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Muir RT, Smith EE. The Spectrum of Cerebral Small Vessel Disease: Emerging Pathophysiologic Constructs and Management Strategies. Neurol Clin 2024; 42:663-688. [PMID: 38937035 DOI: 10.1016/j.ncl.2024.03.003] [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] [Indexed: 06/29/2024]
Abstract
Cerebral small vessel disease (CSVD) is a spectrum of disorders that affect small arterioles, venules, cortical and leptomeningeal vessels, perivascular spaces, and the integrity of neurovascular unit, blood brain barrier, and surrounding glia and neurons. CSVD is an important cause of lacunar ischemic stroke and sporadic hemorrhagic stroke, as well as dementia-which will constitute some of the most substantive population and public health challenges over the next century. This article provides an overview of updated pathophysiologic frameworks of CSVD; discusses common and underappreciated clinical and neuroimaging manifestations of CSVD; and reviews emerging genetic risk factors linked to sporadic CSVD.
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Affiliation(s)
- Ryan T Muir
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.
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Song Y, Zhou J, Tan Y, Wu Y, Liu M, Cheng Y. Risk Factors and Clinical Significance of Ultra-Long-Term Microischemia After Intracranial Aneurysm Embolization. Neurol Ther 2024; 13:1173-1190. [PMID: 38814531 PMCID: PMC11263440 DOI: 10.1007/s40120-024-00630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION This study aimed to explore influencing factors and clinical significance of ultra-long-term microischemia following intracranial aneurysm (IA) embolization and establish a theoretical foundation for reducing both the incidence of ultra-long-term microischemia and cognitive dysfunction in patients post embolization. METHODS A retrospective analysis was conducted on data from 147 patients who received endovascular treatment for IAs. Patients were categorized into microischemic and control (non-microischemic) groups on the based on the findings of high-resolution magnetic resonance vessel wall imaging (HR-VWI) examinations performed 3 days postoperatively and 6 months postoperatively. Risk factors for the occurrence of ultra-long-term microischemia were determined by univariate analysis and multivariate logistic regression analysis. RESULTS Out of 147 patients included in the study, 51 (34.69%) developed microischemia while the remaining 96 (65.31%) did not experience this condition. Analysis revealed that factors such as sex, age, history of underlying diseases (hypertension, diabetes mellitus), aneurysmal site characteristics, the presence or absence of stenosis in the aneurysm-bearing artery, modified Fisher score at admission, Barthel's index at discharge, immunoinflammatory index at 3 days postoperatively and at the 6-month follow-up, the presence or absence of aneurysmal wall enhancement, and the presence or absence of aneurysmal lumen showed no statistically significant differences between the two groups (all P > 0.05). By contrast, variables like in operative time, rupture status of the aneurysm before surgery according to World Federation of Neurologic Surgeons (WFNS) grade, aneurysm size, number of stents used, number of guidewires and catheters used, and Evans index between the two groups were found to have statistically significant disparities between those who developed microischemia and those who did not (P < 0.05). A subsequent multivariate analysis revealed that aneurysm size, Evans index, and the number of stents used were independent risk factors for the occurrence of ultra-long-term microischemia after surgical intervention of aneurysms (P < 0.05). The receiver operating characteristic (ROC) curves of the patients were constructed on the basis of risk factors determined through multivariate logistic regression analysis. Results indicated that aneurysm size (area under ROC curve (AUC) 0.619, sensitivity 94.7%, specificity 17.1%, P = 0.049), Evans index (AUC 0.670, sensitivity 96.4%, specificity 26.8%, P = 0.004), and number of stents (AUC 0.639, sensitivity 44.6%, specificity 90.2%, P < 0.001) effectively predicted the occurrence of microischemia. The incidence of cognitive dysfunction was higher in the microischemic group than in the control group (P < 0.05), and a greater number of microischemic foci was associated with a higher incidence of cognitive dysfunction. The proportion of microschemia foci in the thalamus and basal ganglia in patients with cognitive dysfunction (60.87%) was significantly higher than that in patients without cognitive dysfunction (34.55%) (P < 0.05). CONCLUSION Aneurysm size, Evans index > 0.3, and the quantity of stents were independent risk factors for the occurrence of ultra-long-term microischemia after aneurysm embolization and provided good predictive performance. Cognitive dysfunction was closely associated with microischemia, with its severity increasing with an increase in the number of ischemic foci.
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Affiliation(s)
- Yi Song
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, No. 74, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Jianxin Zhou
- Department of Neurosurgery, Chongqing University Three Gorges Hospital, No. 165 Xincheng Road, Wanzhou District, Chongqing, 404000, China
| | - Yun Tan
- Department of Neurosurgery, Chongqing University Three Gorges Hospital, No. 165 Xincheng Road, Wanzhou District, Chongqing, 404000, China
| | - Yao Wu
- Department of Neurosurgery, Chongqing University Three Gorges Hospital, No. 165 Xincheng Road, Wanzhou District, Chongqing, 404000, China
| | - Mingdong Liu
- Department of Neurosurgery, Chongqing University Three Gorges Hospital, No. 165 Xincheng Road, Wanzhou District, Chongqing, 404000, China
| | - Yuan Cheng
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, No. 74, Linjiang Road, Yuzhong District, Chongqing, 400010, China.
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Fleischman DA, Arfanakis K, Leurgans SE, Arvanitakis Z, Lamar M, Han SD, Poole VN, Bennett DA, Barnes LL. Cerebral arteriolosclerosis, lacunar infarcts, and cognition in older Black adults. Alzheimers Dement 2024; 20:5375-5384. [PMID: 38988020 PMCID: PMC11350059 DOI: 10.1002/alz.13917] [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: 02/12/2024] [Revised: 04/05/2024] [Accepted: 05/01/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Older Black adults are at risk of cerebral small vessel disease (CSVD), which contributes to dementia risk. Two subtypes of CSVD, arteriolosclerosis and ischemic lacunar infarcts, have been independently linked to lower cognition and higher dementia risk, but their combined effects on cognition in older Black adults are unclear. METHODS Mixed models were used to examine the associations of in vivo measures of arteriolosclerosis (ARTS) and ischemic lacunar infarcts to cognitive level and change in 370 older Black adults without dementia. RESULTS: Modeled together, higher ARTS load accounted for lower levels of global cognition, episodic memory, semantic memory, and perceptual speed, whereas higher infarct load accounted for lower levels of working memory. There were no associations with rate of cognitive change. DISCUSSION Both arteriolosclerosis and ischemic infarcts impact the cognitive health of older Black adults, but arteriolosclerosis affects cognition more broadly and offers promise as an in vivo biomarker of dementia risk. HIGHLIGHTS Older Black adults are at risk of cerebral small vessel disease (CSVD) and dementia. Examined magnetic resonance imaging-derived measure of arteriolosclerosis (ARTS), infarcts, and cognition. ARTS load was widely associated with lower cognition after adjusting for infarct load. Infarct load was specifically associated with lower complex attention. More within-Black in vivo studies of CSVD subtypes and cognition are needed.
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Affiliation(s)
- Debra A. Fleischman
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Diagnostic Radiology and Nuclear MedicineRush University Medical CenterChicagoIllinoisUSA
- Department of Biomedical EngineeringIllinois Institute of TechnologyChicagoIllinoisUSA
| | - Sue E. Leurgans
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Department of Family & Preventive MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Zoe Arvanitakis
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Melissa Lamar
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
| | - S. Duke Han
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Victoria N. Poole
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - David A. Bennett
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Lisa L. Barnes
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
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Seidel F, Fluiter K, Kleemann R, Worms N, van Nieuwkoop A, Caspers MPM, Grigoriadis N, Kiliaan AJ, Baas F, Michailidou I, Morrison MC. Ldlr-/-.Leiden mice develop neurodegeneration, age-dependent astrogliosis and obesity-induced changes in microglia immunophenotype which are partly reversed by complement component 5 neutralizing antibody. Front Cell Neurosci 2023; 17:1205261. [PMID: 37457817 PMCID: PMC10346859 DOI: 10.3389/fncel.2023.1205261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Obesity has been linked to vascular dysfunction, cognitive impairment and neurodegenerative diseases. However, experimental models that recapitulate brain pathology in relation to obesity and vascular dysfunction are still lacking. Methods In this study we performed the histological and histochemical characterization of brains from Ldlr-/-.Leiden mice, an established model for obesity and associated vascular disease. First, HFD-fed 18 week-old and 50 week-old Ldlr-/-.Leiden male mice were compared with age-matched C57BL/6J mice. We then assessed the effect of high-fat diet (HFD)-induced obesity on brain pathology in Ldlr-/-.Leiden mice and tested whether a treatment with an anti-complement component 5 antibody, a terminal complement pathway inhibitor recently shown to reduce vascular disease, can attenuate neurodegeneration and neuroinflammation. Histological analyses were complemented with Next Generation Sequencing (NGS) analyses of the hippocampus to unravel molecular pathways underlying brain histopathology. Results We show that chow-fed Ldlr-/-.Leiden mice have more severe neurodegeneration and show an age-dependent astrogliosis that is not observed in age-matched C57BL/6J controls. This was substantiated by pathway enrichment analysis using the NGS data which showed that oxidative phosphorylation, EIF2 signaling and mitochondrial dysfunction pathways, all associated with neurodegeneration, were significantly altered in the hippocampus of Ldlr-/-.Leiden mice compared with C57BL/6J controls. Obesity-inducing HFD-feeding did not aggravate neurodegeneration and astrogliosis in Ldlr-/-.Leiden mice. However, brains from HFD-fed Ldlr-/-.Leiden mice showed reduced IBA-1 immunoreactivity and increased CD68 immunoreactivity compared with chow-fed Ldlr-/-.Leiden mice, indicating alteration of microglial immunophenotype by HFD feeding. The systemic administration of an anti-C5 treatment partially restored the HFD effect on microglial immunophenotype. In addition, NGS data of hippocampi from Ldlr-/-.Leiden mice showed that HFD feeding affected multiple molecular pathways relative to chow-fed controls: HFD notably inactivated synaptogenesis and activated neuroinflammation pathways. The anti-C5 treatment restored the HFD-induced effect on molecular pathways to a large extent. Conclusion This study shows that the Ldlr-/-.Leiden mouse model is suitable to study brain histopathology and associated biological processes in a context of obesity and provides evidence of the potential therapeutic value of anti-complement therapy against obesity-induced neuroinflammation.
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Affiliation(s)
- Florine Seidel
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Leiden, Netherlands
- Department of Medical Imaging, Anatomy, Preclinical Imaging Center (PRIME), Radboud Alzheimer Center, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kees Fluiter
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Robert Kleemann
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Nicole Worms
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Anita van Nieuwkoop
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Martien P. M. Caspers
- Department of Microbiology and Systems Biology, Netherlands Organisation for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Nikolaos Grigoriadis
- Laboratory of Experimental Neurology and Neuroimmunology and the Multiple Sclerosis Center, 2 Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Amanda J. Kiliaan
- Department of Medical Imaging, Anatomy, Preclinical Imaging Center (PRIME), Radboud Alzheimer Center, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Iliana Michailidou
- Laboratory of Experimental Neurology and Neuroimmunology and the Multiple Sclerosis Center, 2 Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martine C. Morrison
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Leiden, Netherlands
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Chen K, Jin Z, Fang J, Qi L, Liu C, Wang R, Su Y, Yan H, Liu A, Xi J, Fang B. Lacunes may worsen cognition but not motor function in Parkinson's disease. Brain Behav 2023; 13:e2880. [PMID: 36586096 PMCID: PMC9927847 DOI: 10.1002/brb3.2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/28/2022] [Accepted: 12/18/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND As one of the imaging markers of cerebral small vessel disease, lacunes has received little attention. The objective of this study was to investigate the associations of lacunes, cognition and motor function in patients with Parkinson's disease (PD) and whether these associations are independent of other imaging markers. METHODS Patients were consecutively included from April 2019 to July 2022 in Beijing Rehabilitation Hospital. All patients underwent brain magnetic resonance imaging scans, clinical scale evaluations, and neuropsychological tests, as well as quantitative evaluation of postural control. To eliminate the possible factors contributing to cognition and motor dysfunction in patients with PD, in particular white matter hyperintensities and enlarged perivascular space in the basal ganglia, multivariate linear regression models were constructed to sort out the effect of lacunes. RESULTS Ninety-four patients were included in this study, 56 without lacunes and 38 with lacunes. Patients with lacunes showed shorter disease duration, slower gait speed and spent more time on Trail-Making Test part A (TMT-A) than those without lacunes. The number of lacunes were positively correlated with the time to complete the TMT-A and negatively related to gait speed. Multivariate linear regression models showed that the presence of lacunes was associated with longer TMT-A time after adjusting for potential confounders. CONCLUSIONS Lacunes were independently associated with worse visual scanning, attention, and processing speed in patients with PD. In addition, lacunes may accelerate the course of PD. Early treatment of vascular disease provides an alternate way to mitigate some motor and cognitive dysfunction in patients with PD.
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Affiliation(s)
- Keke Chen
- School of Beijing Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Zhaohui Jin
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jinping Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lin Qi
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Cui Liu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Ruidan Wang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuan Su
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Hongjiao Yan
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Aixian Liu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jianing Xi
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Boyan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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Chen X, Luo Y, Zhang S, Yang X, Dong Z, Wang Y, Wu D. Deep medullary veins: a promising neuroimaging marker for mild cognitive impairment in outpatients. BMC Neurol 2023; 23:3. [PMID: 36604624 PMCID: PMC9814341 DOI: 10.1186/s12883-022-03037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Mild cognitive impairment is an age-dependent pre-dementia state caused by varied reasons. Early detection of MCI helps handle dementia. Vascular factors are vital for the occurrence of MCI. This study investigates the correlation between deep medullary veins and multi-dimensional cognitive outcomes. MATERIALS AND METHODS A total of 73 participants with MCI and 32 controls were enrolled. Minimum Mental State Examination and Montreal Cognitive Assessment were used to examine the global cognitive function, and different cognitive domains were measured by specific neuropsychological tests. MRI was used to assess the visibility of the DMV and other neuroimage markers. RESULTS DMV score was statistically significantly higher in the MCI group compared with the control group (P = 0.009) and independently related to MCI (P = 0.007). Linear regression analysis verified that DMV score was linearly related to global cognition, memory, attention, and executive function after adjusting for cerebrovascular risk factors. CONCLUSION DMV score was independently related to the onset of MCI, and correlates with overall cognition, memory, attention, and executive function in outpatients.
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Affiliation(s)
- Xiuqi Chen
- grid.8547.e0000 0001 0125 2443Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, No.801, He Qing Road, Minhang District, Shanghai, China
| | - Yufan Luo
- grid.8547.e0000 0001 0125 2443Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, No.801, He Qing Road, Minhang District, Shanghai, China
| | - Shufan Zhang
- grid.8547.e0000 0001 0125 2443Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, No.801, He Qing Road, Minhang District, Shanghai, China ,grid.8547.e0000 0001 0125 2443Department of Neurology, Shanghai Jing’an District Central Hospital, Fudan University, Shanghai, China
| | - Xiaoli Yang
- grid.8547.e0000 0001 0125 2443Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, No.801, He Qing Road, Minhang District, Shanghai, China
| | - Zhiyuan Dong
- grid.8547.e0000 0001 0125 2443Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, No.801, He Qing Road, Minhang District, Shanghai, China
| | - Yilin Wang
- Georgetown Preparatory School, North Bethesda, MD Washington, USA
| | - Danhong Wu
- grid.8547.e0000 0001 0125 2443Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, No.801, He Qing Road, Minhang District, Shanghai, China
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Li X, Yang S, Li Y, Qin W, Yang L, Yuan J, Hu W. The performance of patients with cerebral microbleeds in different cognitive tests: A cross-sectional study. Front Aging Neurosci 2023; 15:1114426. [PMID: 37113576 PMCID: PMC10126261 DOI: 10.3389/fnagi.2023.1114426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
Background The clinical features and pathological process of cerebral microbleed (CMB)-related cognitive impairment are hot topics of cerebral small vessel disease (CSVD). However, how to choose a more suitable cognitive assessment battery for CMB patients is still an urgent issue to be solved. This study aimed to analyze the performance of CMB patients on different cognitive tests. Methods This study was designed as a cross-sectional study. The five main markers of CSVD (including the CMB, white matter hyperintensities, perivascular spaces, lacunes and brain atrophy) were assessed according to magnetic resonance imaging. The burden of CMB was categorized into four grades based on the total number of lesions. Cognitive function was assessed by Mini-Mental State Examination (MMSE), Trail-Making Test (TMT, Part A and Part B), Stroop color-word test (Stroop test, Part A, B and C), Verbal Fluency Test (VF, animal), Digit-Symbol Substitution Test (DSST), Digit Cancellation Test (DCT) and Maze. Multiple linear regression analysis was conducted to analyze the association between CMB and cognitive findings. Results A total of 563 participants (median age of 69 years) were enrolled in this study, including 218 (38.7%) CMB patients. CMB patients showed worse performance than non-CMB subjects in each cognitive test. Correlation analysis indicated the total number of CMB lesions had positive correlations with the time of TMT, Maze and Stroop test, and negative correlations with the performance of MMSE, VF, DSST, and DCT. After the adjustment for all the potential confounders by linear regression, the CMB burden grade was correlated with the performance of VF, Stroop test C, Maze and DCT. Conclusion The presence of CMB lesions was associated with much worse cognitive performances. In VF, Stroop test C, Maze and DCT, the correlations between CMB severity and assessment results were more significant. Our study further confirmed that the attention/executive function domain was the most commonly evaluated in CMB, which provided a picture of the most utilized tools to analyze the prognostic and diagnostic value in CMB.
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Affiliation(s)
- Xuanting Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Junliang Yuan
- Department of Neurology, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- Junliang Yuan,
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Wenli Hu,
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Hu W, Guo X, Du Y. Lacunar infarction aggravates the cognitive deficit in the elderly with white matter lesion. Open Life Sci 2022; 17:272-278. [PMID: 35415240 PMCID: PMC8951199 DOI: 10.1515/biol-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/02/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
Cerebral white matter lesion (WML) and lacunar infarction (LI) were primary causes of cognitive deficit. Our study aimed to investigate the correlation between LI and cognitive deficit in the elderly with WML. A total of 118 participants (96 WML patients and 22 controls) were consecutively enrolled according to neuroimaging diagnosis of magnetic resonance imaging for this retrospective study. Neuroimaging evaluation and cognitive function assessment were analyzed. Compared with the controls, moderate and severe WML groups had significantly lower scores of Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA). Most cognitive domains of MOCA scores decreased, corresponding to the severity of WMLs. While there was no significant difference in score of MMSE between deep WML (DWML) and periventricular WML (PVL) groups, the scores of visuospatial/executive and naming function domains of MOCA appeared to be low in the DWML group. The scores of MMSE and MOCA were higher in only WMLs (WML−) group than WMLs combined with LIs (WML+) group, except for the naming cognitive domain. Moreover, LIs were independently correlated with the cognitive deficit in the elderly with WMLs. In the elderly with WMLs, the presence of LIs is associated with further aggravation of cognitive deficit.
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Affiliation(s)
- Wenjun Hu
- Department of General Practice, Central Hospital Affiliated to Shandong First Medical University , Jinan , Shandong Province 250013 , China
| | - Xing Guo
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University , Jinan , Shandong Province , China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , Shandong , China
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Samartsev I, Zhivolupov S, Efimtsev A, Ponomarev V. Analysis of the correlation between neuroimaging markers of the brain damage and the severity of postural instability in patients with chronic cerebrovascular insufficiency (NEMAN open observational study). Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:66-73. [DOI: 10.17116/jnevro202212207166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wang Q, Su N, Huang J, Liang X, Yuan J, Yao M, Zhou LX, Jin ZY, Zhang SY, Cui LY, Gong G, Tian F, Zhu YC, Ni J. White Matter but not Gray Matter Volumes Are Associated with Cognition in Community-Dwelling Chinese Populations. J Alzheimers Dis 2021; 84:367-375. [PMID: 34542069 DOI: 10.3233/jad-210367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies have investigated the association between cognition and brain volume associated with cerebral small vessel disease (CSVD). OBJECTIVE We investigated the association between cognition and brain volume and neuroimaging markers of CSVD in a community-dwelling population. METHODS Participants (n = 993, age≥35 years) from the community-based Shunyi Study were included to investigate the association between neuroimaging markers and cognition cross-sectionally. Magnetic resonance imaging markers included brain volume measurements of the total cerebrum, white matter, gray matter, and CSVD imaging markers. Cognitive performance was assessed using neuropsychological tests of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Fuld Object Memory, digit span, Trail Making Test (TMT)-A, and TMT-B. RESULTS For brain volume measurement, subcortical white matter fraction was positively associated with MMSE score (β= 0.034, p = 0.0062) and MoCA score (β= 0.034, p = 0.0174), and negatively associated with TMT-A and TMT-B completion time (β= -2.319, p = 0.0002; β= -2.827, p = 0.0073, respectively). For evaluation of CSVD imaging markers, the presence of lacunes was positively associated with TMT-B completion time (β= 17.241, p = 0.0028). CONCLUSION In community-dwelling populations, reduced white matter volumes, as a consequence of aging and vascular damage, are associated with worse global cognition and executive function. Our findings provide potential insights into the correlation between cognition and CSVD-associated subcortical white matter injury.
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Affiliation(s)
- Quan Wang
- Department of Neurology , State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Su
- Department of Neurology , State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Huang
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Xinyu Liang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Jing Yuan
- Department of Neurology , State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology , State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Xin Zhou
- Department of Neurology , State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Ying Cui
- Department of Neurology , State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gaolang Gong
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Feng Tian
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology , State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology , State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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11
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Hamilton OKL, Backhouse EV, Janssen E, Jochems ACC, Maher C, Ritakari TE, Stevenson AJ, Xia L, Deary IJ, Wardlaw JM. Cognitive impairment in sporadic cerebral small vessel disease: A systematic review and meta-analysis. Alzheimers Dement 2021; 17:665-685. [PMID: 33185327 PMCID: PMC8593445 DOI: 10.1002/alz.12221] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 02/08/2020] [Accepted: 05/10/2020] [Indexed: 01/09/2023]
Abstract
This paper is a proposal for an update on the characterization of cognitive impairments associated with sporadic cerebral small vessel disease (SVD). We pose a series of questions about the nature of SVD-related cognitive impairments and provide answers based on a comprehensive review and meta-analysis of published data from 69 studies. Although SVD is thought primarily to affect executive function and processing speed, we hypothesize that SVD affects all major domains of cognitive ability. We also identify low levels of education as a potentially modifiable risk factor for SVD-related cognitive impairment. Therefore, we propose the use of comprehensive cognitive assessments and the measurement of educational level both in clinics and research settings, and suggest several recommendations for future research.
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Affiliation(s)
- Olivia KL Hamilton
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Dementia Research Institute, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Lothian Birth Cohorts, University of Edinburgh, 7 George Square, Edinburgh, UK, EH8 9JZ
| | - Ellen V Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Dementia Research Institute, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
| | - Esther Janssen
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Dementia Research Institute, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
| | - Angela CC Jochems
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Dementia Research Institute, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
| | - Caragh Maher
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Dementia Research Institute, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
| | - Tuula E Ritakari
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Dementia Research Institute, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
| | - Anna J Stevenson
- Dementia Research Institute, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, UK, EH4 2XU
- Centre for Discovery Brain Sciences, University of Edinburgh, Hugh Robson Building, 15 George Square, Edinburgh, UK, EH8 9XD
| | - Lihua Xia
- Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, UK, EH8 9JZ
| | - Ian J Deary
- Lothian Birth Cohorts, University of Edinburgh, 7 George Square, Edinburgh, UK, EH8 9JZ
- Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, UK, EH8 9JZ
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Dementia Research Institute, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB
- Lothian Birth Cohorts, University of Edinburgh, 7 George Square, Edinburgh, UK, EH8 9JZ
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12
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Liu J, Zhao W, Gui Q, Zhang Y, Guo Z, Liu W. Addition of Aβ 42 to Total Cerebral Small Vessel Disease Score Improves the Prediction for Cognitive Impairment in Cerebral Small Vessel Disease Patients. Neuropsychiatr Dis Treat 2021; 17:195-201. [PMID: 33531808 PMCID: PMC7846822 DOI: 10.2147/ndt.s289357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/24/2020] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To investigate the associations between concentrations of Aβ40 and Aβ42 and vascular cognitive impairment (VCI) in cerebral small vessel disease (CSVD) patients and evaluate the value of combination of levels of Aβ40 or Aβ42 and the total CSVD score in predicting VCI. PATIENTS AND METHODS A total of 199 CSVD patients were divided into VCI group and non-VCI group according to the criteria of VCI. Demographic data, MRI markers of CSVD, blood pressure, vascular risk factors, laboratory markers, and serum Aβ40 and Aβ42 concentration were collected. Univariate analysis was performed with the Student's t-test, Mann-Whitney U-test or Chi-square test. Variables with P<0.10 in univariate analysis were then included in multivariate analysis that used a backward stepwise logistic regression model. The predictive values were assessed with receiver operating characteristic (ROC) curve. RESULTS VCI was determined in 112 CSVD patients (56.3%). Hyperlipidemia (OR: 1.618, 95% CI: 1.265-3.049), the total CSVD score (OR: 1.414, 95% CI: 1.213-2.278) and serum Aβ42 concentration (OR: 1.401, 95% CI: 1.212-1.946) were independent risk factors for VCI in CSVD patients with adjustment for age, education years, diabetes and fasting blood-glucose (FBG). The area under curves (AUCs) were 0.640 (SE: 0.040, 95% CI: 0.563-0.718), 0.733 (SE: 0.035, 95% CI: 0.664-0.802) and 0.827 (SE: 0.030, 95% CI: 0.768-0.887), respectively, for the total CSVD score, serum Aβ42 concentration and their combination applied in predicting VCI in CSVD patients. Z test demonstrated that the AUC of combination prediction was significantly higher than individual prediction (0.827 vs 0.640, Z=3.740, P<0.001; 0.827 vs 0.733, Z=2.039, P=0.021). CONCLUSION Combination of Aβ42 and total CSVD score could significantly elevate the predictive value of cognitive impairment in CSVD patients.
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Affiliation(s)
- Jianping Liu
- Department of Neurology, Tianjin TEDA Hospital, Tianjin300457, People’s Republic of China
| | - Weihua Zhao
- Department of Neurosurgery, Tianjin TEDA Hospital, Tianjin300457, People’s Republic of China
| | - Qinghong Gui
- Department of Neurology, Tianjin TEDA Hospital, Tianjin300457, People’s Republic of China
| | - Ying Zhang
- Department of Neurology, Tianjin TEDA Hospital, Tianjin300457, People’s Republic of China
| | - Zaiyu Guo
- Department of Neurosurgery, Tianjin TEDA Hospital, Tianjin300457, People’s Republic of China
| | - Wei Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin300052, People’s Republic of China
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13
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Sharma MJ, Callahan BL. Cerebrovascular and Neurodegenerative Pathologies in Long-Term Stable Mild Cognitive Impairment. J Alzheimers Dis 2021; 79:1269-1283. [PMID: 33427736 DOI: 10.3233/jad-200829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is considered by some to be a prodromal phase of a progressive disease (i.e., neurodegeneration) resulting in dementia; however, a substantial portion of individuals (ranging from 5-30%) remain cognitively stable over the long term (sMCI). The etiology of sMCI is unclear but may be linked to cerebrovascular disease (CVD), as evidence from longitudinal studies suggest a significant proportion of individuals with vasculopathy remain stable over time. OBJECTIVE To quantify the presence of neurodegenerative and vascular pathologies in individuals with long-term (>5-year) sMCI, in a preliminary test of the hypothesis that CVD may be a contributor to non-degenerative cognitive impairment. We expect frequent vasculopathy at autopsy in sMCI relative to neurodegenerative disease, and relative to individuals who convert to dementia. METHODS In this retrospective study, using data from the National Alzheimer's Coordinating Center, individuals with sMCI (n = 28) were compared to those with MCI who declined over a 5 to 9-year period (dMCI; n = 139) on measures of neurodegenerative pathology (i.e., Aβ plaques, neurofibrillary tangles, TDP-43, and cerebral amyloid angiopathy) and CVD (infarcts, lacunes, microinfarcts, hemorrhages, and microbleeds). RESULTS Alzheimer's disease pathology (Aβ plaques, neurofibrillary tangles, and cerebral amyloid angiopathy) was significantly higher in the dMCI group than the sMCI group. Microinfarcts were the only vasculopathy associated with group membership; these were more frequent in sMCI. CONCLUSION The most frequent neuropathology in this sample of long-term sMCI was microinfarcts, tentatively suggesting that silent small vessel disease may characterize non-worsening cognitive impairment.
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Affiliation(s)
- Manu J Sharma
- Department of Psychology, University of Calgary, Calgary (AB), Canada
- Hotchkiss Brain Institute, Calgary (AB), Canada
| | - Brandy L Callahan
- Department of Psychology, University of Calgary, Calgary (AB), Canada
- Hotchkiss Brain Institute, Calgary (AB), Canada
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14
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Perna R, Harik L. The role of rehabilitation psychology in stroke care described through case examples. NeuroRehabilitation 2020; 46:195-204. [PMID: 32083601 DOI: 10.3233/nre-192970] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A stroke event, sometimes referred to as a cerebrovascular accident (CVA), is a sudden and often traumatic life event that results in life-changing consequences with which affected people must cope. There are nearly 800,000 instances of stroke annually in the U.S. (American Heart Association, 2018). Stroke is the leading cause of disability in adults, and more than one-third of people who survive a stroke will have severe disability in the U.S. (Mayo, 2005). Between 35% and 75% of stroke survivors will have significant cognitive impairment (Tatemichi et al., 1994; Nys et al., 2007). An estimated one-third of people suffer depression after stroke (Hackett et al., 2005), about one-fourth experience significant anxiety (Barker-Collo, 2007), and about one-fifth suffer from insomnia (Leppavuoria et al., 2002). These and other stroke-related psychological issues negatively influence rehabilitation and outcomes through a variety of mechanisms. For example, post-stroke depression has been shown to be related to more negative functional consequences (Kneebone et al., 2000; Matsuzaki et al., 2015). Psychological disturbances may affect rehabilitation outcomes through a reduction in adherence to home exercise programs, reduced energy level, increased fatigue, reduced frustration tolerance, and potentially less motivation and hope about the future. OBJECTIVES This manuscript aims to identify and describe the role of rehabilitation psychology in treating these common post-stroke complaints and, ultimately, optimizing post-stroke outcomes via two case examples. METHODOLOGY This manuscript describes two cases of individuals in post-acute rehabilitation who had psychological issues which were negatively affecting outcomes. CONCLUSION Given the abrupt and significant life-changing nature of stroke, it is often necessary to manage a diverse array of psychological issues that often cannot be simply managed via psychotropic medications. Moreover, an understanding of the patients' emotional adjustment and issues can help them maximize their rehabilitation, recovery, and community integration. For the cases discussed, psychology consultations were central in helping optimize their rehabilitation and functional outcomes.
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15
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Network topology and machine learning analyses reveal microstructural white matter changes underlying Chinese medicine Dengzhan Shengmai treatment on patients with vascular cognitive impairment. Pharmacol Res 2020; 156:104773. [PMID: 32244028 DOI: 10.1016/j.phrs.2020.104773] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
Abstract
With the increasing incidence of cerebrovascular diseases and dementia, considerable efforts have been made to develop effective treatments on vascular cognitive impairment (VCI), among which accumulating practice-based evidence has shown great potential of the traditional Chinese medicine (TCM). Current randomized double-blind controlled trial has been designed to evaluate the 6-month treatment effects of Dengzhan Shengmai (DZSM) capsules, one TCM herbal preparations on VCI, and to explore the underlying neural mechanisms with graph theory-based analysis and machine learning method based on diffusion tensor imaging (DTI) data. A total of 82 VCI patients were recruited and randomly assigned to drug (45 with DZSM) and placebo (37 with placebo) groups, and neuropsychological and neuroimaging data were acquired at baseline and after 6-month treatment. After treatment, compared to the placebo group, the drug groups showed significantly improved performance in Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-cog) score (p < 0.001) and the other cognitive domains. And with the reconstruction of white matter structural network, there were more streamlines connecting the left thalamus and right hippocampus in the drug groups (p < 0.001 uncorrected), with decreasing nodal efficiency of the right olfactory associated with slower decline in the general cognition (r = -0.364, p = 0.048). Moreover, support vector machine classification analyses revealed significant white matter network alterations after treatment in the drug groups (accuracy of baseline vs. 6-month later, 68.18 %). Taking together, the present study showed significant efficacy of DZSM treatment on VCI, which might result from white matter microstructure alterations and the topological changes in brain structural network.
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16
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Chabriat H, Jouvent E. Imaging of the aging brain and development of MRI signal abnormalities. Rev Neurol (Paris) 2020; 176:661-669. [PMID: 32229042 DOI: 10.1016/j.neurol.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 02/04/2023]
Abstract
Major changes occur at the cerebral level with aging. Cerebral atrophy develops progressively. Multiple lesions related to small-vessel diseases are detected in association with cerebral atrophy including white-matter hyperintensities, lacunes, microbleeds, dilated perivascular spaces and cerebral, including cortex, atrophy. The clinical impact and predictive value of these Imaging makers were examined.
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Affiliation(s)
- H Chabriat
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France.
| | - E Jouvent
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France
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17
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Li CC, Chen WX, Wang J, Xia M, Jia ZC, Guo C, Tang XQ, Li MX, Yin Y, Liu X, Feng H. Nicotinamide riboside rescues angiotensin II-induced cerebral small vessel disease in mice. CNS Neurosci Ther 2020; 26:438-447. [PMID: 31943833 PMCID: PMC7080427 DOI: 10.1111/cns.13276] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/08/2019] [Accepted: 11/23/2019] [Indexed: 12/20/2022] Open
Abstract
Aims Hypertension is a leading cause of cerebral small vessel disease (CSVD). Currently, treatments for CSVD are limited. Nicotinamide riboside (NR) can protect against vascular injury and cognitive impairment in neurodegenerative diseases. In this study, the protective effects of NR against angiotensin ‐ (Ang ‐)–induced CSVD were evaluated. Methods To explore the effects of NR in CSVD, C57BL/6 mice were infused with Ang ‐, and NR was added to the food of the mice for 28 days. Then, short‐term memory, blood‐brain barrier (BBB) integrity, and endothelial function were detected. Arteriole injury and glial activation were also evaluated. Results Our data showed that mice infused with Ang ‐ exhibited decreased short‐term memory function and BBB leakage due to decreased claudin‐5 expression and increased caveolae‐mediated endocytosis after 28 days. Furthermore, Ang ‐ decreased the expression of α‐smooth muscle actin (α‐SMA) and increased the expression of proliferating cell nuclear antigen (PCNA) in arterioles and decreased the expression of neurofilament 200 (NF200) and myelin basic protein (MBP) in the white matter. These CSVD‐related damages induced by Ang ‐ were inhibited by NR administration. Moreover, NR administration significantly reduced glial activation around the vessels. Conclusion Our results indicated that NR administration alleviated Ang ‐–induced CSVD by protecting BBB integrity, vascular remodeling, neuroinflammation, and white matter injury (WMI)–associated cognitive impairment.
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Affiliation(s)
- Cheng-Cheng Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,State Key Laboratory of Silkworm Genome Biology, Southwest University, Chongqing, China
| | - Wei-Xiang Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Wang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Min Xia
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zheng-Cai Jia
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chao Guo
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiao-Qin Tang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ming-Xi Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yi Yin
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xin Liu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Neurosurgery Southwest Hospital, Collaborative Innovation Center for Brain Science, Third Military Medical University (Army Medical University), Chongqing, China
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18
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Abstract
PURPOSE OF REVIEW This article provides an overview of vascular cognitive impairment; discusses its epidemiology, subtypes, and associations with other neurodegenerative diseases; and reviews the diagnostic evaluation and management of these disorders. RECENT FINDINGS Cerebrovascular disease is a common cause of dementia and frequently coexists with neurodegenerative causes. The heterogeneity of mechanisms leading to vascular cognitive impairment makes developing unifying clinical and research criteria difficult. Recognizing the neuroimaging hallmarks of different forms of vascular cognitive impairment can allow for individualized treatment and management. In individuals with mild vascular cognitive impairment, aerobic exercise appears to be a promising treatment but requires further investigation. SUMMARY Vascular cognitive impairment can be caused by several mechanisms. While treating vascular risk factors is rational to prevent worsening of cognitive impairment, well-designed studies are needed to demonstrate efficacy.
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19
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Abstract
Cognitive impairment (CI) is one of the leading causes of disability after stroke; CI is observed in more than half of patients and reaches a pronounced degree (of dementia) in every three to five patients. CI in poststroke patients is often caused not only by focal vascular lesions of the brain, but also by the presence of concomitant vascular and neurodegenerative diseases. The treatment and prevention of progressive CI are based on stroke prevention, non-drug and drug methods to improve cognitive functions. Blood pressure normalization during antihypertensive therapy is most effective in preventing the progression of CI in stroke patients. The use of Actovegin in patients with CI after stroke is discussed. The results of the author's own 5-year follow-up of 350 patients with stroke are presented.
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Affiliation(s)
- V. A. Parfenov
- Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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20
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Ghaznawi R, Geerlings MI, Jaarsma-Coes MG, Zwartbol MH, Kuijf HJ, van der Graaf Y, Witkamp TD, Hendrikse J, de Bresser J. The association between lacunes and white matter hyperintensity features on MRI: The SMART-MR study. J Cereb Blood Flow Metab 2019; 39:2486-2496. [PMID: 30204039 PMCID: PMC6890997 DOI: 10.1177/0271678x18800463] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lacunes and white matter hyperintensities (WMHs) are features of cerebral small vessel disease (CSVD) that are associated with poor functional outcomes. However, how the two are related remains unclear. In this study, we examined the association between lacunes and several WMH features in patients with a history of vascular disease. A total of 999 patients (mean age 59 ± 10 years) with a 1.5 T brain magnetic resonance imaging (MRI) scan were included from the SMART-MR study. Lacunes were scored visually and WMH features (volume, subtype and shape) were automatically determined. Analyses consisted of linear and Poisson regression adjusted for age, sex, and total intracranial volume (ICV). Patients with lacunes (n = 188; 19%) had greater total (B = 1.03, 95% CI: 0.86 to 1.21), periventricular/confluent (B = 1.08, 95% CI: 0.89 to 1.27), and deep (B = 0.71, 95% CI: 0.44 to 0.97) natural log-transformed WMH volumes than patients without lacunes. Patients with lacunes had an increased risk of confluent type WMHs (RR = 2.41, 95% CI: 1.98 to 2.92) and deep WMHs (RR = 1.41, 95% CI: 1.22 to 1.62) and had a more irregular shape of confluent WMHs than patients without lacunes, independent of total WMH volume. In conclusion, we found that lacunes on MRI were associated with WMH features that correspond to more severe small vessel changes, mortality, and poor functional outcomes.
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Affiliation(s)
- Rashid Ghaznawi
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Myriam G Jaarsma-Coes
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten Ht Zwartbol
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Theo D Witkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen de Bresser
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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21
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Jokinen H, Koikkalainen J, Laakso HM, Melkas S, Nieminen T, Brander A, Korvenoja A, Rueckert D, Barkhof F, Scheltens P, Schmidt R, Fazekas F, Madureira S, Verdelho A, Wallin A, Wahlund LO, Waldemar G, Chabriat H, Hennerici M, O'Brien J, Inzitari D, Lötjönen J, Pantoni L, Erkinjuntti T. Global Burden of Small Vessel Disease-Related Brain Changes on MRI Predicts Cognitive and Functional Decline. Stroke 2019; 51:170-178. [PMID: 31699021 PMCID: PMC6924941 DOI: 10.1161/strokeaha.119.026170] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is available in the text. Cerebral small vessel disease is characterized by a wide range of focal and global brain changes. We used a magnetic resonance imaging segmentation tool to quantify multiple types of small vessel disease–related brain changes and examined their individual and combined predictive value on cognitive and functional abilities.
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Affiliation(s)
- Hanna Jokinen
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland.,Department of Psychology and Logopedics, Faculty of Medicine (H.J., H.M.L.), Finland
| | - Juha Koikkalainen
- Combinostics, Ltd, Finland (J.K., T.N., J.L.).,VTT Technical Research Centre of Finland (J.K., J.L.).,Faculty of Health Sciences, University of Eastern Finland (J.K.)
| | - Hanna M Laakso
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland.,Department of Psychology and Logopedics, Faculty of Medicine (H.J., H.M.L.), Finland
| | - Susanna Melkas
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland
| | | | - Antti Brander
- Department of Radiology, Medical Imaging Center, Tampere University Hospital, Finland (A.B.)
| | - Antti Korvenoja
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital (A.K.), Finland
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, United Kingdom (D.R.)
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine (F.B.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.)
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology (P.S.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands.,NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, University College London, United Kingdom (F.B.)
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Austria (R.S., F.F.)
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Austria (R.S., F.F.)
| | - Sofia Madureira
- Department of Neurosciences, Santa Maria Hospital, University of Lisbon, Portugal (S. Madureira, A.V.)
| | - Ana Verdelho
- Department of Neurosciences, Santa Maria Hospital, University of Lisbon, Portugal (S. Madureira, A.V.)
| | - Anders Wallin
- Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section for Psychiatry and Neurochemistry, University of Gothenburg, Sweden (A.W.)
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Sweden (L.-O.W.)
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark (G.W.)
| | - Hugues Chabriat
- Department of Neurology, Hopital Lariboisiere, APHP and INSERM U1161-University Denis Diderot (DHU NeuroVasc), France (H.C.)
| | | | - John O'Brien
- Department of Psychiatry, University of Cambridge, United Kingdom (J.O.)
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council (D.I.).,Department NEUROFARBA, University of Florence, Italy (D.I.)
| | - Jyrki Lötjönen
- Combinostics, Ltd, Finland (J.K., T.N., J.L.).,VTT Technical Research Centre of Finland (J.K., J.L.).,Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Finland (J.L.)
| | - Leonardo Pantoni
- L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy (L.P.)
| | - Timo Erkinjuntti
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland
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22
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Janes F, Cifù A, Pessa ME, Domenis R, Gigli GL, Sanvilli N, Nilo A, Garbo R, Curcio F, Giacomello R, Fabris M, Valente M. ADMA as a possible marker of endothelial damage. A study in young asymptomatic patients with cerebral small vessel disease. Sci Rep 2019; 9:14207. [PMID: 31578412 PMCID: PMC6775279 DOI: 10.1038/s41598-019-50778-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023] Open
Abstract
Sporadic small vessel disease (SVD) has high prevalence in aging population and stroke patients, but also in younger asymptomatic subjects. In this last group it can represents a prelude to stroke and cognitive impairment. Still nowadays, its pathogenesis is unclear. 35 consecutive patients with SVD at brain MRI and 35 age- and sex-matched controls, between January 2016 and February 2018, underwent an extended screening for thrombophilia, autoimmunity and evaluated levels of blood markers of inflammation and endothelial activation. Asymmetric DiMethyl Arginine (ADMA) levels proved higher in patients (70.44 ± 36.25 ng/ml vs. 46.58 ± 30.67 ng/ml; p = 0.004), also after controlling for confounding factors. ADMA levels showed positive correlation with Fazekas score (r = 0.304; p = 0.01). ROC curve analysis showed a moderate accuracy in discriminating patients and controls (AUC = 0.70; CI 0.57–0.82; p = 0.004): a cut-off of 46 ng/ml is associated with 80% sensitivity, but limited (54%) specificity. Higher ADMA levels characterize selected subjects with sporadic SVD, asymptomatic for vascular diseases and without latent inflammatory conditions or coagulopathy. This reinforces the hypothesis of the key role of endothelial dysfunction in SVD. Further studies should explore the cause-effect relationship between ADMA pathway and SVD.
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Affiliation(s)
- Francesco Janes
- Department of Neuroscience, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Adriana Cifù
- Department of Laboratory Medicine, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Maria Elena Pessa
- Department of Neuroscience, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Rossana Domenis
- Department of Laboratory Medicine, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Gian Luigi Gigli
- Department of Neuroscience, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Nova Sanvilli
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Annacarmen Nilo
- Department of Neuroscience, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Riccardo Garbo
- Department of Neuroscience, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Francesco Curcio
- Department of Laboratory Medicine, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Roberta Giacomello
- Department of Laboratory Medicine, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Martina Fabris
- Department of Laboratory Medicine, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Mariarosaria Valente
- Department of Neuroscience, S. Maria della Misericordia University Hospital, Udine, Italy
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Qin Y, Zhu W, Liu C, Wang Z, Zhu W. Functional brain connectome and its relation to mild cognitive impairment in cerebral small vessel disease patients with thalamus lacunes: A cross-sectional study. Medicine (Baltimore) 2019; 98:e17127. [PMID: 31577703 PMCID: PMC6783192 DOI: 10.1097/md.0000000000017127] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To investigate the functional connectome alterations in cerebral small-vessel disease (CSVD) patients with thalamus lacunes and its relation to cognitive impairment.This case-control study was approved by the local research ethics committee, and all participants provided informed consent. There were 14 CSVD patients with thalamus lacunes (CSVDw.), 27 without (CSVDwo.), and 34 healthy controls (HC) recruited matched for age, sex, and education to undergo a 3T resting-state functional MR examination. The whole-brain functional connectome was constructed by thresholding the Pearson correlation matrices of 90 brain regions, and the topologic properties were analyzed by using graph theory approaches. Networks were compared between CSVD patients and HC, and associations between network measures and cognitive function were tested.Compared with HC, the functional connectome in CSVDw. patients showed abnormalities at the global level and at the nodal level (P < .05, false discovery rate corrected). The network-based statistics method identified a significantly altered network consisting 6 nodes and 13 connections. Among all the 13 connections, only two connections had significant correlation with episodic memory (EM) and processing speed (PS) respectively (P < .05). The CSVDwo. patients showed no significant network alterations relative to controls (P > .05).The configurations of brain functional connectome in CSVDw. patients were perturbed but not obvious for those without, and correlated with the mild cognitive impairment, especially for EM and PS. This study suggested that lacunes on thalamus played a vital role in mediating the neural functional changes of CSVD patients.
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Affiliation(s)
| | - Wenhao Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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24
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Passiak BS, Liu D, Kresge HA, Cambronero FE, Pechman KR, Osborn KE, Gifford KA, Hohman TJ, Schrag MS, Davis LT, Jefferson AL. Perivascular spaces contribute to cognition beyond other small vessel disease markers. Neurology 2019; 92:e1309-e1321. [PMID: 30814324 PMCID: PMC6511092 DOI: 10.1212/wnl.0000000000007124] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 11/13/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To cross-sectionally relate multiple small vessel disease (SVD) neuroimaging markers to cognition among older adults. METHODS Vanderbilt Memory & Aging Project participants free of clinical dementia and stroke (n = 327, age 73 ± 7 years, 59% male, 40% with mild cognitive impairment) completed neuropsychological assessment and 3T MRI to measure white matter hyperintensities (WMH), perivascular spaces (PVS), cerebral microbleeds (CMBs), and lacunes. Linear regressions related each SVD marker to neuropsychological performances and adjusted for age, sex, race/ethnicity, education, cognitive diagnosis, APOE ε4 presence, Framingham Stroke Risk Profile, and intracranial volume. RESULTS WMH related to the most neuropsychological measures, including the Boston Naming Test, Animal Naming, Coding, Number Sequencing, Executive Function Composite, and Hooper Visual Organization Test performances (p ≤ 0.01). PVS related to multiple information processing and executive function performances (p ≤ 0.02). Lacunes and CMBs related to fewer measures than expected. Combined models simultaneously testing multiple statistically significant SVD predictors suggested that WMH, PVS, and CMBs each independently related to information processing and executive function performances; however, compared to other SVD markers, PVS remained statistically significant in models related to information processing and executive functioning performances. CONCLUSIONS As expected, increased WMH corresponded to poorer performances across multiple cognitive domains. PVS, previously considered a benign neuroimaging feature in older adults, may have important clinical implications because PVS was related to information processing and executive function performances even in combined models. On the basis of models with multiple SVD predictors, WMH, PVS, and CMBs may each reflect a separate pathway of small vessel injury.
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Affiliation(s)
- Brittany S Passiak
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Dandan Liu
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Hailey A Kresge
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Francis E Cambronero
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Kimberly R Pechman
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Katie E Osborn
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Katherine A Gifford
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Timothy J Hohman
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Matthew S Schrag
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - L Taylor Davis
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Angela L Jefferson
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN.
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25
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Cipolla MJ, Liebeskind DS, Chan SL. The importance of comorbidities in ischemic stroke: Impact of hypertension on the cerebral circulation. J Cereb Blood Flow Metab 2018; 38:2129-2149. [PMID: 30198826 PMCID: PMC6282213 DOI: 10.1177/0271678x18800589] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comorbidities are a hallmark of stroke that both increase the incidence of stroke and worsen outcome. Hypertension is prevalent in the stroke population and the most important modifiable risk factor for stroke. Hypertensive disorders promote stroke through increased shear stress, endothelial dysfunction, and large artery stiffness that transmits pulsatile flow to the cerebral microcirculation. Hypertension also promotes cerebral small vessel disease through several mechanisms, including hypoperfusion, diminished autoregulatory capacity and localized increase in blood-brain barrier permeability. Preeclampsia, a hypertensive disorder of pregnancy, also increases the risk of stroke 4-5-fold compared to normal pregnancy that predisposes women to early-onset cognitive impairment. In this review, we highlight how comorbidities and concomitant disorders are not only risk factors for ischemic stroke, but alter the response to acute ischemia. We focus on hypertension as a comorbidity and its effects on the cerebral circulation that alters the pathophysiology of ischemic stroke and should be considered in guiding future therapeutic strategies.
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Affiliation(s)
- Marilyn J Cipolla
- 1 Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - David S Liebeskind
- 2 Neurovascular Imaging Research Core and Stroke Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Siu-Lung Chan
- 1 Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
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Gao F, Zhang Q, Li Y, Tai Y, Xin X, Wang X, Wang Q. Transcutaneous electrical acupoint stimulation for prevention of postoperative delirium in geriatric patients with silent lacunar infarction: a preliminary study. Clin Interv Aging 2018; 13:2127-2134. [PMID: 30425466 PMCID: PMC6205526 DOI: 10.2147/cia.s183698] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose This study aims to investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative delirium (POD) in elderly patients with silent lacunar infarct and preliminarily to determine the relationship among TEAS, blood–brain barrier (BBB), neuroinflammation, and POD. Patients and methods Sixty-four-old patients with silent lacunar infarct were randomly divided into two groups: group TEAS and control group (group C). Patients in the group TEAS received TEAS (disperse-dense waves; frequency, 2/100 Hz) on acupoints Hegu and Neiguan of both sides starting from 30 minutes before induction of anesthesia until the end of surgery, and the intensity was the maximum current that could be tolerated. In group C, electrodes were placed on the same acupoints before anesthesia induction, but no current was given. At 0 minute before the treatment of TEAS, 30 minutes after skin incision, and after completion of surgery (T1–3), blood samples were extracted to detect the concentration of serum tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP-9), and S100β. We assessed patients for delirium and coma twice daily in the first 3 postoperative days using the Confusion Assessment Method for the intensive care unit and the Richmond Agitation-Sedation Scale. Results This study preliminarily suggests that TEAS can reduce the development of POD in elderly patients with silent lacunar infarction (6.3% vs 25.0%; P=0.039). Compared with the baseline value at T1, the serum concentrations of IL-6, TNF-α, MMP-9, and S100β were significantly increased at T2–3 in both the groups (P<0.05). Compared with group TEAS, serum levels of TNF-α and IL-6 were higher at T2–3 and serum levels of MMP-9 and S100β were higher at T3 in group C (P<0.05). The intraoperative anesthetic consumptions were less in group TEAS than group C. Conclusion TEAS can alleviate POD in older patients with silent lacunar infarction and may be related to reduce the neuroinflammation by lowering the permeability of BBB.
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Affiliation(s)
- Fang Gao
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
| | - Qi Zhang
- Department of Anesthesiology, Children's Hospital of Hebei Province, Shijiazhuang City, Hebei, People's Republic of China
| | - Yanan Li
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
| | - Yanlei Tai
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
| | - Xi Xin
- Department of Anesthesiology, Tianjin Third Central Hospital, Tianjin, People's Republic of China
| | - Xiuli Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
| | - Qiujun Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
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Ghaznawi R, de Bresser J, van der Graaf Y, Zwartbol MH, Witkamp TD, Geerlings MI, Hendrikse J. Detection and characterization of small infarcts in the caudate nucleus on 7 Tesla MRI: The SMART-MR study. J Cereb Blood Flow Metab 2018; 38:1609-1617. [PMID: 28436255 PMCID: PMC6120126 DOI: 10.1177/0271678x17705974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Small infarcts are among the key imaging features of cerebral small vessel disease (CSVD), but remain largely undetected on conventional MRI. We aimed to evaluate (1) imaging criteria for the detection of small infarcts in the caudate nucleus on 7T MRI, (2) intra- and inter-rater agreement, (3) frequency and (4) detection rate on 7T versus 1.5T MRI. In 90 patients (68 ± 8 years) with a history of vascular disease from the SMART-MR study, we defined 7T imaging criteria for cavitated and non-cavitated small infarcts in the caudate nucleus. In a separate set of 23 patients from the SMART study, intra-rater and inter-rater agreement was excellent for presence, number, and individual locations (Kappa's, ICCs, and Dice similarity coefficients ranged from 0.85 to 1.00). In the 90 patients, 21 infarcts (20 cavitated) in 12 patients were detected on 7T (13%) compared to 7 infarcts in 6 patients on 1.5T (7%). In conclusion, we established reproducible imaging criteria for the detection of small infarcts in the caudate nucleus on 7T MRI and showed that 7T MRI allows for a higher detection rate than conventional 1.5T MRI. These imaging criteria can be used in future studies to provide new insights into the pathophysiology of CSVD.
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Affiliation(s)
- Rashid Ghaznawi
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands.,2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Jeroen de Bresser
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Yolanda van der Graaf
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Maarten Ht Zwartbol
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Theo D Witkamp
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Mirjam I Geerlings
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Jeroen Hendrikse
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands
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Lambert C, Zeestraten E, Williams O, Benjamin P, Lawrence AJ, Morris RG, Mackinnon AD, Barrick TR, Markus HS. Identifying preclinical vascular dementia in symptomatic small vessel disease using MRI. Neuroimage Clin 2018; 19:925-938. [PMID: 30003030 PMCID: PMC6039843 DOI: 10.1016/j.nicl.2018.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/23/2018] [Accepted: 06/17/2018] [Indexed: 11/21/2022]
Abstract
Sporadic cerebral small vessel disease is an important cause of vascular dementia, a syndrome of cognitive impairment together with vascular brain damage. At post-mortem pure vascular dementia is rare, with evidence of co-existing Alzheimer's disease pathology in 95% of cases. This work used MRI to characterize structural abnormalities during the preclinical phase of vascular dementia in symptomatic small vessel disease. 121 subjects were recruited into the St George's Cognition and Neuroimaging in Stroke study and followed up longitudinally for five years. Over this period 22 individuals converted to dementia. Using voxel-based morphometry, we found structural abnormalities present at baseline in those with preclinical dementia, with reduced grey matter density in the left striatum and hippocampus, and more white matter hyperintensities in the frontal white-matter. The lacunar data revealed that some of these abnormalities may be due to lesions within the striatum and centrum semiovale. Using support vector machines, future dementia could be best predicted using hippocampal and striatal Jacobian determinant data, achieving a balanced classification accuracy of 73%. Using cluster ward linkage we identified four anatomical subtypes. Successful predictions were restricted to groups with lower levels of vascular damage. The subgroup that could not be predicted were younger, further from conversion, had the highest levels of vascular damage, with milder cognitive impairment at baseline but more rapid deterioration in processing speed and executive function, consistent with a primary vascular dementia. In contrast, the remaining groups had decreasing levels of vascular damage and increasing memory impairment consistent with progressively more Alzheimer's-like pathology. Voxel-wise rates of hippocampal atrophy supported these distinctions, with the vascular group closely resembling the non-dementing cohort, whereas the Alzheimer's like group demonstrated global hippocampal atrophy. This work reveals distinct anatomical endophenotypes in preclinical vascular dementia, forming a spectrum between vascular and Alzheimer's like pathology. The latter group can be identified using baseline MRI, with 73% converting within 5 years. It was not possible to predict the vascular dominant dementia subgroup, however 19% of negative predictions with high levels of vascular disease would ultimately develop dementia. It may be that techniques more sensitive to white matter damage, such as diffusion weighted imaging, may prove more useful for this vascular dominant subgroup in the future. This work provides a way to accurately stratify patients using a baseline MRI scan, and has utility in future clinical trials designed to slow or prevent the onset of dementia in these high-risk cohorts.
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Affiliation(s)
- Christian Lambert
- Wellcome Centre for Human Neuroimaging, 12 Queen Square, WC1N 3BG London, UK; Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK.
| | - Eva Zeestraten
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Owen Williams
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Philip Benjamin
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Andrew J Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, CB2 0QQ, UK
| | - Robin G Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Andrew D Mackinnon
- St George's NHS Healthcare Trust, Atkinson Morley Regional Neuroscience Centre, London, UK
| | - Thomas R Barrick
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Hugh S Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, CB2 0QQ, UK
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Role of Cerebrovascular Disease in Cognition. NEURODEGENER DIS 2018. [DOI: 10.1007/978-3-319-72938-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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30
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Williams OA, Zeestraten EA, Benjamin P, Lambert C, Lawrence AJ, Mackinnon AD, Morris RG, Markus HS, Charlton RA, Barrick TR. Diffusion tensor image segmentation of the cerebrum provides a single measure of cerebral small vessel disease severity related to cognitive change. Neuroimage Clin 2017; 16:330-342. [PMID: 28861335 PMCID: PMC5568143 DOI: 10.1016/j.nicl.2017.08.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/05/2017] [Accepted: 08/12/2017] [Indexed: 02/02/2023]
Abstract
Cerebral small vessel disease (SVD) is the primary cause of vascular cognitive impairment and is associated with decline in executive function (EF) and information processing speed (IPS). Imaging biomarkers are needed that can monitor and identify individuals at risk of severe cognitive decline. Recently there has been interest in combining several magnetic resonance imaging (MRI) markers of SVD into a unitary score to describe disease severity. Here we apply a diffusion tensor image (DTI) segmentation technique (DSEG) to describe SVD related changes in a single unitary score across the whole cerebrum, to investigate its relationship with cognitive change over a three-year period. 98 patients (aged 43-89) with SVD underwent annual MRI scanning and cognitive testing for up to three years. DSEG provides a vector of 16 discrete segments describing brain microstructure of healthy and/or damaged tissue. By calculating the scalar product of each DSEG vector in reference to that of a healthy ageing control we generate an angular measure (DSEG θ) describing the patients' brain tissue microstructural similarity to a disease free model of a healthy ageing brain. Conventional MRI markers of SVD brain change were also assessed including white matter hyperintensities, cerebral atrophy, incident lacunes, cerebral-microbleeds, and white matter microstructural damage measured by DTI histogram parameters. The impact of brain change on cognition was explored using linear mixed-effects models. Post-hoc sample size analysis was used to assess the viability of DSEG θ as a tool for clinical trials. Changes in brain structure described by DSEG θ were related to change in EF and IPS (p < 0.001) and remained significant in multivariate models including other MRI markers of SVD as well as age, gender and premorbid IQ. Of the conventional markers, presence of new lacunes was the only marker to remain a significant predictor of change in EF and IPS in the multivariate models (p = 0.002). Change in DSEG θ was also related to change in all other MRI markers (p < 0.017), suggesting it may be used as a surrogate marker of SVD damage across the cerebrum. Sample size estimates indicated that fewer patients would be required to detect treatment effects using DSEG θ compared to conventional MRI and DTI markers of SVD severity. DSEG θ is a powerful tool for characterising subtle brain change in SVD that has a negative impact on cognition and remains a significant predictor of cognitive change when other MRI markers of brain change are accounted for. DSEG provides an automatic segmentation of the whole cerebrum that is sensitive to a range of SVD related structural changes and successfully predicts cognitive change. Power analysis shows DSEG θ has potential as a monitoring tool in clinical trials. As such it may provide a marker of SVD severity from a single imaging modality (i.e. DTIs).
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Affiliation(s)
- Owen A. Williams
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Eva A. Zeestraten
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Philip Benjamin
- Department of Radiology, Charing Cross Hospital Campus, Imperial College NHS Trust, London, UK
| | - Christian Lambert
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Andrew J. Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Andrew D. Mackinnon
- Atkinson Morley Regional Neuroscience Centre, St George's NHS Healthcare Trust, London, UK
| | - Robin G. Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Hugh S. Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Thomas R. Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Geng S, Liu N, Meng P, Ji N, Sun Y, Xu Y, Zhang G, He X, Cai Z, Wang B, Xu B, Li Z, Niu X, Zhang Y, Xu B, Zhou X, He M. Midterm Blood Pressure Variability Is Associated with Poststroke Cognitive Impairment: A Prospective Cohort Study. Front Neurol 2017; 8:365. [PMID: 28804475 PMCID: PMC5532726 DOI: 10.3389/fneur.2017.00365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/11/2017] [Indexed: 01/27/2023] Open
Abstract
Objective The aim of this study was to investigate the relationship between blood pressure variability (BPV) and poststroke cognitive impairment (PSCI). Methods Seven-hundred ninety-six patients with acute ischemic stroke were included in this study. Midterm BPV was evaluated by calculating the SD and coefficient of variation (CV, 100 × SD/mean) of systolic blood pressure (SBP) and diastolic blood pressure during the 7 days after stroke onset. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) at admission and at all follow-up visits. Patients with MoCA scores <26 were considered to have PSCI. Results The incidence of PSCI reached its peak (72%) 3 months after stroke onset and decreased to 30.3% at 12 months poststroke. After adjusting for covariables, the increase in the prevalence of PSCI at 3 months was independently associated with increases in the CV of blood pressure during the 7 days after stroke [odds ratios and 95% CI for patients in the second to fifth quintiles of SBP CV were 2.28 (1.18, 4.39), 2.33 (1.18, 4.62), 2.69 (1.31, 5.53), and 4.76 (1.95, 11.67), respectively]. Sub-analysis of the MoCA scores revealed that the patients had impairments in visuoperceptual abilities and executive functions, as well as in naming and delayed recall (p < 0.05). Conclusion Midterm BPV during the early phase of acute ischemic stroke is independently associated with PSCI, especially in the visuoperceptual, executive, and delayed recall domains. Clinical Trial Registration http://www.chictr.org.cn, identifier ChiCTR-TRC-14004804.
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Affiliation(s)
- Shan Geng
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Na Liu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Pin Meng
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Niu Ji
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yong'an Sun
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yingda Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Guanghui Zhang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaobing He
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Zenglin Cai
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Bei Wang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Bei Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Zaipo Li
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaoqin Niu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yongjin Zhang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Bingchao Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xinyu Zhou
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Mingli He
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
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Abstract
Zusammenfassung. Zerebrale Mikroangiopathien umfassen eine Gruppe neuropathologischer Prozesse, die die kleinen Perforationsarterien, Arteriolen und Kapillaren beeinflussen. Neuroimaging-Merkmale der Einengung der kleinen Koronararterienäste (Small Vessel Disease) sind ischämische und hämorrhagische Marker: jüngster kleiner subkortikaler Infarkt, Lakune vermuteten vaskulären Ursprungs, Hyperintensität der weissen Masse, perivaskuläre Räume, zerebrale Mikroblutungen, Hirnatrophie, kortikale oberflächliche Siderose und akute subarachnoidale Blutungen. Diese Läsionen gelten als der Hauptrisikofaktor der vaskulären kognitiven Störungen. Die zerebrale Mikroangiopathie wird typischerweise in zwei Hauptformen kategorisiert: die nicht-amyloide Angiopathie, die auch als «hypertensive Arteriopathie» bezeichnet wird, die oft mit fortgeschrittenem Alter und vaskulären Risikofaktoren und der zerebralen Amyloidangiopathie zusammenhängt. Die zerebrale Amyloidangiopathie ist klinisch charakterisiert durch kognitive Beeinträchtigungen, intrazerebrale Blutungen und durch transiente Episoden fokal-neurologischer Defizite aufgrund von Subarachnoidalblutungen.
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Affiliation(s)
- Agnès Jacquin-Piques
- 1 Centre Mémoire, Ressources et Recherche - Département de Neurologie, Centre Hospitalier Universitaire Dijon - Bourgogne, Dijon, France
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Usman S, Oskouian RJ, Loukas M, Tubbs RS. Clinical anatomy of the most common dementias. Clin Anat 2016; 30:53-57. [PMID: 27588364 DOI: 10.1002/ca.22784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Sameera Usman
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Seattle, Washington
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Seattle, Washington
| | - Marios Loukas
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Seattle, Washington
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Seattle, Washington
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Tsubota-Utsugi M, Satoh M, Tomita N, Hara A, Kondo T, Hosaka M, Saito S, Asayama K, Inoue R, Hirano M, Hosokawa A, Murakami K, Murakami T, Metoki H, Kikuya M, Izumi SI, Imai Y, Ohkubo T. Lacunar Infarcts Rather than White Matter Hyperintensity as a Predictor of Future Higher Level Functional Decline: The Ohasama Study. J Stroke Cerebrovasc Dis 2016; 26:376-384. [PMID: 28029606 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to determine the associations between silent cerebrovascular lesions, characterized by lacunar infarcts and white matter hyperintensity, and future decline in higher level functional capacity in older community-dwelling adults. MATERIALS AND METHODS For this observational study, we selected individuals from the general population of Ohasama, a rural Japanese community. Three hundred thirty-one participants who were free of functional decline at baseline and who were at least 60 years old underwent brain magnetic resonance imaging and answered a questionnaire on higher level functional capacity derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Weassessed the relationship between silent cerebrovascular lesions with a decline in higher level functional capacity at 7 years using multiple logistic regression analysis adjusted for possible confounding factors. RESULTS During the follow-up, 22.1% reported declines in higher level functional capacity. After adjustment for putative confounding factors, the presence of silent cerebrovascular lesions (odds ratio [95% confidence interval], 2.10 [1.05-4.21]) and both lacunar infarcts (2.04 [1.05-3.95]) and white matter hyperintensity (2.02 [1.02-3.95]) was significantly associated with the risk of functional decline at 7-year follow-up. In subscale analysis, specifically lacunar infarcts were strongly associated with the future risk of decline in intellectual activity (3.16 [1.27-7.84]). CONCLUSION Silent cerebrovascular lesions are associated with future risk of decline in higher level functional capacity. Appropriate management of health risk factors to prevent silent cerebrovascular lesions may prevent higher level functional decline in the elderly population.
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Affiliation(s)
- Megumi Tsubota-Utsugi
- Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Naoki Tomita
- Institute of Development, Aging and Cancer, Department of Geriatrics and Gerontology, Tohoku University, Sendai, Japan
| | - Azusa Hara
- Department of Social Pharmacy and Public Health, Showa Pharmaceutical University, Tokyo, Japan
| | - Takeo Kondo
- Physical Medicine and Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Miki Hosaka
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Sho Saito
- Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryusuke Inoue
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mikio Hirano
- Department of Community Medical Support, Tohoku University, Sendai, Japan
| | - Aya Hosokawa
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Keiko Murakami
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masahiro Kikuya
- Tohoku Medical Megabank organization, Tohoku University, Sendai, Japan
| | - Shin-Ichi Izumi
- Physical Medicine and Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Yutaka Imai
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
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Shibata K, Nishimura Y, Otsuka K, Sakura H. Influence of cerebral white matter hyperintensities on cognitive impairment in elderly medical patients. Geriatr Gerontol Int 2016; 17:1488-1493. [PMID: 27680506 DOI: 10.1111/ggi.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/28/2016] [Accepted: 07/24/2016] [Indexed: 11/28/2022]
Abstract
AIM We investigated the characteristics of elderly medical patients with white matter hyperintensities on magnetic resonance imaging. METHODS A total of 213 patients (123 men and 90 women; mean age 74.8 years) reported their history of hypertension, diabetes, dyslipidemia, previous stroke, coronary heart disease and chronic kidney disease (CKD). All patients completed the Mini-Mental State Examination and Geriatric Depression Scale. White matter hyperintensities were evaluated for the periventricular region, basal ganglia (BGH), deep white matter and infratentorial region, and brain atrophy was calculated as bicaudate ratios. RESULTS Patients with cognitive impairment (Mini-Mental State Examination score < 24) were significantly older (P = 0.001), had periventricular region hyperintensities (P = 0.029) and BGH (P = 0.0015), and showed atrophy (P < 0.0001). Logistic regression showed that cognitive impairment was predicted by stroke (OR 2.5, 95% CI 0.033-0.894, P = 0.036) and atrophy (OR 8.43, 95% CI 5.71-37.0, P = 0.0109). Multiple regressions showed that BGH was associated with CKD (β = 0.213; P = 0.003), and infratentorial region was associated with stroke (β = 0.157; P =0.035) and CKD (β = 0.172; P = 0.016). Periventricular region was associated with age (β = 0.2; P = 0.011) and Geriatric Depression Scale (β = 0.151; P = 0.037), and deep white matter hyperintensities with age (β = 0.189; P = 0.016). CONCLUSIONS Although cognitive impairment in elderly medical patients is associated with stroke and brain atrophy, white matter hyperintensities, especially BGH and infratentorial region, are associated with cognitive decline in relation to CKD. Geriatr Gerontol Int 2017; 17: 1488-1493.
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Affiliation(s)
- Koichi Shibata
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yoshiko Nishimura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kuniaki Otsuka
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hiroshi Sakura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Pantoni L, Fierini F, Poggesi A. Impact of cerebral white matter changes on functionality in older adults: An overview of the LADIS Study results and future directions. Geriatr Gerontol Int 2016; 15 Suppl 1:10-6. [PMID: 26671152 DOI: 10.1111/ggi.12665] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/30/2022]
Abstract
The evidence on the clinical significance of cerebral white matter changes (WMC) has mounted over the past few decades. WMC are recognized as one of the neuroimaging features of cerebral small vessel disease, and are associated with various disturbances and a poor prognosis. The Leukoaraiosis and Disability (LADIS) Study has contributed substantially to this body of knowledge. LADIS is a European multicenter collaboration aimed at assessing the role of WMC as an independent predictor of the transition to disability in initially non-disabled patients aged 65-84 years. Besides the demonstration that severe WMC cause a more than double risk of transition from an autonomous to a dependent status after 3 years of follow-up, the LADIS Study has also provided evidence on the role of WMC in relation to the decline of cognitive and motor performances, depressive symptoms associated with aging and cerebrovascular diseases, the presence of urinary disturbances, and various neurological abnormalities. The possible role of other lesions (lacunar infarcts, cerebral atrophy, corpus callosum morphology) and microstructural abnormalities (diffusion-weighted imaging changes in normal appearing brain tissue and in WMC) has also been investigated. In the present article, we review the main results of the LADIS Study and offer some considerations for future developments in the field, paying attention to the potential use of WMC progression as a surrogate marker in intervention trials in cerebral small vessel diseases. We also discuss some therapeutic perspectives regarding the beneficial impact of physical activity on the risk of vascular cognitive impairment in patients with WMC.
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Affiliation(s)
- Leonardo Pantoni
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Fabio Fierini
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
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De Reuck J, Auger F, Durieux N, Cordonnier C, Deramecourt V, Pasquier F, Maurage CA, Leys D, Bordet R. Topographic distribution of white matter changes and lacunar infarcts in neurodegenerative and vascular dementia syndromes: A post-mortem 7.0-tesla magnetic resonance imaging study. Eur Stroke J 2016; 1:122-129. [PMID: 31008274 PMCID: PMC6301232 DOI: 10.1177/2396987316650780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND White matter changes and lacunar infarcts are regarded as linked to the same underlying small-vessel pathology. On magnetic resonance imaging, white matter changes are frequently observed, while the number of lacunar infarcts is probably underestimated. The present study post-mortem 7.0-tesla magnetic resonance imaging study compares the severity and the distribution of white matter changes and lacunar infarcts in different neurodegenerative and vascular dementia syndromes in order to determine their impact on the disease evolution. PATIENTS AND METHODS Eighty-four post-mortem brains consisting of 15 patients with pure Alzheimer's disease and 12 with associated cerebral amyloid angiopathy, 14 patients with frontotemporal lobar degeneration, 7 with Lewy body dementia, 10 with progressive supranuclear palsy, 14 with vascular dementia and 12 control brains were examined. Six hemispheric coronal sections of each brain underwent 7.0-tesla magnetic resonance imaging. Location and severity of white matter changes and lacunar infarcts were evaluated semi-quantitatively in each section separately. RESULTS White matter changes predominated in the prefrontal and frontal sections of frontotemporal lobar degeneration and in the post-central section of associated cerebral amyloid angiopathy brains, while overall increased in vascular dementia cases. Lacunar infarcts were more frequent in the vascular dementia brains and mainly increased in the centrum semiovale. CONCLUSIONS White matter changes have a different topographic distribution in neurodegenerative diseases and are most severe and extended in vascular dementia. Lacunar infarcts predominate in the deep white matter of vascular dementia compared to the neurodegenerative diseases. Vascular cognitive impairment is mainly linked to white matter changes due to chronic ischaemia as well as to lacunar infarcts due to small-vessel occlusion.
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Affiliation(s)
| | | | | | | | | | | | | | - Didier Leys
- Université Lille 2, INSERM U 1171, Lille,
France
| | - Regis Bordet
- Université Lille 2, INSERM U 1171, Lille,
France
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38
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Bonifacio G, Zamboni G. Brain imaging in dementia. Postgrad Med J 2016; 92:333-40. [PMID: 26933232 DOI: 10.1136/postgradmedj-2015-133759] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/04/2016] [Indexed: 12/16/2022]
Abstract
The introduction of MRI and positron emission tomography (PET) brain imaging has contributed significantly to the understanding of different dementia syndromes. Over the past 20 years these imaging techniques have been increasingly used for clinical characterisation and differential diagnosis, and to provide insight into the effects on functional capacity of the brain, patterns of spatial distribution of different dementia syndromes and their natural history and evolution over time. Brain imaging is also increasingly used in clinical trials, as part of inclusion criteria and/or as a surrogate outcome measure. Here we review all the relatively specific findings that can be identified with different MRI and PET techniques in each of the most frequent dementing disorders.
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Affiliation(s)
- Guendalina Bonifacio
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Giovanna Zamboni
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Italy
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Cai Z, Wang C, He W, Tu H, Tang Z, Xiao M, Yan LJ. Cerebral small vessel disease and Alzheimer's disease. Clin Interv Aging 2015; 10:1695-704. [PMID: 26604717 PMCID: PMC4629951 DOI: 10.2147/cia.s90871] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is a group of pathological processes with multifarious etiology and pathogenesis that are involved into the small arteries, arterioles, venules, and capillaries of the brain. CSVD mainly contains lacunar infarct or lacunar stroke, leukoaraiosis, Binswanger's disease, and cerebral microbleeds. CSVD is an important cerebral microvascular pathogenesis as it is the cause of 20% of strokes worldwide and the most common cause of cognitive impairment and dementia, including vascular dementia and Alzheimer's disease (AD). It has been well identified that CSVD contributes to the occurrence of AD. It seems that the treatment and prevention for cerebrovascular diseases with statins have such a role in the same function for AD. So far, there is no strong evidence-based medicine to support the idea, although increasing basic studies supported the fact that the treatment and prevention for cerebrovascular diseases will benefit AD. Furthermore, there is still lack of evidence in clinical application involved in specific drugs to benefit both AD and CSVD.
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Affiliation(s)
- Zhiyou Cai
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Chuanling Wang
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Wenbo He
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Hanjun Tu
- Department of Basic Research Center, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Zhengang Tang
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Ming Xiao
- Department of Anatomy, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Liang-Jun Yan
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
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40
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Yang J, d'Esterre C, Ceruti S, Roversi G, Saletti A, Fainardi E, Lee TY. Temporal changes in blood-brain barrier permeability and cerebral perfusion in lacunar/subcortical ischemic stroke. BMC Neurol 2015; 15:214. [PMID: 26490140 PMCID: PMC4618936 DOI: 10.1186/s12883-015-0468-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/08/2015] [Indexed: 12/21/2022] Open
Abstract
Background Cerebral microvascular abnormality is frequently associated with lacunar and subcortical ischemic lesions. We performed acute and follow-up CT perfusion scans over the first 3 months after ischemic stroke to investigate disturbances of the blood–brain barrier (BBB) and cerebral perfusion in patients with lacunar/subcortical lesions compared to those with cortical lesions alone. Methods Thirty-one patients with lacunar/subcortical infarct (n = 14) or with cortical large vessel infarct (n = 17) were recruited and underwent a CT perfusion study at admission, 24 h, 7 days and 3 months after stroke using a two-phase imaging protocol. Functional maps of BBB permeability surface area product (BBB-PS), cerebral blood flow (CBF) and blood volume (CBV) at follow-up were co-registered with those at admission, and the measurements in non-infarcted ipsilateral basal ganglia and thalamus were compared within each group and between the two groups. Results For the lacunar/subcortical group, BBB-PS within non-infarcted ipsilateral basal ganglia and thalamus peaked at day 7 compared to all other time points, and was significantly higher than the cortical group at day 7 and month 3. The CBF and CBV in the same region were significantly lower at admission and transient hyperemia was seen at day 7 in the lacunar/subcortical group. Conclusion Disturbed BBB-PS and compromised cerebral perfusion over the first 3 months post stroke were shown in the non-infarcted basal ganglia and thalamus of lacunar/subcortical stroke using CT perfusion. Future studies are required to elucidate the relationship of post-stroke BBB disturbances to chronic cognitive impairment.
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Affiliation(s)
- Jun Yang
- Imaging Program, Lawson Health Research Institute, London, ON, Canada. .,Imaging Research Lab, Robarts Research Institute, Western University, 1151 Richmond St. N, London, ON, N6A 5B7, Canada.
| | - Christopher d'Esterre
- Radiology Department and Calgary Stroke Program, University of Calgary, Calgary, AB, Canada.
| | - Stefano Ceruti
- Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
| | - Gloria Roversi
- Section of Neurology, Department of Medical and Surgical Sciences of the Communication and Behaviour, University of Ferrara, Ferrara, Italy.
| | - Andrea Saletti
- Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
| | - Ting Yim Lee
- Imaging Program, Lawson Health Research Institute, London, ON, Canada. .,Imaging Research Lab, Robarts Research Institute, Western University, 1151 Richmond St. N, London, ON, N6A 5B7, Canada. .,Radiology Department and Calgary Stroke Program, University of Calgary, Calgary, AB, Canada.
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Murray A, McNeil C, Salarirad S, Deary I, Phillips L, Whalley L, Staff R. Brain hyperintensity location determines outcome in the triad of impaired cognition, physical health and depressive symptoms: A cohort study in late life. Arch Gerontol Geriatr 2015; 63:49-54. [PMID: 26791171 DOI: 10.1016/j.archger.2015.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 07/30/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE STUDY Brain hyperintensities, detectable with MRI, increase with age. They are associated with a triad of impairment in cognitive ability, depression and physical health. Here we test the hypothesis that the association between hyperintensities and cognitive ability, physical health and depressive symptoms depends on lesion location. DESIGN AND METHODS 244 members of the Aberdeen 1936 Birth Cohort were recruited to this study. 227 participants completed brain MRI and their hyperintensities were scored using Scheltens's scale. 205 had complete imaging, cognitive, physical health and depressive symptom score data. The relationships between hyperintensity location and depressive symptoms, cognitive ability and physical health were examined by correlation and structural equation analysis. RESULTS We found that depressive symptoms correlated with hyperintensity burden in the grey matter (r=0.14, p=0.04) and infratentorial regions (r=0.17, p=0.01). Infratentorial hyperintensities correlated with reduced peak expiratory flow rate (r=-0.26, p<0.001) and impaired gait (r=0.13, p=0.05). No relationship was found between white matter and periventricular (supratentoral) hyperintensities and depressive symptoms. Hyperintensities in the supratentorial and infratentorial regions were associated with reduced cognitive performance. Using structural equation modelling we found that the association between hyperintensities and depressive symptoms was mediated by negative effects on physical health and cognitive ability. CONCLUSIONS Hyperintensities in deep brain structures are associated with depressive symptoms, mediated via impaired physical health and cognitive ability. Participants with higher cognitive ability and better physical health are at lower risk of depressive symptoms.
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Affiliation(s)
| | | | | | - Ian Deary
- University of Edinburgh, Edinburgh, UK.
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Abstract
Dementia is defined as chronic deterioration of intellectual function and cognitive skills significant enough to interfere with the ability to perform daily activities. Recent advances in the treatment of dementia have renewed interest in the use of various neuroimaging techniques that can assist in the diagnosis and differentiation of various subtypes. Neuroimaging and computational techniques have helped the radiological community to monitor disease progression of various neurodegenerative conditions presenting with dementia, such as Alzheimer disease, frontotemporal lobe dementia (FTLD), progressive supranuclear palsy (PSP) and multisystem atrophy-cerebellar variant (MSA-C), and their response to newer therapies. Prompt identification of treatable or reversible forms of dementia, such as tumours, subdural haemorrhage and intracranial dAVF, is crucial for the effective management of these conditions. It is also prudent to recognize the imaging spectrum of metabolic, infective and autoimmune diseases with rapidly progressing dementia, such as methanol toxicity, central pontine myelinolysis (CPM), delayed post hypoxic leukoencephalopathy (DPHL), HIV, Creutzfeldt-Jakob Disease (CJD), Sjogren's syndrome, multiple sclerosis (MS), radiation necrosis and Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS), which are difficult to treat and often require palliative care. This pictorial review emphasizes various non-Alzheimer’s dementia entities and discusses their imaging highlights. Teaching Points • Non Alzheimer’s dementia constitutes a broad spectrum of conditions. • Neuroimaging plays an important role in differentiating treatable from irreversible dementia. • Neuroimaging is often non-specific in early stages of neurodegenerative conditions with dementia. • Neuroimaging plays an important role in the multimodal approach towards management of dementia.
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Staals J, Booth T, Morris Z, Bastin ME, Gow AJ, Corley J, Redmond P, Starr JM, Deary IJ, Wardlaw JM. Total MRI load of cerebral small vessel disease and cognitive ability in older people. Neurobiol Aging 2015; 36:2806-11. [PMID: 26189091 PMCID: PMC4706154 DOI: 10.1016/j.neurobiolaging.2015.06.024] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 06/08/2015] [Accepted: 06/23/2015] [Indexed: 01/06/2023]
Abstract
Cerebral small vessel disease (SVD) may cause cognitive dysfunction. We tested the association between the combined presence of magnetic resonance imaging (MRI) features of SVD and cognitive ability in older age. Cognitive testing and brain MRI were performed in 680 older participants. MRI presence of lacunes, white matter hyperintensities, microbleeds, and perivascular spaces were summed in a score of 0-4 representing all SVD features combined. We also applied latent variable modeling to test whether the 4 MRI features form a unitary SVD construct. The SVD score showed significant associations with general cognitive ability. Latent variable modeling indicated that the 4 MRI markers formed a unitary construct, which showed consistent associations with cognitive ability compared with the SVD score. Total MRI load of SVD is associated with lower general cognitive ability in older age. The total SVD score performed consistently with the more complex latent variable model, suggesting validity and potential utility in future research for determining total SVD load.
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Affiliation(s)
- Julie Staals
- Department of Neurology and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands; Brain Research Imaging Centre, Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
| | - Tom Booth
- Department of Psychology, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Zoe Morris
- Brain Research Imaging Centre, Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Brain Research Imaging Centre, Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Alan J Gow
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, School of Life Sciences, Heriot-Watt University, Edinburgh, UK
| | - Janie Corley
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Paul Redmond
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Brain Research Imaging Centre, Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
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Rodríguez García P, Rodríguez García D. Diagnosis of vascular cognitive impairment and its main categories. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2011.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Warren MW, Weiner MF, Rossetti HC, McColl R, Peshock R, King KS. Cognitive impact of lacunar infarcts and white matter hyperintensity volume. Dement Geriatr Cogn Dis Extra 2015; 5:170-5. [PMID: 26034488 PMCID: PMC4448068 DOI: 10.1159/000370109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Subcortical lacunar infarcts and white matter hyperintensities (WMH) are common neuroradiological findings, but few studies associate between these insults and cognition in a community-dwelling population. Methods The Dallas Heart Study is a population-based initiative whose assessments included demographic and clinical findings including brain MRI and the Montreal Cognitive Assessment (MoCA). The presence and number of lacunes in subjects aged over 55 years were assessed by study physicians. The WMH volume was measured by an automated method. The association between the presence and number of lacunar infarcts and of WMH volume with the total MoCA score and subdomains was assessed using linear regression with adjustment for age, gender and self-reported ethnicity. Results In 609 subjects with valid data, both the presence and the increasing number of lacunes were associated with lower MoCA scores, even after adjusting for demographic variables. The presence of lacunes was also associated with lower scores in the memory, executive and attention subdomains. The WMH volume was not significantly associated with the MoCA score. Conclusion The presence and increasing number of lacunes in midlife is associated with a lower performance in multiple domains of a cognitive screening measure after adjusting for demographic factors.
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Affiliation(s)
| | | | | | | | - Ron Peshock
- UT Southwestern Medical Center, Dallas, Tex., USA
| | - Kevin S King
- UT Southwestern Medical Center, Dallas, Tex., USA
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Post-stroke memory impairment among patients with vascular mild cognitive impairment. BMC Neurol 2014; 14:244. [PMID: 25927318 PMCID: PMC4300833 DOI: 10.1186/s12883-014-0244-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 12/11/2014] [Indexed: 11/30/2022] Open
Abstract
Background The American Stroke Association/American Heart Association recommended the criteria for diagnosis of vascular cognitive impairment and memory impairment (MI) is a feature in the classification of vascular mild cognitive impairment (VaMCI). VaMCI patients with MI may differ in terms of infarct location or demographic features, so we evaluated the clinical characteristics associated with MI in patients with VaMCI. Methods A prospective multicenter study enrolled 353 acute ischemic stroke patients who underwent evaluation using the Korean Vascular Cognitive Impairment Harmonization Standard Neuropsychological Protocol at three months after onset. The association between MI and demographic features, stroke risk factors, and infarct location was assessed. Results VaMCI was diagnosed in 141 patients, and 58 (41.1%) exhibited MI. Proportions of men and of left side infarcts were higher in VaMCI with MI than those without (75.9 vs. 57.8%, P = 0.03, 66.7 vs. 47%, P = 0.02). Multiple logistic analyses revealed that male sex (odds ratio [OR] 3.07, 95% confidence interval [95% CI] 1.12-8.42), left-side infarcts (OR 3.14, 95% CI 1.37-7.20), and basal ganglia/internal capsule infarcts (OR 4.53, 95% CI 1.55-13.22) were associated with MI after adjusting other demographic variables, vascular risk factors, and subtypes of stroke. Conclusions MI is associated with sex and infarct location in VaMCI patients.
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Li J, Hu W. Glucose metabolism measured by positron emission tomography is reduced in patients with white matter presumably ischemic lesions. Med Sci Monit 2014; 20:1525-30. [PMID: 25159539 PMCID: PMC4156339 DOI: 10.12659/msm.892137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The severity and progression of white matter ischemic lesion (WMIL) are closely linked to vascular dementia. The function of neural tissue is closely linked to glucose consumption as the most important energy-supplying metabolic process. At present, [18]fluorine-fluorodeoxy glucose ([18]FDG) positron emission tomography (PET) can provide regional and 3-dimensional quantification of glucose metabolism in the human brain. Although MMSE and MoCA are commonly used screens in cognitive impairment, no research team has yet validated their performance in WMIL. The purpose of our study was to compare MMSE and MoCA in screening for cognitive impairment and to explore the correlations between CMRglu values and executive function. MATERIAL AND METHODS All the participants underwent comprehensive clinical, MoCA, MMSE, MRI, and PET examinations. Patients in the WMIL group were subdivided into 3 severity subgroups according to the Fazekas scale. RESULTS The MoCA scores were lower in the WMIL group. Our research indicates that MoCA is a more sensitive screening tool than the commonly used MMSE in detecting cognitive impairment in patients with WMIL. CMRglu values of gray matter were decreased in the WMIL group. Reductions of CMRglu in parietal lobe, frontal lobe, and white matter centrum semiovale were observed to different degrees in the WMIL groups according to the modified Fazekas scale. A significant negative correlation was found between executive function and CMRglu in the frontal lobe. CONCLUSIONS MoCA appears to be a more sensitive screening tool than the commonly used MMSE in detecting cognitive impairment in patients with WMIL. CMRglu can potentially be used as a biomarker for predicting the severity of WMIL.
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Affiliation(s)
- Jian Li
- Department of Neurology, Beijing Chaoyang Hospital (Xi District), Capital Medical University, Beijing, China (mainland)
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital (Xi District), Capital Medical University, Beijing, China (mainland)
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Sun JH, Tan L, Yu JT. Post-stroke cognitive impairment: epidemiology, mechanisms and management. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:80. [PMID: 25333055 PMCID: PMC4200648 DOI: 10.3978/j.issn.2305-5839.2014.08.05] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 07/18/2014] [Indexed: 01/26/2023]
Abstract
Post-stroke cognitive impairment occurs frequently in the patients with stroke. The prevalence of post-stroke cognitive impairment ranges from 20% to 80%, which varies for the difference between the countries, the races, and the diagnostic criteria. The risk of post-stroke cognitive impairment is related to both the demographic factors like age, education and occupation and vascular factors. The underlying mechanisms of post-stroke cognitive impairment are not known in detail. However, the neuroanatomical lesions caused by the stroke on strategic areas such as the hippocampus and the white matter lesions (WMLs), the cerebral microbleeds (CMBs) due to the small cerebrovascular diseases and the mixed AD with stroke, alone or in combination, contribute to the pathogenesis of post-stroke cognitive impairment. The treatment of post-stroke cognitive impairment may benefit not only from the anti-dementia drugs, but also the manage measures on cerebrovascular diseases. In this review, we will describe the epidemiological features and the mechanisms of post-stroke cognitive impairment, and discuss the promising management strategies for these patients.
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Alteraciones neuropsicológicas asociadas en pacientes con infarto lacunar. ACTA COLOMBIANA DE PSICOLOGIA 2014. [DOI: 10.14718/acp.2014.17.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Existe poca evidencia del deterioro cognoscitivo que defina el perfil del paciente con Infarto Lacunar (IL). El propósito de este estudio fue identificar las alteraciones neuropsicológicas en este tipo de pacientes. La muestra estuvo compuesta por 16 pacientes con IL y 16 participantes sanos con una edad promedio de 63 ± 9.41 y 64.75 ± 9.06 años y una escolaridad de 7.55 ± 4.34 y 7.94 ± 3.51, respectivamente. Se valoró la función cognoscitiva mediante un instrumento de tamizaje y una batería neuropsicológica. El análisis estadístico se llevó a cabo a través de la prueba Kruskal-Wallis y la U de Man-Whitney. Los pacientes con IL se caracterizan por la alteración de dominios como planeación, fluidez verbal, cambio atencional, habilidad visoconstructiva y velocidad de procesamiento de la información (p < 0.050). El IL se relaciona con el deterioro del funcionamiento ejecutivo y de velocidad de procesamiento, debido a la interrupción de circuitos frontocortico-subcorticales asociados con su correcto desempeño.
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Benjamin P, Lawrence AJ, Lambert C, Patel B, Chung AW, MacKinnon AD, Morris RG, Barrick TR, Markus HS. Strategic lacunes and their relationship to cognitive impairment in cerebral small vessel disease. NEUROIMAGE-CLINICAL 2014; 4:828-37. [PMID: 24936433 PMCID: PMC4055894 DOI: 10.1016/j.nicl.2014.05.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/02/2014] [Accepted: 05/16/2014] [Indexed: 01/09/2023]
Abstract
Objectives Lacunes are an important disease feature of cerebral small vessel disease (SVD) but their relationship to cognitive impairment is not fully understood. To investigate this we determined (1) the relationship between lacune count and total lacune volume with cognition, (2) the spatial distribution of lacunes and the cognitive impact of lacune location, and (3) the whole brain anatomical covariance associated with these strategically located regions of lacune damage. Methods One hundred and twenty one patients with symptomatic lacunar stroke and radiological leukoaraiosis were recruited and multimodal MRI and neuropsychological data acquired. Lacunes were mapped semi-automatically and their volume calculated. Lacune location was automatically determined by projection onto atlases, including an atlas which segments the thalamus based on its connectivity to the cortex. Lacune locations were correlated with neuropsychological results. Voxel based morphometry was used to create anatomical covariance maps for these ‘strategic’ regions. Results Lacune number and lacune volume were positively associated with worse executive function (number p < 0.001; volume p < 0.001) and processing speed (number p < 0.001; volume p < 0.001). Thalamic lacunes, particularly those in regions with connectivity to the prefrontal cortex, were associated with impaired processing speed (Bonferroni corrected p = 0.016). Regions of associated anatomical covariance included the medial prefrontal, orbitofrontal, anterior insular cortex and the striatum. Conclusion Lacunes are important predictors of cognitive impairment in SVD. We highlight the importance of spatial distribution, particularly of anteromedial thalamic lacunes which are associated with impaired information processing speed and may mediate cognitive impairment via disruption of connectivity to the prefrontal cortex. Lacunes are a predictor of cognitive impairment in cerebral small vessel disease Lacunes in the anteromedial thalamus are associated with impaired processing speed This region was identified to have connectivity to the prefrontal cortex We validate this finding with the help of a structural covariance analysis
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Affiliation(s)
- Philip Benjamin
- Neurosciences Research Centre, St George's University of London, UK
| | - Andrew J Lawrence
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Bhavini Patel
- Neurosciences Research Centre, St George's University of London, UK
| | - Ai Wern Chung
- Neurosciences Research Centre, St George's University of London, UK
| | - Andrew D MacKinnon
- Atkinson Morley Regional Neuroscience Centre, St George's NHS Healthcare Trust, London, UK
| | | | - Thomas R Barrick
- Neurosciences Research Centre, St George's University of London, UK
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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