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van Dijk SE, Drenth N, Hafkemeijer A, Labadie G, Witjes-Ané MNW, Blauw GJ, Rombouts SARB, van der Grond J, van Rooden S. Neurovascular coupling in early stage dementia - A case-control study. J Cereb Blood Flow Metab 2024; 44:1013-1023. [PMID: 37994030 PMCID: PMC11318393 DOI: 10.1177/0271678x231214102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/11/2023] [Accepted: 10/05/2023] [Indexed: 11/24/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is frequently found post mortem in Alzheimer's dementia, but often undetected during life especially since in vivo hallmarks of CAA and its vascular damage become overt relatively late in the disease process. Decreased neurovascular coupling to visual stimulation has been put forward as an early MRI marker for CAA disease severity. The current study investigates the role of neurovascular coupling in AD related dementia and its early stages. We included 25 subjective cognitive impairment, 33 mild cognitive impairment and 17 dementia patients and 44 controls. All participants underwent magnetic resonance imaging of the brain and neuropsychological assessment. Univariate general linear modeling analyses were used to assess neurovascular coupling between patient groups and controls. Moreover, linear regression analyses was used to assess the associations between neurovascular coupling and cognition. Our data show that BOLD amplitude is lower in dementia (mean 0.8 ± 0.2, p = 0.001) and MCI patients (mean 0.9 ± 0.3, p = 0.004) compared with controls (mean 1.1 ± 0.2). A low BOLD amplitude was associated with low scores in multiple cognitive domains. We conclude that cerebrovascular dysfunction, most likely due CAA, is an important comorbidity in early stages of dementia and has an independent effect on cognition.
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Affiliation(s)
- Suzanne E van Dijk
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nadieh Drenth
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne Hafkemeijer
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Gerda Labadie
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-Noëlle W Witjes-Ané
- Department of Geriatrics and Psychiatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerard J Blauw
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Geriatrics, Haaglanden Medical Center, The Hague, the Netherlands
| | - Serge ARB Rombouts
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanneke van Rooden
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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DeConne TM, Fancher IS, Edwards DG, Trott DW, Martens CR. CD8 + T-cell metabolism is related to cerebrovascular reactivity in middle-aged adults. Am J Physiol Regul Integr Comp Physiol 2024; 326:R416-R426. [PMID: 38406845 DOI: 10.1152/ajpregu.00267.2023] [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: 11/30/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Cerebrovascular reactivity (CVR) decreases with advancing age, contributing to increased risk of cognitive impairment; however, the mechanisms underlying the age-related decrease in CVR are incompletely understood. Age-related changes to T cells, such as impaired mitochondrial respiration, increased inflammation, likely contribute to peripheral and cerebrovascular dysfunction in animals. However, whether T-cell mitochondrial respiration is related to cerebrovascular function in humans is not known. Therefore, we hypothesized that peripheral T-cell mitochondrial respiration would be positively associated with CVR and that T-cell glycolytic metabolism would be negatively associated with CVR. Twenty middle-aged adults (58 ± 5 yr) were recruited for this study. T cells were separated from peripheral blood mononuclear cells. Cellular oxygen consumption rate (OCR) and extracellular acidification rate (ECAR, a marker of glycolytic activity) were measured using extracellular flux analysis. CVR was quantified using the breath-hold index (BHI), which reflects the change in blood velocity in the middle-cerebral artery (MCAv) during a 30-s breath-hold. In contrast to our hypothesis, we found that basal OCR in CD8+ T cells (β = -0.59, R2 = 0.27, P = 0.019) was negatively associated with BHI. However, in accordance with our hypothesis, we found that basal ECAR (β = -2.20, R2 = 0.29, P = 0.015) and maximum ECAR (β = -50, R2 = 0.24, P = 0.029) were negatively associated with BHI in CD8+ T cells. There were no associations observed in CD4+ T cells. These associations appeared to be primarily mediated by an association with the pressor response to the breath-hold test. Overall, our findings suggest that CD8+ T-cell respiration and glycolytic activity may influence CVR in humans.NEW & NOTEWORTHY Peripheral T-cell metabolism is related to in vivo cerebrovascular reactivity in humans. Higher glycolytic metabolism in CD8+ T cells was associated with lower cerebrovascular reactivity to a breath-hold in middle-aged adults, which is possibly reflective of a more proinflammatory state in midlife.
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Affiliation(s)
- Theodore M DeConne
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
| | - Ibra S Fancher
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Daniel W Trott
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Christopher R Martens
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
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Skinner BD, Lucas RAI, Lucas SJE. Exposure to passive heat and cold stress differentially modulates cerebrovascular-CO 2 responsiveness. J Appl Physiol (1985) 2024; 136:23-32. [PMID: 37969086 DOI: 10.1152/japplphysiol.00494.2023] [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: 07/20/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023] Open
Abstract
Heat and cold stress influence cerebral blood flow (CBF) regulatory factors (e.g., arterial CO2 partial pressure). However, it is unclear whether the CBF response to a CO2 stimulus (i.e., cerebrovascular-CO2 responsiveness) is maintained under different thermal conditions. This study aimed to compare cerebrovascular-CO2 responsiveness between normothermia, passive heat, and cold stress conditions. Sixteen participants (8 females; 25 ± 7 yr) completed two experimental sessions (randomized) comprising normothermic and either passive heat or cold stress conditions. Middle and posterior cerebral artery velocity (MCAv, PCAv) were measured during rest, hypercapnia (5% CO2 inhalation), and hypocapnia (voluntary hyperventilation to an end-tidal CO2 of 30 mmHg). The linear slope of the cerebral blood velocity (CBv) response to changing end-tidal CO2 was calculated to measure cerebrovascular-CO2 responsiveness, and cerebrovascular conductance (CVC) was used to examine responsiveness independent of blood pressure. CBv-CVC-CO2 responsiveness to hypocapnia was greater during heat stress compared with cold stress (MCA: +0.05 ± 0.08 cm/s/mmHg/mmHg, P = 0.04; PCA: +0.02 ± 0.02 cm/s/mmHg/mmHg, P = 0.002). CBv-CO2 responsiveness to hypercapnia decreased during heat stress (MCA: -0.67 ± 0.89 cm/s/mmHg, P = 0.02; PCA: -0.64 ± 0.62 cm/s/mmHg; P = 0.01) and increased during cold stress (MCA: +0.98 ± 1.33 cm/s/mmHg, P = 0.03; PCA: +1.00 ± 0.82 cm/s/mmHg; P = 0.01) compared with normothermia. However, CBv-CVC-CO2 responsiveness to hypercapnia was not different between thermal conditions (P > 0.08). Overall, passive heat, but not cold, stress challenges the maintenance of cerebral perfusion. A greater cerebrovascular responsiveness to hypocapnia during heat stress likely reduces an already impaired cerebrovascular reserve capacity and may contribute to adverse events (e.g., syncope).NEW & NOTEWORTHY This study demonstrates that thermoregulatory-driven perfusion pressure changes, from either cold or heat stress, impact cerebrovascular responsiveness to hypercapnia. Compared with cold stress, heat stress poses a greater challenge to the maintenance of cerebral perfusion during hypocapnia, challenging cerebrovascular reserve capacity while increasing cerebrovascular-CO2 responsiveness. This likely exacerbates cerebral hypoperfusion during heat stress since hyperthermia-induced hyperventilation results in hypocapnia. No regional differences in middle and posterior cerebral artery responsiveness were found with thermal stress.
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Affiliation(s)
- Bethany D Skinner
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rebekah A I Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
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Fresnais D, Ihle-Hansen H, Lundström E, Andersson ÅG, Fure B. Cerebrovascular Hemodynamics in Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of Transcranial Doppler Studies. Dement Geriatr Cogn Disord 2023; 52:277-295. [PMID: 38008061 PMCID: PMC10911167 DOI: 10.1159/000535422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023] Open
Abstract
INTRODUCTION Transcranial Doppler (TCD) sonography is a noninvasive tool for measuring cerebrovascular hemodynamics. Studies have reported alterations in cerebrovascular hemodynamics in normal aging, mild cognitive impairment (MCI), and dementia, as well as in different etiologies of dementia. This systematic review and meta-analysis was designed to investigate the relationship between cerebral blood velocity (CBv) and pulsatility index (PI) in the middle cerebral artery (MCA) in persons with MCI and dementia. METHODS A systematic literature search was conducted in Pubmed, Embase, Cochrane Library, Epistemonikos, PsychINFO, and CINAHL. The search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After screening of 33,439 articles, 86 were reviewed in full-text, and 35 fulfilled the inclusion criteria. RESULTS CBv was significantly lower and PI significantly higher in MCA in vascular dementia (VaD) and Alzheimer's disease (AD) compared to cognitively normal (CN) older persons. Also, CBv was lower in MCI compared to CN. There were no significant differences in CBv in MCA in AD compared with VaD, although PI was higher in VaD compared to AD. CONCLUSION Alterations in cerebrovascular hemodynamics are seen in AD, VaD, and MCI. While PI was slightly higher in VaD compared to AD, the reduction in CBv appears to be equally pronounced across neurodegenerative and vascular etiologies of dementia.
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Affiliation(s)
- David Fresnais
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
- Department of Internal Medicine, Central Hospital Karlstad, Karlstad, Sweden
| | | | - Erik Lundström
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
- Department of Neurology, Academic University Hospital Uppsala, Uppsala, Sweden
| | - Åsa G Andersson
- Department of Geriatrics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | - Brynjar Fure
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
- Department of Internal Medicine, Central Hospital Karlstad, Karlstad, Sweden
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Beishon L, Haunton VJ, Panerai RB. Antihypertensives in dementia: Good or bad for the brain? J Cereb Blood Flow Metab 2023; 43:1800-1802. [PMID: 36284494 PMCID: PMC10581243 DOI: 10.1177/0271678x221133473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 11/15/2022]
Abstract
Hypertension is associated with both ageing and dementia. Despite this, optimal blood pressure targets in dementia remain unclear. Both high and low blood pressure are associated with poorer cognition. Changes in vascular physiology in dementia may increase the vulnerability of the brain to hypoperfusion associated with antihypertensives. We discuss the potential risks of antihypertensives in the context of altered cerebral haemodynamics, and evidence from antihypertensive trials in dementia. We suggest that individualised blood pressure targets should be the focus for antihypertensive therapy in dementia, rather than strict control to uniform targets extrapolated from trials in cognitively healthy individuals.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | | | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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Carter KJ, Ward AT, Kellawan JM, Harrell JW, Peltonen GL, Roberts GS, Al-Subu A, Hagen SA, Serlin RC, Eldridge MW, Wieben O, Schrage WG. Reduced basal macrovascular and microvascular cerebral blood flow in young adults with metabolic syndrome: potential mechanisms. J Appl Physiol (1985) 2023; 135:94-108. [PMID: 37199780 PMCID: PMC10292973 DOI: 10.1152/japplphysiol.00688.2022] [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: 11/15/2022] [Revised: 04/26/2023] [Accepted: 05/13/2023] [Indexed: 05/19/2023] Open
Abstract
Ninety-million Americans suffer metabolic syndrome (MetSyn), increasing the risk of diabetes and poor brain outcomes, including neuropathology linked to lower cerebral blood flow (CBF), predominantly in anterior regions. We tested the hypothesis that total and regional CBF is lower in MetSyn more so in the anterior brain and explored three potential mechanisms. Thirty-four controls (25 ± 5 yr) and 19 MetSyn (30 ± 9 yr), with no history of cardiovascular disease/medications, underwent four-dimensional flow magnetic resonance imaging (MRI) to quantify macrovascular CBF, whereas arterial spin labeling quantified brain perfusion in a subset (n = 38/53). Contributions of cyclooxygenase (COX; n = 14), nitric oxide synthase (NOS, n = 17), or endothelin receptor A signaling (n = 13) were tested with indomethacin, NG-monomethyl-L-arginine (L-NMMA), and Ambrisentan, respectively. Total CBF was 20 ± 16% lower in MetSyn (725 ± 116 vs. 582 ± 119 mL/min, P < 0.001). Anterior and posterior brain regions were 17 ± 18% and 30 ± 24% lower in MetSyn; reductions were not different between regions (P = 0.112). Global perfusion was 16 ± 14% lower in MetSyn (44 ± 7 vs. 36 ± 5 mL/100 g/min, P = 0.002) and regionally in frontal, occipital, parietal, and temporal lobes (range 15-22%). The decrease in CBF with L-NMMA (P = 0.004) was not different between groups (P = 0.244, n = 14, 3), and Ambrisentan had no effect on either group (P = 0.165, n = 9, 4). Interestingly, indomethacin reduced CBF more in Controls in the anterior brain (P = 0.041), but CBF decrease in posterior was not different between groups (P = 0.151, n = 8, 6). These data indicate that adults with MetSyn exhibit substantially reduced brain perfusion without regional differences. Moreover, this reduction is not due to loss of NOS or gain of ET-1 signaling but rather a loss of COX vasodilation.NEW & NOTEWORTHY We tested the impact of insulin resistance (IR) on resting cerebral blood flow (CBF) in adults with metabolic syndrome (MetSyn). Using MRI and research pharmaceuticals to study the role of NOS, ET-1, or COX signaling, we found that adults with MetSyn exhibit substantially lower CBF that is not explained by changes in NOS or ET-1 signaling. Interestingly, adults with MetSyn show a loss of COX-mediated vasodilation in the anterior but not posterior circulation.
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Affiliation(s)
- Katrina J Carter
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, United States
| | - Aaron T Ward
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, United States
| | - J Mikhail Kellawan
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma, United States
| | - John W Harrell
- 711th Human Performance Wing, Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, Ohio, United States
| | - Garrett L Peltonen
- School of Nursing and Kinesiology, Western New Mexico University, Silver City, New Mexico, United States
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, United States
| | - Awni Al-Subu
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States
| | - Scott A Hagen
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States
| | - Ronald C Serlin
- Department of Educational Psychology, University of Wisconsin, Madison, Wisconsin, United States
| | - Marlowe W Eldridge
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, United States
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, United States
| | - William G Schrage
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, United States
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Iadecola C, Smith EE, Anrather J, Gu C, Mishra A, Misra S, Perez-Pinzon MA, Shih AY, Sorond FA, van Veluw SJ, Wellington CL. The Neurovasculome: Key Roles in Brain Health and Cognitive Impairment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2023; 54:e251-e271. [PMID: 37009740 PMCID: PMC10228567 DOI: 10.1161/str.0000000000000431] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Preservation of brain health has emerged as a leading public health priority for the aging world population. Advances in neurovascular biology have revealed an intricate relationship among brain cells, meninges, and the hematic and lymphatic vasculature (the neurovasculome) that is highly relevant to the maintenance of cognitive function. In this scientific statement, a multidisciplinary team of experts examines these advances, assesses their relevance to brain health and disease, identifies knowledge gaps, and provides future directions. METHODS Authors with relevant expertise were selected in accordance with the American Heart Association conflict-of-interest management policy. They were assigned topics pertaining to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS The neurovasculome, composed of extracranial, intracranial, and meningeal vessels, as well as lymphatics and associated cells, subserves critical homeostatic functions vital for brain health. These include delivering O2 and nutrients through blood flow and regulating immune trafficking, as well as clearing pathogenic proteins through perivascular spaces and dural lymphatics. Single-cell omics technologies have unveiled an unprecedented molecular heterogeneity in the cellular components of the neurovasculome and have identified novel reciprocal interactions with brain cells. The evidence suggests a previously unappreciated diversity of the pathogenic mechanisms by which disruption of the neurovasculome contributes to cognitive dysfunction in neurovascular and neurodegenerative diseases, providing new opportunities for the prevention, recognition, and treatment of these conditions. CONCLUSIONS These advances shed new light on the symbiotic relationship between the brain and its vessels and promise to provide new diagnostic and therapeutic approaches for brain disorders associated with cognitive dysfunction.
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Heutz R, Claassen J, Feiner S, Davies A, Gurung D, Panerai RB, Heus RD, Beishon LC. Dynamic cerebral autoregulation in Alzheimer's disease and mild cognitive impairment: A systematic review. J Cereb Blood Flow Metab 2023:271678X231173449. [PMID: 37125762 PMCID: PMC10369144 DOI: 10.1177/0271678x231173449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Dynamic cerebral autoregulation (dCA) is a key mechanism that regulates cerebral blood flow (CBF) in response to transient changes in blood pressure (BP). Impairment of dCA could increase vulnerability to hypertensive vascular damage, but also to BP lowering effects of antihypertensive treatment. The literature remains conflicted on whether dCA is altered in Alzheimer's disease (AD) and mild cognitive impairment (MCI). We summarized available data on dCA in AD and MCI, by searching PubMed, Embase, PsycINFO and Web of Science databases (inception-January 2022). Eight studies (total n = 443) were included in the qualitative synthesis of which seven were eligible for meta-analysis. All studies used Transcranial Doppler (TCD) ultrasonography and transfer function analysis or the autoregulatory index to assess dCA during spontaneous or induced BP fluctuations. Meta-analysis indicated no significant difference between AD, MCI and healthy controls in dCA parameters for spontaneous fluctuations. For induced fluctuations, the available data were limited, but indicative of at least preserved and possibly better autoregulatory functioning in AD and MCI compared to controls. In summary, current evidence does not suggest poorer dCA efficiency in AD or MCI. Further work is needed to investigate dCA in dementia with induced fluctuations controlling for changes in end-tidal carbon dioxide.
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Affiliation(s)
- Rachel Heutz
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Jurgen Claassen
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sanne Feiner
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Aaron Davies
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Dewakar Gurung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Rianne de Heus
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Lucy C Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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Jankowska-Polańska B, Kałuska M, Mazurek T, Badura A, Lisiewicz-Jakubaszko J, Tomasiewicz B, Tański W. THE FRAMEWORK OF THE PILOT PROJECT FOR TESTING A TELEMEDICINE MODEL IN THE FIELD OF GERIATRICS - HEALTH CHALLENGES AND JUSTIFICATION OF THE PROJECT IMPLEMENTATION. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:665-673. [PMID: 38207070 DOI: 10.36740/merkur202306114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Aim: To present the essentials of the pilot project for testing a telemedicine model in the field of geriatrics, along with a snapshot of the health challenges. PATIENTS AND METHODS Materials and Methods: This review paper use the synthetic method summarizing the main objectives of the telemedicine project in the field of geriatrics. The described project involving telemedical care of patients with geriatric complexes in the area of frailty syndrome, sarcopenia and malnutrition, according to the proposed model addresses the aforementioned problems. The project provides a holistic model of home and outpatient care, which will allow concerting on 3 groups of the above-mentioned geriatric syndromes. The project will have a pilot character and is aimed at clinical verification through the introduction (implementation) of the new method and accompanying organizational and technological solutions (platform, equipment) in an area where current models and schemes of therapeutic and diagnostic support were insufficient. CONCLUSION Conclusions: The implementation of telemedicine solutions creates an opportunity for geriatric patients and their families by improving access to specialized medical care. This project will support patients, but also caregivers, who (through training and telemedicine) will be better able to provide care services with the ability to reconcile them with their own work.
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Affiliation(s)
| | - Magdalena Kałuska
- DEPARTMENT OF FUNDS ACQUISITION, 4TH MILITARY CLINICAL HOSPITAL, WROCLAW, POLAND
| | - Tomasz Mazurek
- CLINICAL RESEARCH SUPPORT CENTRE, 4TH MILITARY CLINICAL HOSPITAL, WROCLAW, POLAND
| | - Andrzej Badura
- DEPARTMENT OF CLINICAL ENDOCRINOLOGY, 4TH MILITARY CLINICAL HOSPITAL, WROCLAW, POLAND
| | | | - Beata Tomasiewicz
- DEPARTMENT OF INTERNAL MEDICINE, 4TH MILITARY CLINICAL HOSPITAL, WROCLAW, POLAND
| | - Wojciech Tański
- DEPARTMENT OF INTERNAL MEDICINE, 4TH MILITARY CLINICAL HOSPITAL, WROCLAW, POLAND
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The impact of cerebral vasomotor reactivity on cerebrovascular diseases and cognitive impairment. J Neural Transm (Vienna) 2022; 129:1321-1330. [PMID: 36205784 PMCID: PMC9550758 DOI: 10.1007/s00702-022-02546-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022]
Abstract
The regulation of cerebral blood flow (CBF) is a complex and tightly controlled function ensuring delivery of oxygen and nutrients and removal of metabolic wastes from brain tissue. Cerebral vasoreactivity (CVR) refers to the ability of the nervous system to regulate CBF according to metabolic demands or changes in the microenvironment. This can be assessed through a variety of nuclear medicine and imaging techniques and protocols. Several studies have investigated the association of CVR with physiological and pathological conditions, with particular reference to the relationship with cognitive impairment and cerebrovascular disorders (CVD). A better understanding of the interaction between CVR and cognitive dysfunction in chronic and particularly acute CVD could help improving treatment and rehabilitation strategies in these patients. In this paper, we reviewed current knowledge on CVR alterations in the context of acute and chronic CVD and cognitive dysfunction. Alterations in CVR and hemodynamics have been described in patients with both neurodegenerative and vascular cognitive impairment, and the severity of these alterations seems to correlate with CVR derailment. Furthermore, an increased risk of cognitive impairment progression has been associated with alterations in CVR parameters and hemodynamics. Few studies have investigated these associations in acute cerebrovascular disorders and the results are inconsistent; thus, further research on this topic is encouraged.
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The role of the autonomic nervous system in cerebral blood flow regulation in dementia: A review. Auton Neurosci 2022; 240:102985. [DOI: 10.1016/j.autneu.2022.102985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/28/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
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12
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Ball J, Panerai RB, Williams CA, Beishon L. Principal component analysis to identify the major contributors to task-activated neurovascular responses. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100039. [PMID: 36324414 PMCID: PMC9616234 DOI: 10.1016/j.cccb.2022.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
A range of metrics are available to measure to cerebrovascular responses to task activation. We used principal component analysis to reduce dimensionality in a large dataset and determine physiological variables with the greatest contribution to the cerebrovascular response. Peak percentage change in cerebrovascular response was a consistent marker across datasets and the visuospatial task contributed the most variance. There was limited overlap between cognitive tasks and domains suggesting lack of redundancy in the data.
Background Consensus on the optimal metrics for neurovascular coupling (NVC) is lacking. The aim of this study was to use principal component analysis (PCA) to determine the most significant contributors to NVC responses in healthy adults (HC), Alzheimer's disease (AD), and mild cognitive impairment (MCI). New method PCA was applied to three datasets: 1) 69 HC, 2) 30 older HC, 34 AD, and 22 MCI, 3) 1&2 combined. Data were extracted on peak percentage change in cerebral blood flow velocity (CBFv), variance ratio (VR), cross-correlation function peak (CCF), and blood pressure, for five cognitive tasks. An equamax rotation was applied and factors were significant where the eignevalue was ≥1. Rotated factor loadings ≥0.4 determined significant NVC variables. Results PCA identified 12 significant factors accounting for 78% of variance (all datasets). Contributing variables loaded differently on the factors across the datasets. In datasets 1&2, peak percentage change in CBFv contributed to factors explaining the most variance (45–58%), whereas cognitive test scores, fluency and memory domains contributed the least (15–37%). In the combined dataset, CBFv, CCF and fluency domain contributed the majority (33–43%), whereas VR and attention the least (6–24%). Conclusions Peak percentage change in CBFv and the visuospatial task consistently accounted for a large proportion of the variance, suggesting these are robust NVC markers for future studies.
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13
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Zhang H, Wang Y, Lyu D, Li Y, Li W, Wang Q, Li Y, Qin Q, Wang X, Gong M, Jiao H, Liu W, Jia J. Cerebral blood flow in mild cognitive impairment and Alzheimer's disease: A systematic review and meta-analysis. Ageing Res Rev 2021; 71:101450. [PMID: 34419673 DOI: 10.1016/j.arr.2021.101450] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/05/2021] [Accepted: 08/17/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Reduced cerebral blood flow (CBF) contributes to the pathophysiology of Alzheimer's disease (AD). However, it is unclear whether there is a spatial-temporal-specific pattern of changed CBF in AD progression. METHODS We systematically screened literature databases for cross-sectional and longitudinal studies reporting resting CBF or CBF velocity (CBFv) among patients with AD, mild cognitive impairment (MCI), and healthy controls (HCs). Standardised mean differences (SMDs) for CBF and mean differences (MDs) for CBFv were calculated. Quality assessments, meta-analysis, subgroup analysis, and meta-regression were subsequently performed (PROSPERO: CRD42020207548). RESULTS Overall, 244 studies comprising 13,644 participants and 60 regions were included. Compared with HCs, AD subjects had decreased resting CBF throughout the brain (SMD range: -1.87 to -0.32), especially within the posterior cingulate and temporal-parietal regions. However, MCI subjects presented decreased CBF in ten regions with modest effects (SMD range: -0.86 to -0.25), especially in the precuneus. We identified the decreased CBF in the temporal, parietal, and hippocampal regions was associated with the lower AD Mini-Mental State Examination scores. CONCLUSIONS Our findings suggest that the spatial-temporal pattern of CBF decreased from the precuneus, posterior cingulate and temporal-parietal regions to broader areas with progression from HC to MCI to AD, supporting the incorporation of CBF into the AD research framework.
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14
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Claassen JAHR, Thijssen DHJ, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation. Physiol Rev 2021; 101:1487-1559. [PMID: 33769101 PMCID: PMC8576366 DOI: 10.1152/physrev.00022.2020] [Citation(s) in RCA: 304] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Brain function critically depends on a close matching between metabolic demands, appropriate delivery of oxygen and nutrients, and removal of cellular waste. This matching requires continuous regulation of cerebral blood flow (CBF), which can be categorized into four broad topics: 1) autoregulation, which describes the response of the cerebrovasculature to changes in perfusion pressure; 2) vascular reactivity to vasoactive stimuli [including carbon dioxide (CO2)]; 3) neurovascular coupling (NVC), i.e., the CBF response to local changes in neural activity (often standardized cognitive stimuli in humans); and 4) endothelium-dependent responses. This review focuses primarily on autoregulation and its clinical implications. To place autoregulation in a more precise context, and to better understand integrated approaches in the cerebral circulation, we also briefly address reactivity to CO2 and NVC. In addition to our focus on effects of perfusion pressure (or blood pressure), we describe the impact of select stimuli on regulation of CBF (i.e., arterial blood gases, cerebral metabolism, neural mechanisms, and specific vascular cells), the interrelationships between these stimuli, and implications for regulation of CBF at the level of large arteries and the microcirculation. We review clinical implications of autoregulation in aging, hypertension, stroke, mild cognitive impairment, anesthesia, and dementias. Finally, we discuss autoregulation in the context of common daily physiological challenges, including changes in posture (e.g., orthostatic hypotension, syncope) and physical activity.
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Affiliation(s)
- Jurgen A H R Claassen
- Department of Geriatrics, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- >National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Frank M Faraci
- Departments of Internal Medicine, Neuroscience, and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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15
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Sit less and move more for cardiovascular health: emerging insights and opportunities. Nat Rev Cardiol 2021; 18:637-648. [PMID: 34017139 DOI: 10.1038/s41569-021-00547-y] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
Sedentary behaviour - put simply, too much sitting, as a distinct concept from too little exercise - is a novel determinant of cardiovascular risk. This definition provides a perspective that is complementary to the well-understood detrimental effects of physical inactivity. Sitting occupies the majority of the daily waking hours in most adults and has become even more pervasive owing to the COVID-19 pandemic. The potential for a broad cardiovascular health benefit exists through an integrated approach that involves 'sitting less and moving more'. In this Review, we first consider observational and experimental evidence on the adverse effects of prolonged, uninterrupted sitting and the evidence identifying the possible mechanisms underlying the associated risk. We summarize the results of randomized controlled trials demonstrating the feasibility of changing sedentary behaviour. We also highlight evidence on the deleterious synergies between sedentary behaviour and physical inactivity as the underpinnings of our case for addressing them jointly in mitigating cardiovascular risk. This integrated approach should not only reduce the specific risks of too much sitting but also have a positive effect on the total amount of physical activity, with the potential to more broadly benefit the health of individuals living with or at risk of developing cardiovascular disease.
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16
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Beishon L, Panerai RB, Robinson TG, Haunton VJ. Cerebral blood flow response rate to task-activation using a novel method can discriminate cognitive impairment from healthy aging. Physiol Meas 2021; 42. [PMID: 34229305 DOI: 10.1088/1361-6579/ac1185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/06/2021] [Indexed: 12/20/2022]
Abstract
Objective.A new method to classify individuals as 'responders' to task-activated cerebral blood flow velocity (CBFv) has recently been developed. This study investigated whether CBFv response rate to task-activation is affected by Alzheimer's disease (AD) and mild cognitive impairment (MCI).Approach.The 95th thresholds for cross correlation function peak and variance ratio were derived from 270 unstimulated, healthy hemispheres, and were used to classify the presence of a response to task-activation. Thresholds were applied to five cognitive tasks (attention, verbal fluency, language, visuospatial, memory) in CBFv data from 30 healthy older adults (HC), 35 AD and 22 MCI participants. Cumulative response rate (CRR) was calculated from the sum of responses across five tasks, for both hemispheres. Area under the curve (AUC) was derived from receiver operating characteristic (ROC) curve analysis.Main results. The number of responders differed significantly between tasks (p < 0.005) and diagnostic groups (p = 0.011). On post hoc tests there were more responders in the visuospatial (79%-90%) compared to fluency (45%-80%), language (50%-77%), and memory (44%-70%) tasks bilaterally, and responders were greater in the HC (70%) compared to AD (41%) and MCI (23%) groups to at least eight out of ten tasks. At an optimal threshold of 7.5 out of 10 responses, the AUC-ROC distinguished HC from AD and MCI with a; sensitivity 66% and specificity 70% (AUC = 0.72).Significance. Using a novel method to classify responders to cognitive task-activation, HC demonstrated a higher CRR than those with MCI or AD, and a threshold of <8 responses distinguished healthy ageing from dementia.
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Affiliation(s)
- Lucy Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Ronney B Panerai
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Thompson G Robinson
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Victoria J Haunton
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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17
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Siniscalchi A, Gray C, Malferrari G. Ultrasound Diagnostic Method in Vascular Dementia: Current Concepts. Curr Med Imaging 2021; 17:507-512. [PMID: 33032514 DOI: 10.2174/1573405616999201008145106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing interest in identifying cerebral hemodynamics alterations as a cause of possible onset or worsening of cognitive impairment in elderly patients with vascular risk factors. INTRODUCTION Intracranial ultrasound is a non-invasive, repeatable inexpensive method for recording variation of the cerebral vascular tree in physiological and pathological conditions and the diagnosis of vascular dementia (VaD). METHODS PubMed, Embase, Cochrane library and reference lists have been searched for articles published until March 30, 2020. RESULTS Clinical studies reported different Transcranial Doppler (TCD) parameters and subsequently transcranial duplex with color code (TCCD) in patients affected by vascular dementia. The number of studies using TCCD remains limited and most of the available data are still based on TCD. However, the use of transcranial Doppler could better stratify elderly patients with initial signs of cognitive impairment. CONCLUSION Intracranial ultrasound employment to detect cerebral hemodynamic changes in VaD patients has been briefly discussed in this review.
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Affiliation(s)
- Antonio Siniscalchi
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Cleona Gray
- Vascular and Endovascular Surgery Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Giovanni Malferrari
- Stroke Unit, Neurology Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
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18
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Emmanuel S, Jansz P, Hayward C. How well do we understand pulsatility in the context of modern ventricular assist devices? Int J Artif Organs 2021; 44:923-929. [PMID: 33960234 DOI: 10.1177/03913988211012707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Modern ventricular assist devices (VADs) use a continuous flow design. It has been suggested that a lack of pulsatility contributes to a range of adverse outcomes including pump thrombus, gastrointestinal bleeding and stroke. To better assess the role of pulsatility in these adverse events, we first require a clear definition of 'pulsatility' in the setting of a severely impaired ventricle and a modern continuous flow VAD. METHODS A literature review was conducted to elucidate the understanding of pulsatility in modern VAD literature. Search engines used included PUBMED, EMBASE and the Cochrane library. Articles were appraised on three aspects: Whether they mentioned pulsatility; whether they mentioned which pulsatility measure was used and finally which methodology was used to obtain the value. RESULTS Of 354 articles reviewed, only 13 met our broad inclusion criteria. Of these articles, the most cited measure was pulsatility index (PI) - used by 11 of the publications. The methodology used to obtain the value was not uniform and five articles did not clearly state it. Other measures included pulse pressure and surplus haemodynamic energy. The majority of articles did not directly discuss pulsatility in the setting of patient-pump interaction. CONCLUSION Most publications did not provide a definition for pulsatility. In those that did, the most common measure was PI. Measuring PI was not standardised. Few papers addressed the impact of intrinsic ventricular function and arterial compliance on pulsatility. We suggest that future publications adopt a uniform definition which encompasses both patient and pump characteristics.
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Affiliation(s)
- Sam Emmanuel
- St Vincent's Hospital (Sydney), Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Paul Jansz
- St Vincent's Hospital (Sydney), Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Christopher Hayward
- St Vincent's Hospital (Sydney), Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
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19
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Beishon LC, Panerai RB, Budgeon C, Subramaniam H, Mukaetova-Ladinska E, Robinson TG, Haunton VJ. The Cognition and Flow Study: A Feasibility Randomized Controlled Trial of the Effects of Cognitive Training on Cerebral Blood Flow. J Alzheimers Dis 2021; 80:1567-1581. [PMID: 33720895 DOI: 10.3233/jad-201444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive training (CT) has demonstrated benefits for healthy older adults (HG) and mild cognitive impairment (MCI), but the effects on vascular function are unknown. OBJECTIVE This is a feasibility trial investigating the effects of CT on cerebral blood flow velocity (CBFv). METHODS Twenty HG, 24 with Alzheimer's disease (AD), and 12 with MCI were randomized to 12 weeks of multi-domain CT or control. Outcomes included: cognition (Addenbrooke's Cognitive Examination III), mood, quality of life (QoL), physical, and neurovascular function (transcranial Doppler ultrasonography measured task activation of CBFv responses). Data are presented as mean difference (MD) and 95% confidence interval (CI). RESULTS 47 participants completed the trial. There were three dropouts from the training arm in the AD group, and one in the HG group. The intervention was acceptable and feasible to the majority of participants with a high completion rate (89%). The dropout rate was higher among participants with dementia. Few changes were identified on secondary analyses, but QoL was significantly improved in HG post-training (MD: 4.83 [95% CI: 1.13, 8.54]). CBFv response rate was not significantly different in HG (MD: 1.84 [95% CI: -4.81, 1.12]), but a significant increase was seen in the patient group (MD: 1.79 [95% CI: 0.005, 3.58]), requiring sample sizes of 56 and 84 participants respectively for a fully-powered trial. CONCLUSION A 12-week CT program was acceptable and feasible in HG, AD, and MCI. CT may be associated with alterations in vascular physiology which require further investigation in an appropriately powered randomized controlled trial.
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Affiliation(s)
- Lucy C Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK
| | - Ronney B Panerai
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Charley Budgeon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Hari Subramaniam
- The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Elizabeta Mukaetova-Ladinska
- The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK.,University of Leicester, Department of Neuroscience, Psychology and Behaviour, Leicester, UK
| | - Thompson G Robinson
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Victoria J Haunton
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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20
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Alwatban MR, Aaron SE, Kaufman CS, Barnes JN, Brassard P, Ward JL, Miller KB, Howery AJ, Labrecque L, Billinger SA. Effects of age and sex on middle cerebral artery blood velocity and flow pulsatility index across the adult lifespan. J Appl Physiol (1985) 2021; 130:1675-1683. [PMID: 33703940 DOI: 10.1152/japplphysiol.00926.2020] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Reduced middle cerebral artery blood velocity (MCAv) and flow pulsatility are contributors to age-related cerebrovascular disease pathogenesis. It is unknown whether the rate of changes in MCAv and flow pulsatility support the hypothesis of sex-specific trajectories with aging. Therefore, we sought to characterize the rate of changes in MCAv and flow pulsatility across the adult lifespan in females and males as well as within specified age ranges. Participant characteristics, mean arterial pressure, end-tidal carbon dioxide, unilateral MCAv, and flow pulsatility index (PI) were determined from study records compiled from three institutional sites. A total of 524 participants [18-90 yr; females 57 (17) yr, n = 319; males 50 (21) yr, n = 205] were included in the analysis. MCAv was significantly higher in females within the second (P < 0.001), fifth (P = 0.01), and sixth (P < 0.01) decades of life. Flow PI was significantly lower in females within the second decade of life (P < 0.01). Rate of MCAv decline was significantly greater in females than males (-0.39 vs. -0.26 cm s-1·yr, P = 0.04). Rate of flow PI rise was significantly greater in females than males (0.006 vs. 0.003 flow PI, P = 0.01). Rate of MCAv change was significantly greater in females than males in the sixth decade of life (-1.44 vs. 0.13 cm s-1·yr, P = 0.04). These findings indicate that sex significantly contributes to age-related differences in both MCAv and flow PI. Therefore, further investigation into cerebrovascular function within and between sexes is warranted to improve our understanding of the reported sex differences in cerebrovascular disease prevalence.NEW & NOTEWORTHY We present the largest dataset (n = 524) pooled from three institutions to study how age and sex affect middle cerebral artery blood velocity (MCAv) and flow pulsatility index (PI) across the adult lifespan. We report the rate of MCAv decline and flow PI rise is significantly greater in females compared with in males. These data suggest that sex-specific trajectories with aging and therapeutic interventions to promote healthy brain aging should consider these findings.
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Affiliation(s)
- Mohammed R Alwatban
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas.,Abiomed, Inc., Danvers, Massachusetts
| | - Stacey E Aaron
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Carolyn S Kaufman
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Jill N Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Canada
| | - Jaimie L Ward
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Kathleen B Miller
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anna J Howery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Canada
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas.,Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas.,Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas.,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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21
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Stefanidis KB, Isbel B, Klein T, Lagopoulos J, Askew CD, Summers MJ. Reduced cerebral pressure-flow responses are associated with electrophysiological markers of attention in healthy older adults. J Clin Neurosci 2020; 81:167-172. [PMID: 33222909 DOI: 10.1016/j.jocn.2020.09.034] [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: 02/13/2020] [Revised: 08/10/2020] [Accepted: 09/13/2020] [Indexed: 11/27/2022]
Abstract
The aim of this study was to determine the effect of age on the relationship between cerebrovascular function and the neural bases of sustained attention. Twenty-seven healthy young adults (aged 18-30 years) and 24 older adults (60-75 years) underwent assessments of cerebrovascular function and sustained attention. Blood flow velocity of the middle cerebral artery was assessed via Transcranial Doppler Ultrasound, during seated rest, in response to hypocapnic breathing (cerebrovascular reactivity) and during a repeated sit-to-stand procedure (pressure-flow response). Attentional processing was assessed using the N2 and P3 components of the event-related potential during a two-tone auditory oddball task. Poorer pressure-flow responses were significantly associated with reductions in N2 and P3 amplitude in the old group (b = -0.50, p = .029 and b = -0.46, p = .045), but not the young group. These results suggest that alterations in the brain's capacity to combat reductions in perfusion pressure are associated with age-related differences in attentional processing, supporting the hypothesis that cerebrovascular hemodynamic disturbances play a role in age-related cognitive decline.
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Affiliation(s)
- Kayla B Stefanidis
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
| | - Ben Isbel
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Timo Klein
- Vasoactive Group, School of Health & Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Christopher D Askew
- Vasoactive Group, School of Health & Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia; Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Australia
| | - Mathew J Summers
- Discipline of Psychology, School of Social Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
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22
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Koep JL, Barker AR, Banks R, Banger RR, Sansum KM, Weston ME, Bond B. The reliability of a breath-hold protocol to determine cerebrovascular reactivity in adolescents. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:544-552. [PMID: 32608099 DOI: 10.1002/jcu.22891] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Cerebrovascular reactivity (CVR) is impaired in adolescents with cardiovascular disease risk factors. A breath-hold test is a noninvasive method of assessing CVR, yet there are no reliability data of this outcome in youth. This study aimed to assess the reliability of a breath-hold protocol to measure CVR in adolescents. METHODS Twenty-one 13 to 15 year old adolescents visited the laboratory on two separate occasions, to assess the within-test, within-day and between-day reliability of a breath-hold protocol, consisting of three breath-hold attempts. CVR was defined as the relative increase from baseline in middle cerebral artery mean blood velocity following a maximal breath-hold of up to 30 seconds, quantified via transcranial Doppler ultrasonography. RESULTS Mean breath-hold duration and CVR were never significantly correlated (r < .31, P > .08). The within-test coefficient of variation for CVR was 15.2%, with no significant differences across breath-holds (P = .88), so the three breath-hold attempts were averaged for subsequent analyses. The within- and between-day coefficients of variation for CVR were 10.8% and 15.3%, respectively. CONCLUSIONS CVR assessed via a three breath-hold protocol can be reliably measured in adolescents, yielding similar within- and between-day reliability. Analyses revealed that breath-hold length and CVR were unrelated, indicating the commonly reported normalization of CVR to breath-hold duration (breath-hold index) may be unnecessary in youth.
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Affiliation(s)
- Jodie L Koep
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- School of Human Movement and Nutrition Sciences, University of Queensland, Saint Lucia, Queensland, Australia
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Rhys Banks
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Rohit R Banger
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kate M Sansum
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Max E Weston
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- School of Human Movement and Nutrition Sciences, University of Queensland, Saint Lucia, Queensland, Australia
| | - Bert Bond
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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23
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Mason SA, Al Saikhan L, Jones S, Bale G, James SN, Murray-Smith H, Rapala A, Williams S, Wong B, Richards M, Fox NC, Hardy R, Schott JM, Chaturvedi N, Hughes AD. Study Protocol - Insight 46 Cardiovascular: A Sub-study of the MRC National Survey of Health and Development. Artery Res 2020; 26:170-179. [PMID: 32879639 DOI: 10.2991/artres.k.200417.001] [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] [Indexed: 01/09/2023] Open
Abstract
The commonest causes of dementia are Alzheimer's disease and vascular cognitive impairment. Although these conditions have been viewed as distinct entities, there is increasing evidence that neurodegenerative and vascular pathologies interact or overlap to cause cognitive decline, and that at least in some cases individuals at risk of cognitive decline exhibit abnormal cardiovascular physiology long before emergence of disease. However, the mechanisms linking haemodynamic disturbances with cognitive impairment and the various pathologies that cause dementia are poorly understood. A sub-sample of 502 participants from the Medical Research Council National Survey of Health and Development (NSHD) have participated in the first visit of a neuroscience sub-study referred to as Insight 46, where clinical, cognitive, imaging, and lifestyle data have been collected for the purpose of elucidating the pathological changes preceding dementia. This paper outlines the cardiovascular phenotyping performed in the follow-up visit of Insight 46, with the study participants now aged 74. In addition to standard cardiovascular assessments such as blood pressure measurements, echocardiography, and electrocardiography (ECG), functional Near Infrared Spectroscopy (fNIRS) has been included to provide an assessment of cerebrovascular function. A detailed description of the fNIRS protocol along with preliminary results from pilot data is presented. The combination of lifestyle data, brain structure/function, cognitive performance, and cardiovascular health obtained not only from Insight 46, but also from the whole NSHD provides an exciting opportunity to advance our understanding of the cardiovascular mechanisms underlying dementia and cognitive decline, and identify novel targets for intervention.
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Affiliation(s)
- Sarah Ann Mason
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Lamia Al Saikhan
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiac Technology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, 2835 King Faisal Street, Dammam, Kingdom of Saudi Arabia
| | - Siana Jones
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Gemma Bale
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK.,Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Heidi Murray-Smith
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Alicja Rapala
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Suzanne Williams
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Brian Wong
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Jonathan M Schott
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK.,Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
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24
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Yan Y, Wang J, Zhong C, Zhang Y, Wei Y, Liu H. Effects of Endovascular Stent-Assisted Angioplasty on Cellular Metabolism in the Hippocampus of Elderly Patients with Symptomatic Vertebrobasilar Artery Stenosis. Med Sci Monit 2020; 26:e922131. [PMID: 32390653 PMCID: PMC7241214 DOI: 10.12659/msm.922131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cerebral artery stenosis is closely related to cognitive function, and angioplasty can improve the cognitive function of elderly patients with vertebrobasilar artery stenosis. The specific mechanism, however, is not clear. This study explored the effect of angioplasty on cellular metabolism in the hippocampus of elderly patients with symptomatic vertebrobasilar artery stenosis. MATERIAL AND METHODS Eighteen elderly patients with symptomatic vertebrobasilar artery stenosis who underwent endovascular stent-assisted angioplasty (ESAA) in our department were studied. The changes in cellular metabolism (NAA / Cr, CHO / Cr, NAA / CHO) in bilateral hippocampal areas were detected by MRS before and at 6 months and 12 months after the ESAA. The Montreal Cognitive Assessment Scale (MoCA), Hamilton Depression Self-assessment Scale (HAMD), and Hamilton Anxiety Self-assessment Scale (HAMA) were also used to evaluate the cognition, depression, and anxiety of patients at different time points of the study, and analyzed the correlation between the changes of cellular metabolism in the hippocampus and the scores of MoCA, HAMD, and HAMA. RESULTS The levels of NAA/Cr in left/right hippocampal areas were significantly higher at 6 and 12 months after the ESAA than before (1.01±0.17/1.22±0.26 vs. 1.10±0.20/1.05±0.26 vs. 0.82±0.10/0.84±0.11, respectively) (P<0.01). MoCA scores were positively correlated with the levels of NAA/Cr in the left/right hippocampal areas (P<0.05 and P<0.01, respectively). CONCLUSIONS ESAA can improve cognitive function of patients by changing the cellular metabolism of the hippocampus in elderly patients with symptomatic vertebrobasilar artery stenosis.
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Affiliation(s)
- Yongxing Yan
- Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China (mainland)
| | - Jun Wang
- Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China (mainland)
| | - Changyang Zhong
- Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China (mainland)
| | - Yan Zhang
- Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China (mainland)
| | - Yingnan Wei
- Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China (mainland)
| | - Huili Liu
- Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China (mainland)
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25
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Beishon L, Minhas JS, Patrick K, Shanmugam I, Williams CAL, Panerai RB, Robinson TG, Haunton VJ. The Effects of Healthy Ageing on Cerebral Blood Flow Responses to Cognitive Testing. Curr Aging Sci 2020; 11:226-235. [PMID: 30706798 PMCID: PMC6635423 DOI: 10.2174/1874609812666190131165310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 01/29/2023]
Abstract
Background: Transcranial Doppler Ultrasonography (TCD) can be utilised to measure the tight coupling of cerebral blood flow velocity (CBFv) in response to cognitive demand by task activation, termed neurovascular coupling. Aims: To investigate the differences in neurovascular coupling between healthy older (>50 years) and younger (18-49 years) adults in response to cognitive testing. Methods: Fifty-four older (n=25) and younger (n=29) adults underwent continuous bilateral TCD, beat-to-beat blood pressure (MAP; Finapres), heart rate (HR; electrocardiogram), and end-tidal CO2 (ETCO2; capnography) monitoring. After a 5-min baseline period, memory (M1-4: recalling three learned words, learning a name and address, recalling US presidents and UK prime ministers, and recalling the previously learned name and address) and visuospatial (V1-4: drawing a cube and infinity diagram, drawing a clock face, counting dots, and recognising obscured letters) tasks from the Addenbrooke's Cognitive Examination (ACE-III) were performed. Data are mean (standard deviation). Results: In the memory paradigms, the peak percentage change in CBFv differed significantly between younger and older groups only in the dominant hemisphere during the M1 task, (2.17 (9.16)% vs. 8.38 (9.27)%, respectively, p=0.017). In the visuospatial paradigm, there were also significant differences in peak percentage change in CBFv between younger and older groups in the V1 (5.87 (8.32)% vs. 11.89 (6.60)%, p=0.005) and V2 tasks (6.30 (8.72)% vs. 11.30 (7.77)%, p=0.032). Conclusion: Healthy older adults demonstrate augmented cerebrovascular physiology in response to cognitive challenge compared to younger adults. The impact of abnormal ageing on cerebrovascular physiology, for example, related to cognitively impaired states, requires further investigation.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Kate Patrick
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Iswariya Shanmugam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Claire A L Williams
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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26
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Cerebrovascular Correlates of Subclinical Attentional Disturbances in Non-stroke Cardiovascular Disease. Neuroscience 2019; 421:144-151. [PMID: 31682956 DOI: 10.1016/j.neuroscience.2019.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022]
Abstract
Evidence suggests that cerebrovascular hemodynamic disturbances underlie cognitive deterioration secondary to cardiovascular disease (CVD), including manifestations other than stroke, but the mechanisms remain unclear. To date, the majority of studies have used neuropsychological measures validated for the detection of clinically significant cognitive decline but lack the sensitivity to accurately detect subclinical or subtle cognitive changes. The N2 and P3 components of the event-related potential are sensitive markers of attention and cognitive processing, and are valuable in the assessment of age-related cognitive changes and neurodegenerative disease. The aims of this study were to test (a) the sensitivity of N2 and P3 components in differentiating older adults with CVD from healthy controls, and (b) whether cerebrovascular hemodynamics are associated with alterations in attention in persons with non-stroke CVD. Older adults with CVD (n = 20) and healthy older adults (n = 20) without cognitive impairment or history of stroke and matched for age, were recruited. Cerebral blood flow velocity of the middle cerebral artery (MCAv) and Gosling's Pulsatility Index (PI) were assessed using Transcranial Doppler ultrasound (TCD). ERPs were elicited using a two-tone auditory oddball task. N2 amplitude was significantly reduced in the CVD group at midline frontal, central and parietal sites (p < .05, d > 0.6). No significant group differences were observed in N2 latency, P3 amplitude, or P3 latency. Further, MCAv and PI were strongly associated with N2 amplitude in the CVD group, such that greater MCAv was associated with reductions in N2 amplitude (b = -0.58, p = .018), whilst PI was associated with increases in N2 amplitude (b = 0.66, p = .006). No relationships between MCAv or PI with N2 or P3 ERP components were observed in the healthy control group. The data reported here suggest that a reduction in N2 amplitude may be an important objective indicator of subclinical cognitive and attentional alterations in non-stroke CVD, and support the notion that cerebrovascular hemodynamic disturbances play a role in the pathogenesis of cognitive deterioration secondary to non-stroke CVD.
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27
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Yang D, Hong KS, Yoo SH, Kim CS. Evaluation of Neural Degeneration Biomarkers in the Prefrontal Cortex for Early Identification of Patients With Mild Cognitive Impairment: An fNIRS Study. Front Hum Neurosci 2019; 13:317. [PMID: 31551741 PMCID: PMC6743351 DOI: 10.3389/fnhum.2019.00317] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/26/2019] [Indexed: 12/13/2022] Open
Abstract
Mild cognitive impairment (MCI), a condition characterizing poor cognition, is associated with aging and depicts early symptoms of severe cognitive impairment, known as Alzheimer's disease (AD). Meanwhile, early detection of MCI can prevent progression to AD. A great deal of research has been performed in the past decade on MCI detection. However, availability of biomarkers for MCI detection requires greater attention. In our study, we evaluated putative and reliable biomarkers for diagnosing MCI by performing different mental tasks (i.e., N-back task, Stroop task, and verbal fluency task) using functional near-infrared spectroscopy (fNIRS) signals on a group of 15 MCI patients and 9 healthy control (HC). The 15 digital biomarkers (i.e., five means, seven slopes, peak, skewness, and kurtosis) and two image biomarkers (t-map, correlation map) in the prefrontal cortex (PFC) (i.e., left PFC, middle PFC, and right PFC) between the MCI and HC groups were investigated by the statistical analysis, linear discriminant analysis (LDA), and convolutional neural network (CNN) individually. The results reveal that the statistical analysis using digital biomarkers (with a p-value < 0.05) could not distinguish the MCI patients from the HC over 60% accuracy. Therefore, the current statistical analysis needs to be improved to be used for diagnosing the MCI patients. The best accuracy with LDA was 76.67% with the N-back and Stroop tasks. However, the CNN classification results trained by image biomarkers showed a high accuracy. In particular, the CNN results trained via t-maps revealed the best accuracy (90.62%) with the N-back task, whereas the CNN result trained by the correlation maps was 85.58% with the N-back task. Also, the results illustrated that investigating the sub-regions (i.e., right, middle, left) of the PFC for detecting MCI would be better than examining the whole PFC. The t-map (or/and the correlation map) is conclusively recommended as an image biomarker for early detection of AD. The combination of CNN and image biomarkers can provide a reliable clinical tool for diagnosing MCI patients.
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Affiliation(s)
- Dalin Yang
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
| | - Keum-Shik Hong
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, South Korea
| | - So-Hyeon Yoo
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
| | - Chang-Soek Kim
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, South Korea
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28
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Optical measures of cerebral arterial stiffness are associated with white matter signal abnormalities and cognitive performance in normal aging. Neurobiol Aging 2019; 84:200-207. [PMID: 31500910 DOI: 10.1016/j.neurobiolaging.2019.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 05/29/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
Decline in fluid abilities in normal aging is associated with increased white matter lesions, measured on T1-weighted images as white matter signal abnormalities (WMSAs). WMSAs are particularly evident in hypertensive older adults, suggesting vascular involvement. However, because hypertension is assessed systemically, the specific role of cerebral arterial stiffening in WMSAs has yet to be demonstrated. In 93 cognitively normal adults (aged 18-87 years), we used a novel method to measure cerebral arterial elasticity (pulse relaxation function [PReFx]) with diffuse optical tomography (pulse-DOT) and investigated its association with WMSAs, age, and cognition. PReFx was associated with WMSAs, with older adults with low PReFx showing the greatest WMSA burden. PReFx in brain regions perfused by the middle cerebral artery showed the largest associations with WMSAs and partially mediated the relationship between age and WMSAs. Finally, WMSAs partially mediated the relationship between PReFx and fluid but not crystallized abilities scores. Taken together, these findings suggest that loss of cerebral arterial elasticity is associated with cerebral white matter lesions and age-related cognitive decline.
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29
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Jalaleddini K, Canac N, Thorpe SG, O'Brien MJ, Ranjbaran M, Delay B, Dorn AY, Scalzo F, Thibeault CM, Wilk SJ, Hamilton RB. Objective Assessment of Beat Quality in Transcranial Doppler Measurement of Blood Flow Velocity in Cerebral Arteries. IEEE Trans Biomed Eng 2019; 67:883-892. [PMID: 31217091 DOI: 10.1109/tbme.2019.2923146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Transcranial Doppler (TCD) ultrasonography measures pulsatile cerebral blood flow velocity in the arteries and veins of the head and neck. Similar to other real-time measurement modalities, especially in healthcare, the identification of high-quality signals is essential for clinical interpretation. Our goal is to identify poor quality beats and remove them prior to further analysis of the TCD signal. METHODS We selected objective features for this purpose including Euclidean distance between individual and average beat waveforms, cross-correlation between individual and average beat waveforms, ratio of the high-frequency power to the total beat power, beat length, and variance of the diastolic portion of the beat waveform. We developed an iterative outlier detection algorithm to identify and remove the beats that are different from others in a recording. Finally, we tested the algorithm on a dataset consisting of more than 15 h of TCD data recorded from 48 stroke and 34 in-hospital control subjects. RESULTS We assessed the performance of the algorithm in the improvement of estimation of clinically important TCD parameters by comparing them to that of manual beat annotation. The results show that there is a strong correlation between the two, that demonstrates the algorithm has successfully recovered the clinically important features. We obtained significant improvement in estimating the TCD parameters using the algorithm accepted beats compared to using all beats. SIGNIFICANCE Our algorithm provides a valuable tool to clinicians for automated detection of the reliable portion of the data. Moreover, it can be used as a pre-processing tool to improve the data quality for automated diagnosis of pathologic beat waveforms using machine learning.
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30
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Guiney H, Lucas SJE, Cotter JD, Machado L. Investigating links between habitual physical activity, cerebrovascular function, and cognitive control in healthy older adults. Neuropsychologia 2019; 125:62-69. [PMID: 30682349 DOI: 10.1016/j.neuropsychologia.2019.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/29/2018] [Accepted: 01/22/2019] [Indexed: 12/20/2022]
Abstract
A growing body of evidence indicates regular physical activity benefits older adults' cognitive functioning, particularly when a high level of cognitive control is required. Recent research has pointed to improved cerebrovascular function as one mechanism through which such benefits might arise. This study built on previous research by investigating in 51 healthy older adults aged 60-72 years relationships between habitual physical activity, cerebrovascular function (indicated by resting cerebral blood flow velocity in the middle cerebral artery [n = 42], and its responsiveness to hypercapnia [n = 26] and hypocapnia [n = 25]), and cognitive control (inhibition and switching). Linear regression analyses showed moderate positive associations between physical activity and inhibitory control, but not cerebrovascular function. There were also no significant relationships between the cerebrovascular measures and cognitive control. These results indicate that regular engagement in physical activity is associated with superior inhibitory control in older adulthood, but cerebrovascular function was not found to explain those relationships. Taken together, the current findings reinforce reports of positive links between habitual physical activity and cognition in healthy older adults, but also signal that interrelationships with cerebrovascular function may be more complex than currently indicated by the literature, necessitating further research to elucidate the role cerebrovascular function might play in accounting for physical activity-cognition links in healthy older adults.
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Affiliation(s)
- Hayley Guiney
- Department of Psychology and Brain Health Research Centre, University of Otago, Dunedin, New Zealand; Brain Research New Zealand, Auckland, New Zealand.
| | - Samuel J E Lucas
- Department of Physiology, University of Otago, Dunedin, New Zealand; School of Sport, Exercise, and Rehabilitation Sciences and Centre for Human Brain Health, University of Birmingham, Birmingham, England
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Liana Machado
- Department of Psychology and Brain Health Research Centre, University of Otago, Dunedin, New Zealand; Brain Research New Zealand, Auckland, New Zealand
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31
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Miyazawa T, Shibata S, Nagai K, Hirasawa A, Kobayashi Y, Koshiba H, Kozaki K. Relationship between cerebral blood flow estimated by transcranial Doppler ultrasound and single-photon emission computed tomography in elderly people with dementia. J Appl Physiol (1985) 2018; 125:1576-1584. [DOI: 10.1152/japplphysiol.00118.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transcranial Doppler (TCD) ultrasonography is a noninvasive technique allowing continuous recording of cerebral blood flow (CBF) velocity. However, it is unclear whether the CBF estimated by TCD would be reliable for the comparison between individuals. The present study aimed to clarify the relationship between middle cerebral artery blood flow (MCA BF) measured by TCD and regional and total CBF measured by single-photon emission computed tomography (SPECT-CBF) with a quantification software program, a three-dimensional stereotaxic region of interest template. We recruited 91 elderly subjects with and without dementia. MCA blood flow velocity (MCA V) and middle cerebral artery cross-sectional area (AM) were measured by TCD and magnetic resonance angiography, respectively. MCA BF was calculated by the product of MCA V and AM. Diastolic or mean MCA V and MCA BF were significantly correlated with SPECT-CBF in several segments. Interestingly, the correlation coefficient in the temporal segment of SPECT-CBF was higher than those of the other segments. Moreover, correlations between MCA BF and SPECT-CBF were stronger as compared with those between MCA V and SPECT-CBF. These findings suggest that both mean MCA V and MCA BF with TCD ultrasonography would be useful for CBF comparison between individuals especially in the temporal region, although estimated blood flow with arterial area seems to be better than using simple flow velocity. NEW & NOTEWORTHY Correlations between middle cerebral artery blood flow (MCA BF) calculated by the product of MCA blood flow velocity (MCA V) and middle cerebral artery cross-sectional area and regional and total cerebral blood flow (CBF) measured by single-photon emission computed tomography (SPECT-CBF) were stronger as compared with those between MCA V and SPECT-CBF. These findings suggest that both mean MCA V and MCA BF would be useful for CBF comparison between individuals although estimated blood flow with arterial area seems to be better than using simple flow velocity.
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Affiliation(s)
- Taiki Miyazawa
- Department of Health and Sports Science, Faculty of Wellness, Shigakkan University, Obu-shi, Japan
- Department of Geriatric Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Shigeki Shibata
- Department of Geriatric Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Kumiko Nagai
- Department of Geriatric Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Ai Hirasawa
- Department of Geriatric Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Yoshio Kobayashi
- Department of Geriatric Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Hitomi Koshiba
- Department of Geriatric Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, School of Medicine, Kyorin University, Tokyo, Japan
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Beishon LC, Panerai RB, Robinson TG, Subramaniam H, Haunton VJ. The Assessment of Cerebrovascular Response to a Language Task from the Addenbrooke's Cognitive Examination in Cognitive Impairment: A Feasibility Functional Transcranial Doppler Ultrasonography Study. J Alzheimers Dis Rep 2018; 2:153-164. [PMID: 30480258 PMCID: PMC6218154 DOI: 10.3233/adr-180068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The incidence of dementia is predicted to rise rapidly, but sensitive diagnostic tests remain elusive. Changes in cerebral blood flow velocity (CBFv) can occur at an early stage of cognitive decline, and can be measured by transcranial Doppler ultrasonography (TCD). Objective: The aim of this study was to characterize the CBFv changes that occur in healthy older adults (HC), mild cognitive impairment (MCI), and Alzheimer’s disease (AD), in response to a language task from the Addenbrooke’s cognitive examination (ACE-III). Methods: Participants underwent bilateral TCD, continuous heart rate (ECG), end-tidal CO2 (capnography, ETCO2), and beat-to-beat blood pressure (Finometer, MAP), monitoring, during a 5-minute baseline, followed by cognitive tasks from the ACE-III. Data are presented for a language task (repeating words and phrases aloud), as peak percentage change in CBFv, HR, MAP, and ETCO2 from a normalized baseline. Results: 30 participants (mean age 73.2 years, 20% female) were recruited; HC (n = 10), MCI (n = 10), AD (n = 10). Language scores did not differ between groups (p = 0.16). Peak percentage change in CBFv differed between groups with the language task (HC: 15.9 (7.5)%, MCI: 6.7 (4.5)%, AD: 0.1 (7.1)%; p < 0.005). However, changes in MAP (HC: 7.9 (4.6)%, MCI: –0.1 (0.9)%, AD: 0.9 (4.4)%; p < 0.005), HR (HC: 8.8 (8.2)%, MCI: 0.7 (4.3)%, AD: –0.5 (5.6)%; p = 0.005), and ETCO2 (HC: –0.9 (3.2)%, MCI: 0.9 (3.2)%, AD: –5.2 (5.7)%; p = 0.006), also occurred. Conclusions: TCD measured CBFv changes to a language task from the ACE-III was feasible in a cognitively impaired population, further work is required in a larger population.
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Affiliation(s)
- Lucy C Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Hari Subramaniam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Leicestershire Partnership Trust, Evington Centre, Gwendolen Road, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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Salinet ASM, Panerai RB, Caldas J, Nogueira RC, Conforto AB, Texeira MJ, Bor-Seng-Shu E, Robinson TG. Pooling data from different populations: should there be regional differences in cerebral haemodynamics? BMC Neurol 2018; 18:156. [PMID: 30261857 PMCID: PMC6161439 DOI: 10.1186/s12883-018-1155-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/14/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Though genetic and environmental determinants of systemic haemodynamic have been reported, surprisingly little is known about their influences on cerebral haemodynamics. We assessed the potential geographical effect on cerebral haemodynamics by comparing the individual differences in cerebral blood flow velocity (CBFv), vasomotor tone (critical closing pressure- CrCP), vascular bed resistance (resistance-area product- RAP) and cerebral autoregulation (CA) mechanism on healthy subjects and acute ischaemic stroke (AIS) patients from two countries. METHODS Participants were pooled from databases in Leicester, United Kingdom (LEI) and São Paulo, Brazil (SP) research centres. Stroke patients admitted within 48 h of ischaemic stroke onset, as well as age- and sex-matched controls were enrolled. Beat-to-beat blood pressure (BP) and bilateral mean CBFv were recorded during 5 min baseline. CrCP and RAP were calculated. CA was quantified using transfer function analysis (TFA) of spontaneous oscillations in arterial BP and mean CBFv, and the derived autoregulatory index (ARI). RESULTS A total of 100 participants (50 LEI and 50 SP) were recruited. No geographical differences were found. Both LEI and SP AIS participants showed lower values of CA compared to controls. Moreover, the affected hemisphere presented lower resting CBFv and higher RAP compared to the unaffected hemisphere in both populations. CONCLUSIONS Impairments of cerebral haemodynamics, demonstrated by several key parameters, was observed following AIS compared to controls irrespective of geographical region. These initial results should encourage further research on cerebral haemodynamic research with larger cohorts combining different populations.
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Affiliation(s)
- Angela S. M. Salinet
- Neurology Department, School of Medicine, University of São Paulo, São Paulo, SP Brazil
- Biomedical Engineering, Engineering, Modelling and Applied Social Sciences Centre, Federal ABC University, Sao Bernardo do Campo, Sao Paulo, Brazil
- Faculty of Physiotherapy, Ibirapuera University, São Paulo, Brazil
| | - Ronney B. Panerai
- Department of Cardiovascular Sciences, Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Juliana Caldas
- Neurology Department, School of Medicine, University of São Paulo, São Paulo, SP Brazil
- Critical Care Unit Hospital São Rafael, Salvador, Brazil
| | - Ricardo C. Nogueira
- Neurology Department, School of Medicine, University of São Paulo, São Paulo, SP Brazil
| | - Adriana B. Conforto
- Neurology Department, School of Medicine, University of São Paulo, São Paulo, SP Brazil
| | - Manoel J. Texeira
- Neurology Department, School of Medicine, University of São Paulo, São Paulo, SP Brazil
| | - Edson Bor-Seng-Shu
- Neurology Department, School of Medicine, University of São Paulo, São Paulo, SP Brazil
| | - Thompson G. Robinson
- Department of Cardiovascular Sciences, Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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Carter SE, Draijer R, Holder SM, Brown L, Thijssen DHJ, Hopkins ND. Regular walking breaks prevent the decline in cerebral blood flow associated with prolonged sitting. J Appl Physiol (1985) 2018; 125:790-798. [DOI: 10.1152/japplphysiol.00310.2018] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Decreased cerebrovascular blood flow and function are associated with lower cognitive functioning and increased risk of neurodegenerative diseases. Prolonged sitting impairs peripheral blood flow and function, but its effects on the cerebrovasculature are unknown. This study explored the effect of uninterrupted sitting and breaking up sitting time on cerebrovascular blood flow and function of healthy desk workers. Fifteen participants (10 male, 35.8 ± 10.2 yr, body mass index: 25.5 ± 3.2 kg/m2) completed, on separate days, three 4-h conditions in a randomized order: 1) uninterrupted sitting (SIT), 2) sitting with 2-min light-intensity walking breaks every 30 min (2WALK), or 3) sitting with 8-min light-intensity walking breaks every 2 h (8WALK). At baseline and 4 h, middle cerebral artery blood flow velocity (MCAv) and CO2 reactivity (CVR) of the MCA and carotid artery were measured using transcranial Doppler (TCD) and duplex ultrasound, respectively. Cerebral autoregulation (CA) was assessed with TCD using a squat-stand protocol and analyzed to generate values of gain and phase in the very low, low, and high frequencies. There was a significant decline in SIT MCAv (−3.2 ± 1.2 cm/s) compared with 2WALK (0.6 ± 1.5 cm/s, P = 0.02) but not between SIT and 8WALK (−1.2 ± 1.0 cm/s, P = 0.14). For CA, the change in 2WALK very low frequency phase (4.47 ± 4.07 degrees) was significantly greater than SIT (−3.38 ± 2.82 degrees, P = 0.02). There was no significant change in MCA or carotid artery CVR ( P > 0.05). Results indicate that prolonged uninterrupted sitting in healthy desk workers reduces cerebral blood flow; however, this is offset when frequent short-duration walking breaks are incorporated. NEW & NOTEWORTHY Prolonged uninterrupted sitting in healthy desk workers reduces cerebral blood flow. However, this reduction in cerebral blood flow is offset when frequent short-duration walking breaks are incorporated into this sitting period. For those who engage in long periods of sedentary behavior, chronically breaking up these sitting periods with frequent active break strategies may have important implications for cerebrovascular health; however, further research should explore this hypothesis.
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Affiliation(s)
- Sophie E. Carter
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Richard Draijer
- Unilever Research and Development, Vlaardingen, The Netherlands
| | - Sophie M. Holder
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Louise Brown
- Unilever Research and Development, Colworth Science Park, Bedfordshire, United Kingdom
| | - Dick H. J. Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicola D. Hopkins
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Puglisi V, Bramanti A, Lanza G, Cantone M, Vinciguerra L, Pennisi M, Bonanno L, Pennisi G, Bella R. Impaired Cerebral Haemodynamics in Vascular Depression: Insights From Transcranial Doppler Ultrasonography. Front Psychiatry 2018; 9:316. [PMID: 30061847 PMCID: PMC6055001 DOI: 10.3389/fpsyt.2018.00316] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/25/2018] [Indexed: 02/05/2023] Open
Abstract
Introduction: Late-life depression is a well-known risk factor for future dementia. Increasing evidences also show a link between cerebral hypoperfusion and neurodegeneration, although data on Transcranial Doppler ultrasonography (TCD)-derived measures in patients with "Vascular Depression" (VD) are lacking. The aim of this study was to assess and correlate TCD parameters with cognitive function and severity of subcortical ischemic vascular disease in a sample of VD patients. Methods: Seventy six patients (mean age 72.5 ± 5.3 years; 53.9% females) met the DSM-5 diagnostic criteria for unipolar major depression. Mean blood flow velocity (MBFv) and pulsatility index (PI) were recorded from the middle cerebral artery. Quantification of depressive symptoms (17-item Hamilton Depression Rating Scale -HDRS), neuropsychological test evaluating frontal lobe abilities (Stroop Color-Word test interference-Stroop T), and white matter lesions (WMLs) load according to the Fazekas visual score were also assessed. Results: WMLs severity was mild in 20 patients (group I), moderate in 32 (group II), and severe in 24 (group III). The groups were comparable in terms of clinical features, vascular risk factors profile, and HDRS score, whereas Stroop T score was worse in group III. An increased PI and a reduced MBFv were found in VD patients with severe WMLs. According to the regression analysis, a reduced MBFv was independently and significantly associated with depressive symptoms and executive dysfunction, even after adjusting for demographic features and vascular risk factors. Similarly, an independent and significant association was observed between the increase of PI and both Stroop T and WMLs severity. Conclusions: A TCD profile of low perfusion and high vascular resistance in VD patients suggests a diffuse cerebrovascular pathology likely arising from the small vessels and then extending to larger arteries. Hemodynamic dysfunction might play a pathogenic role in the development of cognitive impairment in patients with late-life depression and subcortical ischemic vascular disease. TCD represents a valuable tool in the early detection, assessment, and management of VD patients at risk for dementia.
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Affiliation(s)
| | - Alessia Bramanti
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
- Istituto di Scienze Applicate e Sistemi Intelligenti, Messina, Italy
| | | | | | | | | | - Lilla Bonanno
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Section of Neurosciences, Department of Medical and Surgical Sciences and Advanced Technology, University of Catania, Catania, Italy
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Beishon L, Williams CAL, Robinson TG, Haunton VJ, Panerai RB. Neurovascular coupling response to cognitive examination in healthy controls: a multivariate analysis. Physiol Rep 2018; 6:e13803. [PMID: 30033685 PMCID: PMC6055030 DOI: 10.14814/phy2.13803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/24/2018] [Indexed: 12/21/2022] Open
Abstract
Cognitive testing with transcranial Doppler ultrasonography (TCD) has been used to assess neurovascular coupling (NVC), but few studies address its multiple contributions. Subcomponent analysis considers the relative myogenic (resistance area product, RAP) and metabolic (critical closing pressure (CrCP)) contributors. The aim of this study was to investigate the changes in subcomponents that occur with cognitive stimulation with the Addenbrooke's Cognitive Examination (ACE-III) in healthy controls. Healthy volunteers underwent continuous recording of bilateral TCD, heart rate (HR, three-lead ECG), end-tidal CO2 (ETCO2 , capnography), and mean arterial pressure (MAP, Finometer). The study comprised a 5-min baseline recording, followed by all 20 paradigms from the ACE-III. The cerebral blood flow velocity (CBFv) response was decomposed into the relative contributions (subcomponents); VBP (MAP), VCrCP (CrCP), and VRAP (RAP). Data are presented as peak population normalized mean changes from baseline, and median area under the curve (AUC). Forty bilateral datasets were obtained (27 female, 37 right hand dominant). VBP increased at task initiation in all paradigms but differed between tasks (range (SD): 4.06 (8.92)-16.04 (12.23) %, P < 0.05). HR, but not ETCO2 , also differed significantly (P < 0.05). Changes in VRAP reflected changes in MAP, but in some paradigms atypical responses were seen. VCrCP AUC varied significantly within paradigm sections (range [SD]: 18.4 [24.17] to 244.21 [243.21] %*s, P < 0.05). All paradigms demonstrated changes in subcomponents with cognitive stimulation, and can be ranked based on their relative presumed metabolic demand. The integrity of NVC requires further investigation in patient populations.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUnited Kingdom
| | | | - Thompson G. Robinson
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUnited Kingdom
- NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUnited Kingdom
| | - Victoria J. Haunton
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUnited Kingdom
- NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUnited Kingdom
| | - Ronney B. Panerai
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUnited Kingdom
- NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUnited Kingdom
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Catchlove SJ, Pipingas A, Hughes ME, Macpherson H. Magnetic resonance imaging for assessment of cerebrovascular reactivity and its relationship to cognition: a systematic review. BMC Neurosci 2018; 19:21. [PMID: 29649969 PMCID: PMC5898077 DOI: 10.1186/s12868-018-0421-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/27/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cerebrovascular reactivity (CVR) refers to the responsiveness of cerebral vasculature to vasoactive stimuli. CVR is an indicator of brain health and can be assessed using vasodilatory techniques and magnetic resonance imaging (MRI). Using such approaches, some researchers have explored the relationship between CVR and cognition; here we systematically review this work. RESULTS We extracted information pertaining to: (1) study location and design, participant characteristics, sample sizes, (2) design of vascular challenge, end-tidal CO 2 (etCO 2 ) concentrations (if applicable), (3) MRI protocol, (4) cognitive assessment, (5) CVR values, and outcomes of statistical analyses with cognitive tests. Five studies assessed participants with cognitive impairment compared to controls, one studied patients with multiple sclerosis with or without cognitive impairment compared to controls, one examined patients with moyamoya disease with or without cognitive impairment, two investigated patients with Type 2 diabetes mellitus (T2DM), and one was a cross-sectional study with younger and older healthy adults. Cognition was typically probed using the MMSE and tests of executive function, while a number of vasodilatory techniques were employed. CONCLUSION CVR was associated with cognition in six of ten studies, but heterogeneity of study samples, designs and vasodilatory methods may have a role in the inconsistent findings. We make recommendations for future research that includes use of a multi-domain cognitive assessment and standardised hypercapnic challenge with MRI.
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Affiliation(s)
- Sarah J. Catchlove
- Centre for Human Psychopharmacology, Swinburne University, Hawthorn, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University, Hawthorn, Australia
| | - Matthew E. Hughes
- Centre for Mental Health, Swinburne University, Hawthorn, Australia
- Australian National Imaging Facility, St. Lucia, Australia
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Beishon L, Haunton VJ, Panerai RB, Robinson TG. Cerebral Hemodynamics in Mild Cognitive Impairment: A Systematic Review. J Alzheimers Dis 2018; 59:369-385. [PMID: 28671118 DOI: 10.3233/jad-170181] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of dementia is projected to rise over the coming decades, but with no sensitive diagnostic tests available. Vascular pathology precedes the deposition of amyloid and is an attractive early target. OBJECTIVE The aim of this review was to investigate the use of cerebral hemodynamics and oxygenation as a novel biomarker for mild cognitive impairment (MCI), focusing on transcranial Doppler ultrasonography (TCD) and near-infrared spectroscopy (NIRS). METHODS 2,698 articles were identified from Medline, Embase, PsychINFO, and Web of Science databases. 306 articles were screened and quality assessed independently by two reviewers; 26 met the inclusion criteria. Meta-analyses were performed for each marker with two or more studies and limited heterogeneity. RESULTS Eleven studies were TCD, 8 NIRS, 5 magnetic resonance imaging, and 2 positron/single photon emission tomography. Meta-analyses showed reduced tissue oxygenation index, cerebral blood flow and velocity, with higher pulsatility index, phase and cerebrovascular resistance in MCI compared to controls. The majority of studies found reduced CO2 reactivity in MCI, with mixed findings in neuroactivation studies. CONCLUSION Despite small sample sizes and heterogeneity, meta-analyses demonstrate clear abnormalities in cerebral hemodynamic and oxygenation parameters, even at an early stage of cognitive decline. Further work is required to investigate the use of cerebral hemodynamic and oxygenation parameters as a sensitive biomarker for dementia.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Biomedical Research Unit in Cardiovascular Disease, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Biomedical Research Unit in Cardiovascular Disease, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Biomedical Research Unit in Cardiovascular Disease, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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39
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Beishon LC, Williams CAL, Panerai RB, Robinson TG, Haunton VJ. The assessment of neurovascular coupling with the Addenbrooke’s Cognitive Examination: a functional transcranial Doppler ultrasonographic study. J Neurophysiol 2018; 119:1084-1094. [DOI: 10.1152/jn.00698.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Cerebrovascular dysfunction occurs early in dementia and can be identified by transcranial Doppler ultrasonography (TCD). Few studies have examined cerebral blood flow velocity (CBFv) responses to a detailed cognitive battery. This study aimed to characterize all CBFv responses, and the effect of hemispheric dominance, to the Addenbrooke’s Cognitive Examination (ACE-III) in healthy volunteers. Forty volunteers underwent continuous bilateral TCD, beat-to-beat blood pressure (MAP; Finapres), heart rate (HR; electrocardiogram), and end-tidal CO2 (ETCO2; capnography) monitoring. After a 5-min baseline period, all tasks from the ACE-III were performed in 3 sections (A: attention, fluency, memory; B: language; C: visuospatial, memory). Data are population mean normalized percentage (PM%) change from a 20-s baseline period before task initiation. Forty bilateral data sets were obtained (27 women, 37 right-hand dominant). All paradigms produced a sharp increase in CBFv in both dominant (PM% range: 3.29 to 9.70%) and nondominant (PM% range: 4.34 to 11.63%) hemispheres at task initiation, with associated increases in MAP (PM% range: 3.06 to 16.04%). ETCO2 did not differ significantly at task initiation (PM% range: −1.1 to 2.4%, P > 0.05). HR differed significantly across A and C tasks at initiation (PM% range: −1.1 to 2.4%, P < 0.05), but not B tasks. In conclusion, all tasks resulted in increases in CBFv, differing significantly between paradigms. These results require further investigation in a cognitively impaired population. NEW & NOTEWORTHY This study is the first to provide a normative data set of cerebral blood flow velocity (CBFv) responses to a complete cognitive assessment (Addenbrooke’s Cognitive Examination, ACE-III) in a large sample ( n = 40) of healthy volunteers. All tasks produced peak and sustained increases in CBFv to different extents. The ACE-III is a feasible tool to assess neurovascular coupling with transcranial Doppler ultrasonography. These data can be used to inform the most appropriate cognitive task to elicit CBFv responses for future studies.
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Affiliation(s)
- Lucy C. Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Claire A. L. Williams
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Ronney B. Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Thompson G. Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Victoria J. Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
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40
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Pasha EP, Tarumi T, Haley AP, Tanaka H. Transcranial Doppler of the middle cerebral artery indicates regional gray matter cerebral perfusion. Physiol Meas 2017; 38:2176-2185. [PMID: 29091052 DOI: 10.1088/1361-6579/aa976f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We determined if transcranial color-coded Doppler derived hemodynamics are associated with MRI-based cerebral blood flow (CBF) in regions clinically important to dementia in healthy middle-aged adults. APPROACH In 30 subjects (18m/12f; age = 52 ± 1 years), blood flow velocity (BFV) and cerebrovascular conductance (CVC) were measured with transcranial color-coded Doppler (TCCD) at the middle cerebral artery (MCA) and cerebral blood flow (CBF) was assessed with arterial spin labeled perfusion MRI. MAIN RESULTS BFV and CVC were associated with hippocampus (r = 0.58 and r = 0.61, both p < 0.01) and occipitoparietal (r = 0.50 and r = 0.58, both p < 0.01) CBF. CVC was further associated with posterior cingulate CBF (r = 0.58 p < 0.01). Independent of age and sex, BFV and CVC were associated with hippocampus (r = 0.59 and r = 0.55, both p < 0.003) and occipitoparietal (r = 0.50 and r = 0.57, both p < 0.01) CBF. CVC was independently associated with posterior cingulate CBF (r = 0.38, p = 0.049). SIGNIFICANCE TCCD-measured BFV and CVC of the MCA are indicators of cerebral perfusion to clinically valuable brain regions in healthy middle-aged adults. TCCD may not be a good indicator of blood flow to cerebral white matter.
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Affiliation(s)
- Evan P Pasha
- Department of Kinesiology and Health Education, Cardiovascular Aging Research Laboratory, The University of Texas at Austin, Austin, TX 78712, United States of America
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Badcock NA, Spooner R, Hofmann J, Flitton A, Elliott S, Kurylowicz L, Lavrencic LM, Payne HM, Holt GK, Holden A, Churches OF, Kohler MJ, Keage HAD. What Box: A task for assessing language lateralization in young children. Laterality 2017; 23:391-408. [PMID: 28803507 DOI: 10.1080/1357650x.2017.1363773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The assessment of active language lateralization in infants and toddlers is challenging. It requires an imaging tool that is unintimidating, quick to setup, and robust to movement, in addition to an engaging and cognitively simple language processing task. Functional Transcranial Doppler Ultrasound (fTCD) offers a suitable technique and here we report on a suitable method to elicit active language production in young children. The 34-second "What Box" trial presents an animated face "searching" for an object. The face "finds" a box that opens to reveal a to-be-labelled object. In a sample of 95 children (1 to 5 years of age), 81% completed the task-32% with ≥10 trials. The task was validated (ρ = 0.4) against the gold standard Word Generation task in a group of older adults (n = 65, 60-85 years of age), though was less likely to categorize lateralization as left or right, indicative of greater measurement variability. Existing methods for active language production have been used with 2-year-old children while passive listening has been conducted with sleeping 6-month-olds. This is the first active method to be successfully employed with infants through to pre-schoolers, forming a useful tool for populations in which complex instructions are problematic.
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Affiliation(s)
- Nicholas A Badcock
- a ARC Centre for Excellence in Cognition and its Disorders, Department of Cognitive Science , Macquarie University , North Ryde , New South Wales , Australia
| | - Rachael Spooner
- b Cognitive Neuroscience Laboratory, School of Psychology, Social Work and Social Policy , University of South Australia , South Australia , Australia
| | - Jessica Hofmann
- c Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy , University of South Australia , South Australia , Australia
| | - Atlanta Flitton
- c Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy , University of South Australia , South Australia , Australia
| | - Scott Elliott
- c Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy , University of South Australia , South Australia , Australia
| | - Lisa Kurylowicz
- c Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy , University of South Australia , South Australia , Australia.,d Department of General Paediatrics , University Children's Hospital Bonn , Bonn , Germany
| | - Louise M Lavrencic
- c Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy , University of South Australia , South Australia , Australia
| | - Heather M Payne
- e Deafness, Cognition, and Language Research Centre , University College London , London , UK.,f Institute of Cognitive Neuroscience , University College London , London , UK
| | - Georgina K Holt
- g Oxford Study of Children's Communication Impairments, Department of Experimental Psychology , University of Oxford , Oxford , UK
| | - Anneka Holden
- g Oxford Study of Children's Communication Impairments, Department of Experimental Psychology , University of Oxford , Oxford , UK
| | - Owen F Churches
- h Brain and Cognition Laboratory , Flinders University , South Australia , Australia
| | - Mark J Kohler
- b Cognitive Neuroscience Laboratory, School of Psychology, Social Work and Social Policy , University of South Australia , South Australia , Australia
| | - Hannah A D Keage
- c Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy , University of South Australia , South Australia , Australia
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Williams C, Panerai R, Robinson T, Haunton V. Transcranial Doppler ultrasonography in the assessment of neurovascular coupling responses to cognitive examination in healthy controls: A feasibility study. J Neurosci Methods 2017; 284:57-62. [DOI: 10.1016/j.jneumeth.2017.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 11/29/2022]
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Henley BC, Shin DC, Zhang R, Marmarelis VZ. Compartmental and Data-Based Modeling of Cerebral Hemodynamics: Nonlinear Analysis. IEEE Trans Biomed Eng 2017; 64:1078-1088. [PMID: 27411214 PMCID: PMC5592738 DOI: 10.1109/tbme.2016.2588438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE As an extension to our study comparing a putative compartmental and data-based model of linear dynamic cerebral autoregulation (CA) and CO2-vasomotor reactivity (VR), we study the CA-VR process in a nonlinear context. METHODS We use the concept of principal dynamic modes (PDM) in order to obtain a compact and more easily interpretable input-output model. This in silico study permits the use of input data with a dynamic range large enough to simulate the classic homeostatic CA and VR curves using a putative structural model of the regulatory control of the cerebral circulation. The PDM model obtained using theoretical and experimental data are compared. RESULTS It was found that the PDM model was able to reflect accurately both the simulated static CA and VR curves in the associated nonlinear functions (ANFs). Similar to experimental observations, the PDM model essentially separates the pressure-flow relationship into a linear component with fast dynamics and nonlinear components with slow dynamics. In addition, we found good qualitative agreement between the PDMs representing the dynamic theoretical and experimental CO2-flow relationship. CONCLUSION Under the modeling assumption and in light of other experimental findings, we hypothesize that PDMs obtained from experimental data correspond with passive fluid dynamical and active regulatory mechanisms. SIGNIFICANCE Both hypothesis-based and data-based modeling approaches can be combined to offer some insight into the physiological basis of PDM model obtained from human experimental data. The PDM modeling approach potentially offers a practical way to quantify the status of specific regulatory mechanisms in the CA-VR process.
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Tan CH, Low KA, Kong T, Fletcher MA, Zimmerman B, Maclin EL, Chiarelli AM, Gratton G, Fabiani M. Mapping cerebral pulse pressure and arterial compliance over the adult lifespan with optical imaging. PLoS One 2017; 12:e0171305. [PMID: 28234912 PMCID: PMC5325189 DOI: 10.1371/journal.pone.0171305] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 01/19/2017] [Indexed: 12/22/2022] Open
Abstract
Cerebrovascular health is important for maintaining a high level of cognitive performance, not only in old age, but also throughout the lifespan. Recently, it was first demonstrated that diffuse optical imaging measures of pulse amplitude and arterial compliance can provide estimates of cerebral arterial health throughout the cortex, and were associated with age, estimated cardiorespiratory fitness (eCRF), neuroanatomy and cognitive function in older adults (aged 55-87). The current study replicates and extends the original findings using a broader age range (a new adult sample aged 18-75), longer recording periods (360 s), and a more extensive optical montage (1536 channels). These methodological improvements represent a 5-fold increase in recording time and a 4-fold increase in coverage compared to the initial study. Results show that reliability for both pulse amplitude and compliance measures across recording blocks was very high (r(45) = .99 and .75, respectively). Pulse amplitude and pulse pressure were shown to correlate with age across the broader age range. We also found correlations between arterial health and both cortical and subcortical gray matter volumes. Additionally, we replicated the correlations between arterial compliance and age, eCRF, global brain atrophy, and cognitive flexibility. New regional analyses revealed that higher performance on the operation span (OSPAN) working memory task was associated with greater localized arterial compliance in frontoparietal cortex, but not with global arterial compliance. Further, greater arterial compliance in frontoparietal regions was associated with younger age and higher eCRF. These associations were not present in the visual cortex. The current study not only replicates the initial one in a sample including a much wider age range, but also provides new evidence showing that frontoparietal regions may be especially vulnerable to vascular degeneration during brain aging, with potential functional consequences in cognition.
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Affiliation(s)
- Chin Hong Tan
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Kathy A. Low
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Tania Kong
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Mark A. Fletcher
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Benjamin Zimmerman
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Edward L. Maclin
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Antonio M. Chiarelli
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Gabriele Gratton
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Monica Fabiani
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
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Malojcic B, Giannakopoulos P, Sorond FA, Azevedo E, Diomedi M, Oblak JP, Carraro N, Boban M, Olah L, Schreiber SJ, Pavlovic A, Garami Z, Bornstein NM, Rosengarten B. Ultrasound and dynamic functional imaging in vascular cognitive impairment and Alzheimer's disease. BMC Med 2017; 15:27. [PMID: 28178960 PMCID: PMC5299782 DOI: 10.1186/s12916-017-0799-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/21/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The vascular contributions to neurodegeneration and neuroinflammation may be assessed by magnetic resonance imaging (MRI) and ultrasonography (US). This review summarises the methodology for these widely available, safe and relatively low cost tools and analyses recent work highlighting their potential utility as biomarkers for differentiating subtypes of cognitive impairment and dementia, tracking disease progression and evaluating response to treatment in various neurocognitive disorders. METHODS At the 9th International Congress on Vascular Dementia (Ljubljana, Slovenia, October 2015) a writing group of experts was formed to review the evidence on the utility of US and arterial spin labelling (ASL) as neurophysiological markers of normal ageing, vascular cognitive impairment (VCI) and Alzheimer's disease (AD). Original articles, systematic literature reviews, guidelines and expert opinions published until September 2016 were critically analysed to summarise existing evidence, indicate gaps in current knowledge and, when appropriate, suggest standards of use for the most widely used US and ASL applications. RESULTS Cerebral hypoperfusion has been linked to cognitive decline either as a risk or an aggravating factor. Hypoperfusion as a consequence of microangiopathy, macroangiopathy or cardiac dysfunction can promote or accelerate neurodegeneration, blood-brain barrier disruption and neuroinflammation. US can evaluate the cerebrovascular tree for pathological structure and functional changes contributing to cerebral hypoperfusion. Microvascular pathology and hypoperfusion at the level of capillaries and small arterioles can also be assessed by ASL, an MRI signal. Despite increasing evidence supporting the utility of these methods in detection of microvascular pathology, cerebral hypoperfusion, neurovascular unit dysfunction and, most importantly, disease progression, incomplete standardisation and missing validated cut-off values limit their use in daily routine. CONCLUSIONS US and ASL are promising tools with excellent temporal resolution, which will have a significant impact on our understanding of the vascular contributions to VCI and AD and may also be relevant for assessing future prevention and therapeutic strategies for these conditions. Our work provides recommendations regarding the use of non-invasive imaging techniques to investigate the functional consequences of vascular burden in dementia.
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Affiliation(s)
- Branko Malojcic
- Department of Neurology, University Hospital Center Zagreb, Zagreb School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia.
| | | | - Farzaneh A Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Elsa Azevedo
- Department of Neurology, São João Hospital Center and Faculty of Medicine of University of Porto, Porto, Portugal
| | - Marina Diomedi
- Cerebrovascular Disease Center, Stroke Unit, University of Rome Tor Vergata, Rome, Italy
| | - Janja Pretnar Oblak
- Department of Vascular Neurology and Intensive Therapy, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Nicola Carraro
- Department of Medical Sciences, Clinical Neurology-Stroke Unit, University Hospital, University of Trieste, Trieste, Italy
| | - Marina Boban
- Department of Neurology, University Hospital Center Zagreb, Zagreb School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Laszlo Olah
- Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Stephan J Schreiber
- Department of Neurology, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Aleksandra Pavlovic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zsolt Garami
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Nantan M Bornstein
- Neurology Department, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
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46
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Nealon RS, Howe PRC, Jansen L, Garg M, Wong RHX. Impaired cerebrovascular responsiveness and cognitive performance in adults with type 2 diabetes. J Diabetes Complications 2017; 31:462-467. [PMID: 27431891 DOI: 10.1016/j.jdiacomp.2016.06.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/23/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
AIM Cognitive deficits in type 2 diabetes mellitus (T2DM) may be partly attributable to stiffness in cerebral arteries and impaired vasodilator function, limiting the ability to increase blood flow in brain regions to meet cognitive demands. We undertook a comparison of cerebrovascular responsiveness (CVR) and cognitive performance in adults with and without T2DM. METHODS Older adults with (50) and without (Herath, Cherbuin, Eramudugolla, & Anstey, 2016) T2DM underwent transcranial Doppler ultrasound measurements of basal cerebral mean blood flow velocity (MBFV) and pulsatility index (PI), a measure of arterial stiffness, in the middle cerebral arteries (MCA). A battery of tasks assessing domains of working memory, executive function and information processing/motor speed was then administered while MBFV was recorded. CVR to cognitive tasks was calculated as a percentage increase in MBFV from the basal level. RESULTS There was no difference in basal MBFV between groups. However, PI was 14% higher in the T2DM group (P<0.05), who performed poorer across all cognitive domains assessed and displayed poorer CVR in three tasks. Cognitive performance was inversely related to the PI/MBFV ratio, an indicator of intracranial stenosis. DISCUSSION Impaired cerebral perfusion during mental tasks is accompanied by poor cognitive performance and stiffness in the cerebral vessels.
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Affiliation(s)
- Rhenan Scott Nealon
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Newcastle, New South Wales 2308, Australia.
| | - Peter Ranald Charles Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Newcastle, New South Wales 2308, Australia.
| | - Lyanne Jansen
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Newcastle, New South Wales 2308, Australia.
| | - Manohar Garg
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Newcastle, New South Wales 2308, Australia.
| | - Rachel Heloise Xiwen Wong
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Newcastle, New South Wales 2308, Australia.
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Yang D, Cabral D, Gaspard EN, Lipton RB, Rundek T, Derby CA. Cerebral Hemodynamics in the Elderly: A Transcranial Doppler Study in the Einstein Aging Study Cohort. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1907-14. [PMID: 27417737 PMCID: PMC5500193 DOI: 10.7863/ultra.15.10040] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/07/2015] [Indexed: 05/19/2023]
Abstract
OBJECTIVES We sought to describe the relationship between age, sex, and race/ethnicity with transcranial Doppler hemodynamic characteristics from major intracerebral arterial segments in a large elderly population with varying demographics. METHODS We analyzed 369 stroke-free participants aged 70 years and older from the Einstein Aging Study. Single-gate, nonimaging transcranial Doppler sonography, a noninvasive sonographic technique that assesses real-time cerebrovascular hemodynamics, was used to interrogate 9 cerebral arterial segments. Individual Doppler spectra and cerebral blood flow velocities were acquired, and the pulsatility index and resistive index were calculated by the device's automated waveform-tracking function. Multiple linear regression models were used to examine the independent associations of age, sex, and race/ethnicity with transcranial Doppler measures, adjusting for hypertension, history of myocardial infarction or revascularization, and history of diabetes. RESULTS Among enrolled participants, 303 individuals had at least 1 vessel insonated (mean age [SD], 80 [6] years; 63% women; 58% white; and 32% black). With age, transcranial Doppler measures of mean blood flow velocity were significantly decreased in the basilar artery (P = .001) and posterior cerebral artery (right, P = .003; left, P = .02). Pulsatility indices increased in the left middle cerebral artery (P = .01) and left anterior cerebral artery (P = .03), and the resistive index was increased in the left middle cerebral artery (P = .007) with age. Women had higher pulsatility and resistive indices compared to men in several vessels. CONCLUSIONS We report a decreased mean blood flow velocity and weakly increased arterial pulsatility and resistance with aging in a large elderly stroke-free population. These referential trends in cerebrovascular hemodynamics may carry important implications in vascular diseases associated with advanced age, increased risk of cerebrovascular disease, cognitive decline, and dementia.
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Affiliation(s)
- Dixon Yang
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Digna Cabral
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Emmanuel N Gaspard
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
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48
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Smoliński Ł, Członkowska A. Cerebral vasomotor reactivity in neurodegenerative diseases. Neurol Neurochir Pol 2016; 50:455-462. [PMID: 27553189 DOI: 10.1016/j.pjnns.2016.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022]
Abstract
Small-caliber cerebral vessels change their diameters in response to alterations of key metabolite concentrations such as carbon dioxide or oxygen. This phenomenon, termed the cerebral vasomotor reactivity (CVMR), is the basis for blood flow regulation in the brain in accordance with its metabolic status. Typically, CVMR is determined as the amount of change in cerebral blood flow in response to a vasodilating stimulus, which can be measured by various neuroimaging methods or by transcranial Doppler. It has been shown that CVMR is impaired in cerebrovascular diseases, but there is also evidence of a similar dysfunction in neurodegenerative disorders. Here, we review studies that have investigated CVMR in the common neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease and multiple sclerosis. Moreover, we discuss potential neurodegenerative mechanisms responsible for the impairment of CVMR.
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Affiliation(s)
- Łukasz Smoliński
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland.
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49
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Wolters FJ, de Bruijn RF, Hofman A, Koudstaal PJ, Ikram MA. Cerebral Vasoreactivity, Apolipoprotein E, and the Risk of Dementia. Arterioscler Thromb Vasc Biol 2016; 36:204-10. [DOI: 10.1161/atvbaha.115.306768] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/06/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Frank J. Wolters
- From the Departments of Neurology (F.J.W., R.F.A.G.d.B., P.J.K., M.A.I.), Epidemiology (F.J.W., R.F.A.G.d.B., A.H., M.A.I.), and Radiology (M.A.I.), Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Renée F.A.G. de Bruijn
- From the Departments of Neurology (F.J.W., R.F.A.G.d.B., P.J.K., M.A.I.), Epidemiology (F.J.W., R.F.A.G.d.B., A.H., M.A.I.), and Radiology (M.A.I.), Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Albert Hofman
- From the Departments of Neurology (F.J.W., R.F.A.G.d.B., P.J.K., M.A.I.), Epidemiology (F.J.W., R.F.A.G.d.B., A.H., M.A.I.), and Radiology (M.A.I.), Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Peter J. Koudstaal
- From the Departments of Neurology (F.J.W., R.F.A.G.d.B., P.J.K., M.A.I.), Epidemiology (F.J.W., R.F.A.G.d.B., A.H., M.A.I.), and Radiology (M.A.I.), Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M. Arfan Ikram
- From the Departments of Neurology (F.J.W., R.F.A.G.d.B., P.J.K., M.A.I.), Epidemiology (F.J.W., R.F.A.G.d.B., A.H., M.A.I.), and Radiology (M.A.I.), Erasmus Medical Centre, Rotterdam, The Netherlands
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50
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Cognitive Correlates of Cerebral Vasoreactivity on Transcranial Doppler in Older Adults. J Stroke Cerebrovasc Dis 2015; 24:1262-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.01.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 01/08/2023] Open
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