapped to the cholinergic pathways, but not the NbM, are significantly impaired in VCIND. MRI-based in vivo tracking of cholinergic pathways together with NbM measurement may become a valuable in vivo marker for evaluating the cholinergic system in cognitive disorders.
Collapse
Affiliation(s)
- Qing Liu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University Beijing, China
| | - Zude Zhu
- Collaborative Innovation Center for Language Competence, Jiangsu Normal University Xuzhou, China
| | - Stefan J Teipel
- Department of Psychosomatic Medicine, University of RostockRostock, Germany; German Center for Neurodegenerative DisordersRostock, Germany
| | - Jianwei Yang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University Beijing, China
| | - Yi Xing
- Department of Neurology, Xuan Wu Hospital, Capital Medical University Beijing, China
| | - Yi Tang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University Beijing, China
| | - Jianping Jia
- Department of Neurology, Xuan Wu Hospital, Capital Medical UniversityBeijing, China; Department of Neurology, Beijing Friendship Hospital, Capital Medical UniversityBeijing, China; Center of Alzheimer's Disease, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Geriatric Cognitive Disorders; Neurodegenerative Laboratory of Ministry of Education of the People's Republic of ChinaBeijing, China
| |
Collapse
|
32
|
|
33
|
Moryś JM, Pąchalska M, Bellwon J, Gruchała M. Cognitive impairment, symptoms of depression, and health-related quality of life in patients with severe stable heart failure. Int J Clin Health Psychol 2016; 16:230-238. [PMID: 30487866 PMCID: PMC6225081 DOI: 10.1016/j.ijchp.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 03/28/2016] [Indexed: 11/06/2022] Open
Abstract
Background/Objective: Diseases of the cardiovascular system and depression are common, and they often coexist, significantly deteriorating the quality of life. Another factor influencing vital functions is impairment of cognitive functions occurring in patients with heart failure (HF). Deficits of different degrees of severity have been observed within a variety of cognitive domains. Cognitive deficits, which may impair daily functioning, hinder adaptation to the disease and worsen prognosis, are also observed in depression. The aim of this study was to assess the relationship between the quality of life, the severity of depressive disorders and disorders of certain executive functions, and memory in patients with severe, stable heart failure. Method: The study group consisted of 50 patients with stable, severe heart failure and 50 appropriately selected patients with coronary heart disease, without heart failure. Results: The results of cognitive tests are significantly lower in the HF group than in the control group. In the HF group, a significantly lower quality of life, as well as a higher result in the BDI-II test, was observed. No influence of cognitive disorders on the reduction in the quality of life was demonstrated. The factor that significantly affects the quality of life is the intensification of depression symptoms. Conclusions: The factor that significantly affects the quality of life is the intensification of depression symptoms.
Collapse
Affiliation(s)
| | | | - Jerzy Bellwon
- The Andrzej Frycz Modrzewski Krakow University, Poland
| | | |
Collapse
|
34
|
Tang Y, Zhu Z, Liu Q, Li F, Yang J, Li F, Xing Y, Jia J. The efficacy of Cognitive training in patients with VAsCular Cognitive Impairment, No dEmentia (the Cog-VACCINE study): study protocol for a randomized controlled trial. Trials 2016; 17:392. [PMID: 27496126 PMCID: PMC4974771 DOI: 10.1186/s13063-016-1523-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 07/14/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Vascular cognitive impairment, no dementia (VCIND) refers to cognitive deficits associated with underlying vascular causes that fall short of a dementia diagnosis. There is currently no treatment for VCIND. Computerized cognitive training, which has significantly improved cognitive function in healthy older adults and patients with cognitive impairment has not yet been applied to VCIND. METHODS/DESIGN The proposed study is a three-center, double-blinded, randomized controlled trial that will include 60 patients with VCIND. The patients will be randomized to either a training or a control group. The intervention is internet-based cognitive training performed for 30 min over 35 sessions. Neuropsychological assessment and functional and structural MRI will be performed before and after 7 weeks training. Primary outcomes are global cognitive function and executive function. Secondary outcome measures are neuroplasticity changes measured by functional and structural MRI. DISCUSSION Applying an internet-based, multi-domain, adaptive program, this study aims to assess whether cognitive training improves cognitive abilities and neural plasticity in patients with subcortical VCIND. In addition to the comprehensive assessment of the participants by neuropsychological tests, cerebrovascular risk factors and apolipoprotein E genotyping, neuroplasticity will be used as an evaluation outcome in this study for, to our knowledge, the first time. The combination of functional and structural MRI and neuropsychological tests will have strong sensitivity in evaluating the effects of cognitive training and will also reveal the underlying mechanisms at work. TRIAL REGISTRATION ClinicalTrials.gov NCT02640716 . Retrospectively registered on 21 December 2015.
Collapse
Affiliation(s)
- Yi Tang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
| | - Zude Zhu
- Collaborative Innovation Center for Language Competence, Jiangsu Normal University, Xuzhou, Jiangsu, China
| | - Qing Liu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Fang Li
- Department of Geriatric Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Jianwei Yang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Fangyu Li
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Yi Xing
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Jianping Jia
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China. .,Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
35
|
De Simoni A, Shanks A, Balasooriya-Smeekens C, Mant J. Stroke survivors and their families receive information and support on an individual basis from an online forum: descriptive analysis of a population of 2348 patients and qualitative study of a sample of participants. BMJ Open 2016; 6:e010501. [PMID: 27053271 PMCID: PMC4823439 DOI: 10.1136/bmjopen-2015-010501] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To describe the characteristics of participants of an online stroke forum, their reasons for posting in the forum and whether responses addressed users' needs. METHODS Descriptive analysis of the population of 2004-2011 archives of Talkstroke, the online forum of the Stroke Association, and comparison with patients admitted to hospital with stroke (Sentinel Stroke National Audit Programme, SSNAP). Thematic analysis of posts from a sample of 59 participants representative of age at stroke and sex. SETTINGS UK. MAIN OUTCOME MEASURES Characteristics of participants: age, sex, survivor versus patient by third party, side of stroke (R, L), social class; (from the sample of 59 participants): level of disability, stroke type, classification of users' intents for writing a post in the forum, quantification of needs addressed by the forum, topics of discussion. PARTICIPANTS 2348 participants (957 stroke survivors, 1391 patients with stroke talked about by third party). RESULTS Patients of both sexes and from a wide range of ages at stroke (0 to 95 years) and degrees of disability were represented in the forum, although younger than the UK stroke population (mean age 52 years vs 77 years in SSNAP). Analysis of 841 posts showed that the main users' intents for writing in the forum were requests/offers of information and support (58%) and sharing own experiences of stroke (35%). Most information needs were around stroke-related physical impairments, understanding the cause of stroke and the potential for recovery. Up to 95% of the users' intents were met by the replies received. CONCLUSIONS Patients' needs expressed in the online forum confirm and widen the evidence from traditional research studies, showing that such forums are a potential resource for studying needs in this population. The forum provided an opportunity for patients and families to give and receive advice and social support.
Collapse
Affiliation(s)
- Anna De Simoni
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry,London, UK
| | - Andrew Shanks
- Department of Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Chantal Balasooriya-Smeekens
- Primary Care Unit, Department of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| |
Collapse
|
36
|
Blood and CSF biomarkers in brain subcortical ischemic vascular disease: Involved pathways and clinical applicability. J Cereb Blood Flow Metab 2016; 36:55-71. [PMID: 25899297 PMCID: PMC4758557 DOI: 10.1038/jcbfm.2015.68] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 12/26/2022]
Abstract
Vascular dementia is the second most common type of dementia after Alzheimer’s disease (AD). Subcortical ischemic vascular disease refers to a form of vascular cognitive impairment characterized by the presence of diffuse white matter hyperintensities (WMHs) and multiple lacunar infarcts. These neuroimaging findings are mainly caused by cerebral small-vessel disease (cSVD) and relate to aging and cognitive impairment, but they can also be silent and highly prevalent in otherwise healthy individuals. We aimed to review studies on blood and cerebrospinal fluid (CSF) markers related to the presence of WMHs and lacunar infarcts that have been conducted in the past in large population-based studies and in high-risk selected patients (such as those with vascular risk factors, vascular cognitive impairment, or AD). Relevant associations with the presence and progression of cSVD have been described in the blood for markers related to inflammatory processes, endothelial damage and coagulation/fibrinolysis processes, etc. Also, different combinations of CSF markers might help to differentiate between etiologic types of dementia. In the future, to translate these findings into clinical practice and use biomarkers to early diagnosis and monitoring vascular cognitive impairment would require the replication of candidate markers in large-scale, multicenter, and prospectively designed studies.
Collapse
|
37
|
Huang J, McCaskey MA, Yang S, Ye H, Tao J, Jiang C, Schuster-Amft C, Balzer C, Ettlin T, Schupp W, Kulke H, Chen L. Effects of acupuncture and computer-assisted cognitive training for post-stroke attention deficits: study protocol for a randomized controlled trial. Trials 2015; 16:546. [PMID: 26631161 PMCID: PMC4667410 DOI: 10.1186/s13063-015-1054-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/12/2015] [Indexed: 11/20/2022] Open
Abstract
Background A majority of stroke survivors present with cognitive impairments. Attention disturbance, which leads to impaired concentration and overall reduced cognitive functions, is strongly associated with stroke. The clinical efficacy of acupuncture with Baihui (GV20) and Shenting (GV24) as well as computer-assisted cognitive training in stroke and post-stroke cognitive impairment have both been demonstrated in previous studies. To date, no systematic comparison of these exists and the potential beneficial effects of a combined application are yet to be examined. The main objective of this pilot study is to evaluate the effects of computer-assisted cognitive training compared to acupuncture on the outcomes of attention assessments. The second objective is to test the effects of a combined cognitive intervention that incorporates computer-assisted cognitive training and acupuncture (ACoTrain). Methods/Design An international multicentre, single-blinded, randomised controlled pilot trial will be conducted. In a 1:1:1 ratio, 60 inpatients with post-stroke cognitive dysfunction will be randomly allocated into either the acupuncture group, the computer-assisted cognitive training group, or the ACoTrain group in addition to their individual rehabilitation programme. The intervention period of this pilot trial will last 4 weeks (30 minutes per day, 5 days per week, Monday to Friday). The primary outcome is the test battery for attentional performance. The secondary outcomes include the Trail Making Test, Test des Deux Barrages, National Institute of Health Stroke Scale, and Modified Barthel Index for assessment of daily life competence, and the EuroQol Questionnaire for health-related quality of life. Discussion This trial mainly focuses on evaluating the effects of computer-assisted cognitive training compared to acupuncture on the outcomes of attention assessments. The results of this pilot trial are expected to provide new insights on how Eastern and Western medicine can complement one another and improve the treatment of cognitive impairments in early stroke rehabilitation. Including patients with different cultural backgrounds allows a more generalisable interpretation of the results but also poses risks of performance bias. Using standardised and well-described assessments, validated for each region, is pivotal to allow pooling of the data. Trial registration Clinical Trails.gov ID: NCT02324959 (8 December 2014)
Collapse
Affiliation(s)
- Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China.
| | - Michael A McCaskey
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Shanli Yang
- Fujian University of Traditional Chinese Medicine Affiliated Rehabilitation Hospital, No. 282 Wusi Road, Fuzhou, 350003, Fujian Province, China.
| | - Haicheng Ye
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China.
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China. .,Fujian University of Traditional Chinese Medicine Affiliated Rehabilitation Hospital, No. 282 Wusi Road, Fuzhou, 350003, Fujian Province, China.
| | - Cai Jiang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China.
| | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Christian Balzer
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Thierry Ettlin
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Wilfried Schupp
- m&i-Fachklinik Herzogenaurach, In der Reuth 1, 91074, Herzogenaurach, Germany.
| | - Hartwig Kulke
- m&i-Fachklinik Herzogenaurach, In der Reuth 1, 91074, Herzogenaurach, Germany.
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China.
| |
Collapse
|
38
|
An Investigation of Emotion Recognition and Theory of Mind in People with Chronic Heart Failure. PLoS One 2015; 10:e0141607. [PMID: 26529409 PMCID: PMC4631439 DOI: 10.1371/journal.pone.0141607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/09/2015] [Indexed: 12/19/2022] Open
Abstract
Objectives Cognitive deficits are common in patients with chronic heart failure (CHF), but no study has investigated whether these deficits extend to social cognition. The present study provided the first empirical assessment of emotion recognition and theory of mind (ToM) in patients with CHF. In addition, it assessed whether each of these social cognitive constructs was associated with more general cognitive impairment. Methods A group comparison design was used, with 31 CHF patients compared to 38 demographically matched controls. The Ekman Faces test was used to assess emotion recognition, and the Mind in the Eyes test to measure ToM. Measures assessing global cognition, executive functions, and verbal memory were also administered. Results There were no differences between groups on emotion recognition or ToM. The CHF group’s performance was poorer on some executive measures, but memory was relatively preserved. In the CHF group, both emotion recognition performance and ToM ability correlated moderately with global cognition (r = .38, p = .034; r = .49, p = .005, respectively), but not with executive function or verbal memory. Conclusion CHF patients with lower cognitive ability were more likely to have difficulty recognizing emotions and inferring the mental states of others. Clinical implications of these findings are discussed.
Collapse
|
39
|
Development and Clinical Validity of a Mild Vascular Cognitive Impairment Assessment Tool for Korean Stroke Patients. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:226-34. [DOI: 10.1016/j.anr.2015.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 04/01/2015] [Accepted: 04/08/2015] [Indexed: 11/24/2022] Open
|
40
|
Sörös P, Harnadek M, Blake T, Hachinski V, Chan R. Executive dysfunction in patients with transient ischemic attack and minor stroke. J Neurol Sci 2015; 354:17-20. [DOI: 10.1016/j.jns.2015.04.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 03/28/2015] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
|
41
|
Frederiksen KS, Verdelho A, Madureira S, Bäzner H, O'Brien JT, Fazekas F, Scheltens P, Schmidt R, Wallin A, Wahlund LO, Erkinjunttii T, Poggesi A, Pantoni L, Inzitari D, Waldemar G. Physical activity in the elderly is associated with improved executive function and processing speed: the LADIS Study. Int J Geriatr Psychiatry 2015; 30:744-50. [PMID: 25363336 DOI: 10.1002/gps.4220] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/05/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Physical activity reduces the risk of cognitive decline but may affect cognitive domains differently. We examined whether physical activity modifies processing speed, executive function and memory in a population of non-dementia elderly subjects with age-related white matter changes (ARWMC). METHODS Data from the Leukoaraiosis And DISability (LADIS) study, a multicenter, European prospective cohort study aimed at examining the role of ARWMC in transition to disability, was used. Subjects in the LADIS study were clinically assessed yearly for 3 years including MRI at baseline and 3-year follow-up. Physical activity was assessed at baseline, and cognitive compound scores at baseline and 3-year assessment were used. RESULTS Two-hundred-eighty-two subjects (age, y (mean (SD)): 73.1 (± 5.1); gender (f/m): 164/118); MMSE (mean (SD)): 28.3 (± 1.7)) who had not progressed to MCI or dementia, were included. Multiple variable linear regression analysis with baseline MMSE, education, gender, age, stroke, diabetes and ARWMC rating as covariates revealed that physical activity was associated with better scores at baseline and 3-year follow-up for executive function (baseline: β: 0.39, 95% CI: 0.13-0.90, p = 0.008; follow-up: β: 0.24, 95% CI: 0.10-0.38, p = 0.001) and processing speed (baseline: β: 0.48, 95% CI: 0.14-0.89, p = 0.005; follow-up: β: 0.15, 95% CI: 0.02-0.29, p = 0.02) but not memory. When including baseline cognitive score as a covariate in the analysis of 3-year follow-up scores, executive function remained significant (β: 0.11, 95% CI: 0-0.22, p = 0.04). CONCLUSION Our findings confirm previous findings of a positive effect of physical activity on cognitive functions in elderly subjects, and further extends these by showing that the association is also present in patients with ARWMC.
Collapse
Affiliation(s)
- Kristian Steen Frederiksen
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ana Verdelho
- Department of Neurosciences, University of Lisbon, Santa Maria Hospital, Lisbon, Portugal
| | - Sofia Madureira
- Department of Neurosciences, University of Lisbon, Santa Maria Hospital, Lisbon, Portugal
| | - Hansjörg Bäzner
- Department of Neurology, University of Heidelberg, Klinikum Mannheim, Mannheim, Germany
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge and Cambridgeshire and Peterborough NHS Trust, Cambridge, UK
| | - Franz Fazekas
- Department of Neurology, Medical University Graz, Austria
| | - Philip Scheltens
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | | | - Anders Wallin
- Institute of Clinical Neuroscience, Göteborg University, Göteborg, Sweden
| | - Lars-Olof Wahlund
- Department of Clinical Neuroscience, NEUROTEC, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
| | - Timo Erkinjunttii
- Memory Research Unit, Department of Clinical Neurosciences, Helsinki University, Helsinki, Finland
| | - Anna Poggesi
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Leonardo Pantoni
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Domenico Inzitari
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Gunhild Waldemar
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | | |
Collapse
|
42
|
Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, Hietanen M. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol 2015; 22:1288-94. [DOI: 10.1111/ene.12743] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- H. Jokinen
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - S. Melkas
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - R. Ylikoski
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - T. Pohjasvaara
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. Kaste
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - T. Erkinjuntti
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. Hietanen
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| |
Collapse
|
43
|
Su CY, Wuang YP, Lin YH, Su JH. The role of processing speed in post-stroke cognitive dysfunction. Arch Clin Neuropsychol 2015; 30:148-60. [PMID: 25618135 DOI: 10.1093/arclin/acu057] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The association between speed of information processing and cognition has been extensively validated in normal aging and other neurocognitive disorders. Our aim was to determine whether such a relationship exists in stroke. Thirty patients and 30 age- and education-matched healthy individuals were administered a comprehensive battery of neuropsychological tests divided into the following six cognitive domains: processing speed (PS), verbal memory, visual memory, visuoperceptual function, language, and cognitive flexibility. The results demonstrate that stroke patients were characterized by cognitive deficits in almost all of these domains, but have the most pronounced deficits in PS. After adjusting for symbol digit modalities test score, all significant group differences in cognitive functioning disappeared. However, group differences remained significant after controlling for the influence of other cognitive factors. These findings suggest that decreased PS appears to underlie post-stroke cognitive dysfunction and may serve as a potential target for intervention.
Collapse
Affiliation(s)
- Chwen-Yng Su
- Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yee-Pay Wuang
- Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yueh-Hsien Lin
- Special Education Center, National Taiwan Normal University, Taipei, Taiwan
| | - Jui-Hsing Su
- Department of Rehabilitation Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| |
Collapse
|
44
|
Rawlings AM, Sharrett AR, Schneider ALC, Coresh J, Albert M, Couper D, Griswold M, Gottesman RF, Wagenknecht LE, Windham BG, Selvin E. Diabetes in midlife and cognitive change over 20 years: a cohort study. Ann Intern Med 2014; 161:785-93. [PMID: 25437406 PMCID: PMC4432464 DOI: 10.7326/m14-0737] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Type 2 diabetes is associated with dementia risk, but evidence is limited for possible associations of diabetes and prediabetes with cognitive decline. OBJECTIVE To determine whether diabetes in midlife is associated with 20-year cognitive decline and to characterize long-term cognitive decline across clinical categories of hemoglobin A1c (HbA1c) levels. DESIGN Prospective cohort study. SETTING The community-based ARIC (Atherosclerosis Risk in Communities) study. PARTICIPANTS 13,351 black and white adults aged 48 to 67 years at baseline (1990 to 1992). MEASUREMENTS Diabetes was defined by self-reported physician diagnosis or medication use or HbA1c level of 6.5% or greater. Undiagnosed diabetes, prediabetes, and glucose control in persons with diagnosed diabetes were defined by clinical categories of HbA1c level. Delayed word recall, digit symbol substitution, and word fluency tests were used to assess cognitive performance and were summarized with a global Z score. RESULTS Diabetes in midlife was associated with a 19% greater cognitive decline over 20 years (adjusted global Z-score difference, -0.15 [;95% CI, -0.22 to -0.08];) compared with no diabetes. Cognitive decline was significantly greater among persons with prediabetes (HbA1c level of 5.7% to 6.4%) than among those with an HbA1c level less than 5.7%. Participants with poorly controlled diabetes (HbA1c level ≥ 7.0%) had greater decline than those whose diabetes was controlled (adjusted global Z-score difference, -0.16; P = 0.071). Longer-duration diabetes was also associated with greater late-life cognitive decline (P for trend < 0.001). Rates of decline did not differ significantly between white and black persons (P for interaction = 0.44). LIMITATION Single HbA1c measurement at baseline, 1 test per cognitive domain, and potential geographic confounding of race comparisons. CONCLUSION Diabetes prevention and glucose control in midlife may protect against late-life cognitive decline. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
|
45
|
|
46
|
Abstract
BACKGROUND Lacunar stroke is a small (<2 cm) infarction that accounts for approximately 20% of all strokes. While a third of all stroke patients experience depressive symptoms, the prevalence of depression in the lacunar stroke patient population is unclear. This meta-analysis aimed to synthesize the evidence on the effect of lacunar stroke and deep white matter disease on depressive symptoms. METHODS A systematic search of electronic databases was conducted, resulting in the inclusion of 12 studies. Analyses were performed on the effects of lacunar stroke, volume and location of lacunes on depression prevalence, and the effect on depression severity. The effects estimates were calculated in random-effects models. RESULTS None of the analyses produced statistically significant results. Lacunar stroke patients had a non-significantly higher prevalence of depression compared to patients with non-lacunar cerebrovascular diseases (OR = 1.46, 95% CI: 0.88-2.43, p = 0.15). Neither thalamic (OR = 1.37 (0.85-2.20), p = 0.19), deep white matter (RR = 1.16 (0.85-1.57), p = 0.35), multiple lacunes (OR = 1.34 (0.81-2.22), p = 0.25), or the volume of lacunes (MD = -4.71 (-351.59-342.18), p = 0.98) had an effect on depression prevalence. Lastly, lacunar stroke did not influence depressive symptom severity (MD = 0.96 (-1.57-3.48), p = 0.46). CONCLUSIONS The pooled group of patients with lacunar stroke and deep white matter disease appear to have a similar prevalence of depression compared to those with other types of cerebrovascular diseases. However, the small number of studies, heterogeneous comparison groups, and high statistical heterogeneity between studies posed an obstacle to the meta-analysis. To determine appropriate screening and treatment approaches, future research will need to separate lacunar stroke and deep white matter disease patients, and include larger sample sizes and healthy control groups to determine their distinct contributions to depression.
Collapse
|
47
|
Xu XD, Ren HY, Prakash R, Vijayadas, Kumar R. Outcomes of neuropsychological interventions of stroke. Ann Indian Acad Neurol 2014; 16:319-28. [PMID: 24101809 PMCID: PMC3788273 DOI: 10.4103/0972-2327.116909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/12/2013] [Accepted: 07/17/2013] [Indexed: 11/23/2022] Open
Abstract
The reported prevalence of cognitive deficits within the first month of stroke ranges widely from 10% to 82%, depending primarily on the criteria used to define cognitive impairment and on the selected patient population. These cognitive defects progress toward impairment over a course of time if left untreated. Among the most common cognitive deficits are the attentional, the visuoperceptual, the memory and executive function deficits. As these impairments are being increasingly recognized in the scientific communities, more and more studies are being devoted to the outcomes of various therapies for these disorders. In this review, we focus on the outcomes of various therapies for these cognitive disorders over time. We reviewed all the possible medical databases using key words for individual cognitive deficit treatment outcomes. All the possible studies including randomized controlled trials, pre-post design studies, case series and single case reports were included in this study. On the basis of present literature review, we conclude that the evidence is definitively positive only for outcomes of attentional and visuoperceptive skill deficits. On the other hand, there have been very few studies to conclude for effectiveness of various therapies for memory and executive function outcomes.
Collapse
Affiliation(s)
- Xiao-Di Xu
- Department of Neurology, Liaocheng People's Hospital, Shandong, China
| | | | | | | | | |
Collapse
|
48
|
Melkas S, Jokinen H, Hietanen M, Erkinjuntti T. Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment. Degener Neurol Neuromuscul Dis 2014; 4:21-27. [PMID: 32669898 PMCID: PMC7337160 DOI: 10.2147/dnnd.s37353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/26/2013] [Indexed: 12/21/2022] Open
Abstract
Three aspects of poststroke cognitive impairment and dementia are discussed in this review: prevalence; diagnosis; and treatment. The aim is to increase awareness of poststroke cognitive impairment in order to further stimulate strategies to recognize the condition and to prevent its progression. Approximately two-thirds of all middle-aged and elderly stroke patients develop cognitive impairment, and one in three develops dementia. The standard reference for diagnosis is a detailed neuropsychological examination. Short screening tests have been used for both clinical and research purposes, but their sensitivity is limited and there is no consensus as to which test is the most appropriate. The treatment of poststroke cognitive impairment and dementia is based on effective treatment of vascular risk factors, including lifestyle modification when needed.
Collapse
Affiliation(s)
- Susanna Melkas
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Hanna Jokinen
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Marja Hietanen
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Timo Erkinjuntti
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| |
Collapse
|
49
|
Xu Q, Cao WW, Mi JH, Yu L, Lin Y, Li YS. Brief Screening for Mild Cognitive Impairment in Subcortical Ischemic Vascular Disease: A Comparison Study of the Montreal Cognitive Assessment with the Mini-Mental State Examination. Eur Neurol 2014; 71:106-14. [DOI: 10.1159/000353988] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 06/23/2013] [Indexed: 11/19/2022]
|
50
|
Impaired executive function following ischemic stroke in the rat medial prefrontal cortex. Behav Brain Res 2014; 258:106-11. [DOI: 10.1016/j.bbr.2013.10.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/06/2013] [Accepted: 10/11/2013] [Indexed: 11/23/2022]
|