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Santulli G, Visco V, Ciccarelli M, Ferrante MNV, De Masi P, Pansini A, Virtuoso N, Pirone A, Guerra G, Verri V, Macina G, Taurino A, Komici K, Mone P. Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study. Cardiovasc Diabetol 2024; 23:125. [PMID: 38600564 PMCID: PMC11007948 DOI: 10.1186/s12933-024-02218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Hypertension and chronic kidney disease (CKD) pose significant public health challenges, sharing intertwined pathophysiological mechanisms. Prediabetes is recognized as a precursor to diabetes and is often accompanied by cardiovascular comorbidities such as hypertension, elevating the risk of pre-frailty and frailty. Albuminuria is a hallmark of organ damage in hypertension amplifying the risk of pre-frailty, frailty, and cognitive decline in older adults. We explored the association between albuminuria and cognitive impairment in frail older adults with prediabetes and CKD, assessing cognitive levels based on estimated glomerular filtration rate (eGFR). METHODS We conducted a study involving consecutive frail older patients with hypertension recruited from March 2021 to March 2023 at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, followed up after three months. Inclusion criteria comprised age over 65 years, prior diagnosis of hypertension without secondary causes, prediabetes, frailty status, Montreal Cognitive Assessment (MoCA) score < 26, and CKD with eGFR > 15 ml/min. RESULTS 237 patients completed the study. We examined the association between albuminuria and MoCA Score, revealing a significant inverse correlation (r: 0.8846; p < 0.0001). Subsequently, we compared MoCA Score based on eGFR, observing a significant difference (p < 0.0001). These findings were further supported by a multivariable regression analysis, with albuminuria as the dependent variable. CONCLUSIONS Our study represents the pioneering effort to establish a significant correlation between albuminuria and eGFR with cognitive function in frail hypertensive older adults afflicted with prediabetes and CKD.
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Affiliation(s)
- Gaetano Santulli
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein - Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA.
- Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation (INI), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Fisciano, Italy.
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy.
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | | | | | | | - Nicola Virtuoso
- Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | - Germano Guerra
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | | | | | - Klara Komici
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Pasquale Mone
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein - Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA.
- ASL Avellino, Avellino, Italy.
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
- Casa di Cura "Montevergine", Mercogliano, Avellino, Italy.
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Voss HU, Razlighi QR. Pulsatility analysis of the circle of Willis. AGING BRAIN 2024; 5:100111. [PMID: 38495808 PMCID: PMC10940807 DOI: 10.1016/j.nbas.2024.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose To evaluate the phenomenological significance of cerebral blood pulsatility imaging in aging research. Methods N = 38 subjects from 20 to 72 years of age (24 females) were imaged with ultrafast MRI with a sampling rate of 100 ms and simultaneous acquisition of pulse oximetry data. Of these, 28 subjects had acceptable MRI and pulse data, with 16 subjects between 20 and 28 years of age, and 12 subjects between 61 and 72 years of age. Pulse amplitude in the circle of Willis was assessed with the recently developed method of analytic phase projection to extract blood volume waveforms. Results Arteries in the circle of Willis showed pulsatility in the MRI for both the young and old age groups. Pulse amplitude in the circle of Willis significantly increased with age (p = 0.01) but was independent of gender, heart rate, and head motion during MRI. Discussion and conclusion Increased pulse wave amplitude in the circle of Willis in the elderly suggests a phenomenological significance of cerebral blood pulsatility imaging in aging research. The physiologic origin of increased pulse amplitude (increased pulse pressure vs. change in arterial morphology vs. re-shaping of pulse waveforms caused by the heart, and possible interaction with cerebrospinal fluid pulsatility) requires further investigation.
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Affiliation(s)
- Henning U. Voss
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
- Cornell MRI Facility, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Qolamreza R. Razlighi
- Quantitative Neuroimaging Laboratory, Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
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Shore S, Li H, Zhang M, Whitney R, Gross AL, Bhatt AS, Nallamothu BK, Giordani B, Briceño EM, Sussman JB, Gutierrez J, Yaffe K, Griswold M, Johansen MC, Lopez OL, Gottesman RF, Sidney S, Heckbert SR, Rundek T, Hughes TM, Longstreth WT, Levine DA. Trajectory of Cognitive Function After Incident Heart Failure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.09.24302608. [PMID: 38370803 PMCID: PMC10871464 DOI: 10.1101/2024.02.09.24302608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background The size/magnitude of cognitive changes after incident heart failure (HF) are unclear. We assessed whether incident HF is associated with changes in cognitive function after accounting for pre-HF cognitive trajectories and known determinants of cognition. Methods This pooled cohort study included adults without HF, stroke, or dementia from six US population-based cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Linear mixed-effects models estimated changes in cognition at the time of HF (change in the intercept) and the rate of cognitive change over the years after HF (change in the slope), controlling for pre-HF cognitive trajectories and participant factors. Change in global cognition was the primary outcome. Change in executive function and memory were secondary outcomes. Cognitive outcomes were standardized to a t-score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. Results The study included 29,614 adults (mean [SD] age was 61.1 [10.5] years, 55% female, 70.3% White, 22.2% Black 7.5% Hispanic). During a median follow-up of 6.6 (Q1-Q3: 5-19.8) years, 1,407 (4.7%) adults developed incident HF. Incident HF was associated with an acute decrease in global cognition (-1.08 points; 95% CI -1.36, -0.80) and executive function (-0.65 points; 95% CI -0.96, -0.34) but not memory (-0.51 points; 95% CI -1.37, 0.35) at the time of the event. Greater acute decreases in global cognition after HF were seen in those with older age, female sex and White race. Individuals with incident HF, compared to HF-free individuals, demonstrated faster declines in global cognition (-0.15 points per year; 95% CI, -0.21, -0.09) and executive function (-0.16 points per year; 95% CI -0.23, -0.09) but not memory ( -0.11 points per year; 95% CI -0.26, 0.04) compared with pre-HF slopes. Conclusions In this pooled cohort study, incident HF was associated with an acute decrease in global cognition and executive function at the time of the event and faster declines in global cognition and executive function over the following years.
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Affiliation(s)
| | - Hanyu Li
- University of Michigan, Ann Arbor, MI, USA
| | - Min Zhang
- University of Michigan, Ann Arbor, MI, USA
| | | | - Alden L. Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ankeet S. Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | | | | | | | | | | | - Michael Griswold
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Stephen Sidney
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | - Tatjana Rundek
- University of Miami – Miller School of Medicine, Evelyn F. McKnight Brain Institute, FL, USA
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Shulyatnikova T, Hayden MR. Why Are Perivascular Spaces Important? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050917. [PMID: 37241149 DOI: 10.3390/medicina59050917] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Perivascular spaces (PVS) and their enlargement (EPVS) have been gaining interest as EPVS can be visualized non-invasively by magnetic resonance imaging (MRI) when viewing T-2-weighted images. EPVS are most commonly observed in the regions of the basal ganglia and the centrum semiovale; however, they have also been identified in the frontal cortex and hippocampal regions. EPVS are known to be increased in aging and hypertension, and are considered to be a biomarker of cerebral small vessel disease (SVD). Interest in EPVS has been significantly increased because these PVS are now considered to be an essential conduit necessary for the glymphatic pathway to provide the necessary efflux of metabolic waste. Metabolic waste includes misfolded proteins of amyloid beta and tau that are known to accumulate in late-onset Alzheimer's disease (LOAD) within the interstitial fluid that is delivered to the subarachnoid space and eventually the cerebral spinal fluid (CSF). The CSF acts as a sink for accumulating neurotoxicities and allows clinical screening to potentially detect if LOAD may be developing early on in its clinical progression via spinal fluid examination. EPVS are thought to occur by obstruction of the PVS that associates with excessive neuroinflammation, oxidative stress, and vascular stiffening that impairs flow due to a dampening of the arterial and arteriolar pulsatility that aids in the convective flow of the metabolic debris within the glymphatic effluxing system. Additionally, increased EPVS has also been associated with Parkinson's disease and non-age-related multiple sclerosis (MS).
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Affiliation(s)
- Tatyana Shulyatnikova
- Department of Pathological Anatomy and Forensic Medicine, Zaporizhzhia State Medical University, Mayakovsky Avenue, 26, 69035 Zaporizhzhia, Ukraine
| | - Melvin R Hayden
- Department of Internal Medicine, Endocrinology Diabetes and Metabolism, Diabetes and Cardiovascular Disease Center, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65211, USA
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5
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Laari S, Turunen K, Kauranen T, Mustanoja S, Lahti-Pulkkinen M, Tatlisumak T, Poutiainen E. Memory decline in young stroke survivors during a 9-year follow-up: A cohort study. Front Neurol 2022; 13:1069686. [PMID: 36504659 PMCID: PMC9732240 DOI: 10.3389/fneur.2022.1069686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction A decade after stroke, young stroke survivors continue to suffer from cognitive impairment. However, it is not known whether this long-term cognitive outcome is caused in part by further cognitive decline or solely by incomplete recovery from the acute effects of ischemic stroke. We studied changes in three cognitive domains over a 9-year follow-up period after first-ever and only ischemic stroke. Patients and methods In this prospective, two-center cohort study, we recruited consecutive 18-65 year-old patients with acute stroke between 2007 and 2009, along with demographically matched stroke-free controls. We performed comprehensive neuropsychological assessments at 3 months, 2, and 9 years after stroke, and we also performed neurological examinations at the time of inclusion and at the 9-year follow-up. We assessed the associations among stroke, follow-up time and long-term cognitive outcomes using repeated-measures analysis of variance. Results The subjects comprised 85 patients who had had their first-ever and only ischemic stroke (mean age 53 years at inclusion), along with 31 stroke-free demographic controls. We compared the cognitive changes in patients to those in controls over a 9-year follow-up. After initial recovery between 3 months and 2 years after stroke, patients showed a decline in memory between 2 and 9 years after stroke compared to controls within the same time interval (immediate recall p < 0.001; delayed recall p < 0.001; list learning p < 0.001). Other than memory, we found no difference in cognitive changes between poststroke patients and controls. Discussion Our main finding was memory decline over a decade in young first-ever stroke patients with no further stroke or neurodegenerative disease. Our study extends the previous results of further memory decline in elderly stroke survivors to young stroke survivors. Conclusion Young stroke survivors might be at risk of memory decline over the decade following the stroke.
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Affiliation(s)
- Siiri Laari
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland,HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland,*Correspondence: Siiri Laari
| | - Katri Turunen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tatu Kauranen
- Department of Neurology and Clinical Neurophysiology, Lapland Central Hospital, Rovaniemi, Finland
| | - Satu Mustanoja
- HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erja Poutiainen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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6
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Peng D, Qiao HZ, Tan HY, Wang YX, Luo D, Qiao LJ, Cai YF, Zhang SJ, Wang Q, Guan L. Ligustilide ameliorates cognitive impairment via AMPK/SIRT1 pathway in vascular dementia rat. Metab Brain Dis 2022; 37:1401-1414. [PMID: 35420377 DOI: 10.1007/s11011-022-00947-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
Vascular dementia (VaD) is the second cause of dementia after Alzheimer's disease. Ligustilide (LIG) is one of the main active ingredients of traditional Chinese medicines, such as Angelica. Studies have reported that LIG could protect against VaD. However, the mechanism is still confused. In this study, we employed a bilateral common carotid artery occlusion rat model to study. LIG (20 or 40 mg/kg/day) and Nimodipine (20 mg/kg) were orally administered to the VaD rats for four weeks. Morris water maze test showed that LIG effectively ameliorated learning and memory impairment in VaD rats. LIG obviously reduced neuronal oxidative stress damage and the level of homocysteine in the brain of VaD rats. Western blot results showed that pro-apoptotic protein Bax and cleaved caspase 3 increased and anti-apoptotic protein Bcl-2 decreased in the hippocampi of VaD rats. But after LIG treatment, these changes were reversed. Moreover, Nissl staining result showed that LIG could reduce neuronal degeneration in VaD rats. Furthermore, LIG enhanced the expressions of P-AMPK and Sirtuin1(SIRT1) in VaD rats. In conclusion, these studies indicated that LIG could ameliorate cognitive impairment in VaD rats, which might be related to AMPK/SIRT1 pathway activation.
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Affiliation(s)
- Dong Peng
- College of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Han-Zi Qiao
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hong-Yu Tan
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi-Xue Wang
- College of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dan Luo
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li-Jun Qiao
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ye-Feng Cai
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shi-Jie Zhang
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Qi Wang
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Li Guan
- College of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Rudge JD. A New Hypothesis for Alzheimer’s Disease: The Lipid Invasion Model. J Alzheimers Dis Rep 2022; 6:129-161. [PMID: 35530118 PMCID: PMC9028744 DOI: 10.3233/adr-210299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/05/2022] [Indexed: 02/07/2023] Open
Abstract
This paper proposes a new hypothesis for Alzheimer’s disease (AD)—the lipid invasion model. It argues that AD results from external influx of free fatty acids (FFAs) and lipid-rich lipoproteins into the brain, following disruption of the blood-brain barrier (BBB). The lipid invasion model explains how the influx of albumin-bound FFAs via a disrupted BBB induces bioenergetic changes and oxidative stress, stimulates microglia-driven neuroinflammation, and causes anterograde amnesia. It also explains how the influx of external lipoproteins, which are much larger and more lipid-rich, especially more cholesterol-rich, than those normally present in the brain, causes endosomal-lysosomal abnormalities and overproduction of the peptide amyloid-β (Aβ). This leads to the formation of amyloid plaques and neurofibrillary tangles, the most well-known hallmarks of AD. The lipid invasion model argues that a key role of the BBB is protecting the brain from external lipid access. It shows how the BBB can be damaged by excess Aβ, as well as by most other known risk factors for AD, including aging, apolipoprotein E4 (APOE4), and lifestyle factors such as hypertension, smoking, obesity, diabetes, chronic sleep deprivation, stress, and head injury. The lipid invasion model gives a new rationale for what we already know about AD, explaining its many associated risk factors and neuropathologies, including some that are less well-accounted for in other explanations of AD. It offers new insights and suggests new ways to prevent, detect, and treat this destructive disease and potentially other neurodegenerative diseases.
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Affiliation(s)
- Jonathan D’Arcy Rudge
- School of Biological Sciences, University of Reading, Reading, Berkshire, United Kingdom
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8
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Mehan S, Bhalla S, Siddiqui EM, Sharma N, Shandilya A, Khan A. Potential Roles of Glucagon-Like Peptide-1 and Its Analogues in Dementia Targeting Impaired Insulin Secretion and Neurodegeneration. Degener Neurol Neuromuscul Dis 2022; 12:31-59. [PMID: 35300067 PMCID: PMC8921673 DOI: 10.2147/dnnd.s247153] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/16/2022] [Indexed: 12/20/2022] Open
Abstract
Dementia is a chronic, irreversible condition marked by memory loss, cognitive decline, and mental instability. It is clinically related to various progressive neurological diseases, including Parkinson’s disease, Alzheimer’s disease, and Huntington’s. The primary cause of neurological disorders is insulin desensitization, demyelination, oxidative stress, and neuroinflammation accompanied by various aberrant proteins such as amyloid-β deposits, Lewy bodies accumulation, tau formation leading to neurofibrillary tangles. Impaired insulin signaling is directly associated with amyloid-β and α-synuclein deposition, as well as specific signaling cascades involved in neurodegenerative diseases. Insulin dysfunction may initiate various intracellular signaling cascades, including phosphoinositide 3-kinase (PI3K), c-Jun N-terminal kinases (JNK), and mitogen-activated protein kinase (MAPK). Neuronal death, inflammation, neuronal excitation, mitochondrial malfunction, and protein deposition are all influenced by insulin. Recent research has focused on GLP-1 receptor agonists as a potential therapeutic target. They increase glucose-dependent insulin secretion and are beneficial in neurodegenerative diseases by reducing oxidative stress and cytokine production. They reduce the deposition of abnormal proteins by crossing the blood-brain barrier. The purpose of this article is to discuss the role of insulin dysfunction in the pathogenesis of neurological diseases, specifically dementia. Additionally, we reviewed the therapeutic target (GLP-1) and its receptor activators as a possible treatment of dementia.
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Affiliation(s)
- Sidharth Mehan
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
- Correspondence: Sidharth Mehan, Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, 142001, Punjab, India, Tel +91 8059889909; +91 9461322911, Email ;
| | - Sonalika Bhalla
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Ehraz Mehmood Siddiqui
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Nidhi Sharma
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Ambika Shandilya
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Andleeb Khan
- Department of Pharmacology & Toxicology, College of Pharmacy, Jazan University, Jazan, Kingdom of Saudi Arabia
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Mu R, Qin X, Guo Z, Meng Z, Liu F, Zhuang Z, Zheng W, Li X, Yang P, Feng Y, Jiang Y, Zhu X. Prevalence and Consequences of Cerebral Small Vessel Diseases: A Cross-Sectional Study Based on Community People Plotted Against 5-Year Age Strata. Neuropsychiatr Dis Treat 2022; 18:499-512. [PMID: 35264852 PMCID: PMC8901253 DOI: 10.2147/ndt.s352651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To study the variation tendency of cerebral small vessel disease (CSVD) imaging markers and total burden with aging and to research the relationship between aging, CSVD markers and cognitive function. METHODS Participants in local urban communities were recruited for neuropsychological and magnetic resonance imaging assessments. Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Number Connection Test A (NCT-A) and Digital Symbol Test (DST) were adopted as neuropsychological scale. Age was stratified at 5-year intervals, and the variation tendency of imaging markers and variables of neuropsychological scales in different age groups was studied. We further studied the relationship between aging, image markers and neuropsychological scales by multi-linear regression. RESULTS Finally, a total of 401 stroke-free participants (age, 54.83±7.74y; 45.9% were male) were included in the present analysis. With the increase of age, the incidence of imaging markers of CSVD were increased with aging except cerebral microbleeds. The performance results of NCT-A and DST were significant difference in 6 age groups (P < 0.001). In addition, linear decline of the neuropsychological function reflected by NCT-A and DST variables was observed. Linear regression found that age was an independent factor affecting the neuropsychological function reflected by NCT-A and DST variables, and the standard correction coefficients among different age groups increased gradually with age. In addition, brain atrophy is an independent factor affecting neuropsychological variables (odds ratio: -2.929, 95% CI: [-5.094 to -0.765]). There was no correlation between the number of neuroimaging markers and neuropsychological variables after full adjustment. CONCLUSION There are many CVSD markers even in younger people, the incidence rate and CVSD marker numbers increase with age. Aging and CSVD may eventually affect cognitive function through brain atrophy.
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Affiliation(s)
- Ronghua Mu
- Graduate School of Guilin Medical University, Guilin, 541004, People's Republic of China.,Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Xiaoyan Qin
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Zixuan Guo
- Graduate School of Guilin Medical University, Guilin, 541004, People's Republic of China.,Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Zhuoni Meng
- Graduate School of Guilin Medical University, Guilin, 541004, People's Republic of China.,Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Fuzhen Liu
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Zeyu Zhuang
- Graduate School of Guilin Medical University, Guilin, 541004, People's Republic of China.,Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Wei Zheng
- Graduate School of Guilin Medical University, Guilin, 541004, People's Republic of China.,Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Xin Li
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Peng Yang
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Yuling Feng
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Yanchun Jiang
- Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
| | - Xiqi Zhu
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, People's Republic of China
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10
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Seshadri S, Caunca MR, Rundek T. Vascular Dementia and Cognitive Impairment. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Bellut M, Papp L, Bieber M, Kraft P, Stoll G, Schuhmann MK. NLPR3 inflammasome inhibition alleviates hypoxic endothelial cell death in vitro and protects blood-brain barrier integrity in murine stroke. Cell Death Dis 2021; 13:20. [PMID: 34930895 PMCID: PMC8688414 DOI: 10.1038/s41419-021-04379-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022]
Abstract
In ischemic stroke (IS) impairment of the blood-brain barrier (BBB) has an important role in the secondary deterioration of neurological function. BBB disruption is associated with ischemia-induced inflammation, brain edema formation, and hemorrhagic infarct transformation, but the underlying mechanisms are incompletely understood. Dysfunction of endothelial cells (EC) may play a central role in this process. Although neuronal NLR-family pyrin domain-containing protein 3 (NLRP3) inflammasome upregulation is an established trigger of inflammation in IS, the contribution of its expression in EC is unclear. We here used brain EC, exposed them to oxygen and glucose deprivation (OGD) in vitro, and analyzed their survival depending on inflammasome inhibition with the NLRP3-specific drug MCC950. During OGD, EC death could significantly be reduced when targeting NLRP3, concomitant with diminished endothelial NLRP3 expression. Furthermore, MCC950 led to reduced levels of Caspase 1 (p20) and activated Gasdermin D as markers for pyroptosis. Moreover, inflammasome inhibition reduced the secretion of pro-inflammatory chemokines, cytokines, and matrix metalloproteinase-9 (MMP9) in EC. In a translational approach, IS was induced in C57Bl/6 mice by 60 mins transient middle cerebral artery occlusion and 23 hours of reperfusion. Stroke volume, functional outcome, the BBB integrity, and-in good agreement with the in vitro results-MMP9 secretion as well as EC survival improved significantly in MCC950-treated mice. In conclusion, our results establish the NLRP3 inflammasome as a critical pathogenic effector of stroke-induced BBB disruption by activating inflammatory signaling cascades and pyroptosis in brain EC.
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Affiliation(s)
- Maximilian Bellut
- Department of Neurology, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Lena Papp
- Department of Neurology, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Michael Bieber
- Department of Neurology, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Peter Kraft
- Department of Neurology, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
- Department of Neurology, Klinikum Main-Spessart, Grafen-von-Rieneck-Str. 5, 97816, Lohr, Germany
| | - Guido Stoll
- Department of Neurology, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Michael K Schuhmann
- Department of Neurology, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
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12
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Marmarelis VZ, Shin DC, Zhang R. The Dynamic Relationship Between Cortical Oxygenation and End-Tidal CO 2 Transient Changes Is Impaired in Mild Cognitive Impairment Patients. Front Physiol 2021; 12:772456. [PMID: 34955886 PMCID: PMC8695976 DOI: 10.3389/fphys.2021.772456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Recent studies have utilized data-based dynamic modeling to establish strong association between dysregulation of cerebral perfusion and Mild Cognitive Impairment (MCI), expressed in terms of impaired CO2 dynamic vasomotor reactivity in the cerebral vasculature. This raises the question of whether this is due to dysregulation of central mechanisms (baroreflex and chemoreflex) or mechanisms of cortical tissue oxygenation (CTO) in MCI patients. We seek to answer this question using data-based input-output predictive dynamic models. Objective: To use subject-specific data-based multivariate input-output dynamic models to quantify the effects of systemic hemodynamic and blood CO2 changes upon CTO and to examine possible differences in CTO regulation in MCI patients versus age-matched controls, after the dynamic effects of central regulatory mechanisms have been accounted for by using cerebral flow measurements as another input. Methods: The employed model-based approach utilized the general dynamic modeling methodology of Laguerre expansions of kernels to analyze spontaneous time-series data in order to quantify the dynamic effects upon CTO (an index of relative capillary hemoglobin saturation distribution measured via near-infrared spectroscopy) of contemporaneous changes in end-tidal CO2 (proxy for arterial CO2), arterial blood pressure and cerebral blood flow velocity in the middle cerebral arteries (measured via transcranial Doppler). Model-based indices (physio-markers) were computed for these distinct dynamic relationships. Results: The obtained model-based indices revealed significant statistical differences of CO2 dynamic vasomotor reactivity in cortical tissue, combined with "perfusivity" that quantifies the dynamic relationship between flow velocity in cerebral arteries and CTO in MCI patients versus age-matched controls (p = 0.006). Significant difference between MCI patients and age-matched controls was also found in the respective model-prediction accuracy (p = 0.0001). Combination of these model-based indices via the Fisher Discriminant achieved even smaller p-value (p = 5 × 10-5) when comparing MCI patients with controls. The differences in dynamics of CTO in MCI patients are in lower frequencies (<0.05 Hz), suggesting impairment in endocrine/metabolic (rather than neural) mechanisms. Conclusion: The presented model-based approach elucidates the multivariate dynamic connectivity in the regulation of cerebral perfusion and yields model-based indices that may serve as physio-markers of possible dysregulation of CTO during transient CO2 changes in MCI patients.
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Affiliation(s)
- Vasilis Z. Marmarelis
- Biomedical Engineering Department, University of Southern California, Los Angeles, CA, United States
| | - Dae C. Shin
- Biomedical Engineering Department, University of Southern California, Los Angeles, CA, United States
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, UT Southwestern Medical Center, Dallas, TX, United States
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13
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Aso Y, Kimura N, Matsubara E. Novel Serum Biomarkers of Neurovascular Unit Associated with Cortical Amyloid Deposition. J Alzheimers Dis 2021; 84:905-914. [PMID: 34602488 DOI: 10.3233/jad-215135] [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: 12/25/2022]
Abstract
BACKGROUND Whether blood biomarkers of neurovascular unit are associated with cortical amyloid deposition on positron emission tomography (PET) imaging remains unclear. OBJECTIVE To investigate the association between novel serum biomarkers of neurovascular unit, such as protein tyrosine phosphatase receptor type B (PTPRB), gap junction protein alpha-5 (GJA5), adenosine triphosphate-sensitive inward rectifier potassium channel-8 (KCNJ8), and von Willebrand factor (vWF), and cortical amyloid deposition. METHODS Between 2012 and 2018, 68 elderly individuals with amnestic mild cognitive impairment (32 men and 36 women; mean age 75.2 years) were enrolled. All participants underwent 11C-Pittsburgh compound-B (PiB)-PET, 18F-fluorodeoxyglucose-PET, and measurement of serum PTPRB, GJA5, KCNJ8, and vWF levels using commercially available human enzyme-linked immunosorbent assay kits. Based on the mean cortical standardized uptake value ratio, the participants were divided into two groups: PiB-negative group and PiB-positive group. Serum levels of PTPRB, GJA5, KCNJ8, and vWF were compared between the two groups. Multiple linear regression analysis was performed to investigate the relationship between serum PTPRB, GJA5, KCNJ8, and vWF levels and cortical amyloid deposition. RESULTS PTPRB and GJA5 levels were significantly lower and KCNJ8 and vWF levels were significantly higher in the PiB-positive group than in the PiB-negative group. PTPRB and GJA5 levels inversely correlated with mean PiB uptake, whereas KCNJ8 and vWF levels positively correlated with mean PiB uptake. CONCLUSION Serum levels of PTPRB, GJA5, KCNJ8, and vWF correlate with cortical amyloid deposition. These novel blood biomarkers of neurovascular unit are useful for identifying elderly individuals at risk of developing Alzheimer's disease.
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Affiliation(s)
- Yasuhiro Aso
- Department of Neurology, Oita University, Faculty of Medicine, Yufu, Oita, Japan
| | - Noriyuki Kimura
- Department of Neurology, Oita University, Faculty of Medicine, Yufu, Oita, Japan
| | - Etsuro Matsubara
- Department of Neurology, Oita University, Faculty of Medicine, Yufu, Oita, Japan
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14
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Gong L, Wang H, Dong Q, Zhu X, Zheng X, Gu Y, Cai W, Zhao Y, Liu X. Intracranial Atherosclerotic Stenosis is Related to Post-stroke Cognitive Impairment: A Cross-sectional Study of Minor Stroke. Curr Alzheimer Res 2021; 17:177-184. [PMID: 32124696 DOI: 10.2174/1567205017666200303141920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/30/2020] [Accepted: 03/01/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intracranial Atherosclerotic Stenosis (ICAS) is an important risk factor for cognitive impairment. However, it is unclear whether patients with ICAS are more likely to develop cognitive impairment after an acute, non-disabling ischemic stroke (minor stroke). OBJECTIVE We aimed to investigate the association between ICAS and post-stroke cognitive impairment. METHODS In this cross-sectional study, patients with acute, non-disabling ischemic stroke underwent two cognitive tests and imaging evaluation for ICAS, within two weeks after the stroke. To determine the association between ICAS and post-stroke cognitive impairment, we performed a multivariate logistic regression analysis adjusted for several demographic and vascular risk factors. RESULTS Of the 164 patients with minor stroke in this study, 98 (59.76%) were diagnosed with poststroke cognitive impairment (Montreal Cognitive Assessment score<26). After adjusting for potential confounders, we found that patients with ICAS were more likely to develop cognitive impairment after an acute, non-disabling ischemic stroke, compared to patients without ICAS (Odds Ratio: 2.13; 95% Confidence Interval: 1.07-4.26), and underperformed in the tests of visuospatial and executive function. CONCLUSION In this cross-sectional study of a population that has experienced a minor stroke, our findings demonstrated a positive association between ICAS and post-stroke cognitive impairment.
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Affiliation(s)
- Li Gong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Haichao Wang
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Qiong Dong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Xiaoping Zhu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Xiaoran Zheng
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Yongzhe Gu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Wangli Cai
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Yanxin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
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15
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Berlot R, Koritnik B, Pirtošek Z, Ray NJ. Preserved cholinergic forebrain integrity reduces structural connectome vulnerability in mild cognitive impairment. J Neurol Sci 2021; 425:117443. [PMID: 33865078 DOI: 10.1016/j.jns.2021.117443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/24/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
Neurodegeneration leads to redistribution of processing, which is reflected in a reorganisation of the structural connectome. This might affect its vulnerability to structural damage. Cortical acetylcholine allows favourable adaptation to pathology within the memory circuit. However, it remains unclear if it acts on a broader scale, affecting reconfiguration of whole-brain networks. To investigate the role of the cholinergic basal forebrain (CBFB) in strategic lesions, twenty patients with mild cognitive impairment (MCI) and twenty elderly controls underwent magnetic resonance imaging. Whole-brain tractograms were represented as network graphs. Lesions of individual nodes were simulated by removing a node and its connections from the graph. The impact of simulated lesions was quantified as the proportional change in global efficiency. Relationships between subregional CBFB volumes, global efficiency of intact connectomes and impacts of individual simulated lesions of network nodes were assessed. In MCI but not controls, larger CBFB volumes were associated with efficient network topology and reduced impact of hippocampal, thalamic and entorhinal lesions, indicating a protective effect against the global impact of simulated strategic lesions. This suggests that the cholinergic system shapes the configuration of the connectome, thereby reducing the impact of localised damage in MCI.
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Affiliation(s)
- Rok Berlot
- Department of Neurology, University Medical Centre Ljubljana, Zaloška 2a, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
| | - Blaž Koritnik
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia; Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Centre Ljubljana, Zaloška 2a, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Nicola J Ray
- Department of Psychology, Manchester Metropolitan University, 53 Bonsall St, Manchester M15 6GX, UK
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16
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Marmarelis V, Shin D, Zhang R. Closed-Loop Dynamic Modeling of the Heart-Rate Reflex to Concurrent Spontaneous Changes of Arterial Blood Pressure and CO2 Tension: Quantification of the Effects of Mild Cognitive Impairment. IEEE Trans Biomed Eng 2021; 68:3347-3355. [PMID: 33819147 DOI: 10.1109/tbme.2021.3070900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To extend closed-loop modeling of the heart-rate reflex (HRR) by including the dynamic effects of concurrent changes in blood CO2 tension. This extended dynamic model can be used to generate physio-markers of "baroreflex gain" (BRG) and "chemoreflex gain" (CRG) that allow quantitative assessment of the possible impact of pathologies upon HRR. Mild Cognitive Impairment (MCI) is used as an example. METHODS The proposed data-based closed-loop modeling methodology estimates the forward and reverse dynamic components of the model via Laguerre kernel expansions of two open-loop models using spontaneous time-series data collected in 45 MCI patients and 15 controls. The BRG and CRG physio-markers are subsequently computed for each subject via simulation of the obtained closed-loop model for unit-step change of arterial pressure or blood CO2 tension, respectively. RESULTS Both open-loop and closed-loop HRR modeling revealed that MCI patients exhibit significantly smaller CRG relative to controls (p<0.001), but not significantly different BRG. Furthermore, the closed-loop model captured the dynamic effect of sympathetic activity as resonant peak around 0.1 Hz (Mayer wave) in the chemoreflex and baroreflex transfer functions (not captured via open-loop modeling). This may prove valuable in advancing our understanding of how sympathetic activity impacts HRR in various pathologies. CONCLUSION The extended HRR model, incorporating the dynamic effects of concurrent changes of blood CO2 tension, revealed significantly reduced chemoreflex gain (but not baroreflex gain) in MCI patients. Furthermore, the closed-loop model captured the sympathetic influence around 0.1 Hz. SIGNIFICANCE Multivariate closed-loop dynamic modeling is valuable for understanding physiological autoregulation.
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17
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Bergantin LB. The Interactions Between Alzheimer's Disease and Major Depression: Role of Ca 2+ Channel Blockers and Ca 2+/cAMP Signalling. Curr Drug Res Rev 2021; 12:97-102. [PMID: 32065096 DOI: 10.2174/2589977512666200217093356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The interactions between Alzheimer's Disease (AD) and major depression can be translated into clinical data showing that depressive patients have had an enhanced risk for developing AD (later in life). The cellular mechanisms involved in these interactions remain under intensive debate in the literature. In addition, the role of a Ca2+ homeostasis dysregulation in the pathogenesis of neurodegenerative diseases, like AD, and major depression has been under intensive discussion. OBJECTIVE Thus, revealing the interplay between AD and major depression may provide novel insights into the pathogenesis of these diseases. METHODS Publications involving Ca2+ signalling pathways, AD, and major depression (alone or combined) were collected by searching multiple databases to find the maximum number of relevant citations (using a search strategy with high sensitivity for studies of etiology). RESULTS Ca2+ Channel Blockers (CCBs), classically prescribed for hypertensive patients, have been demonstrating neuroprotective effects, such as decreasing the incidence of AD in hypertensive patients, including alleviating major depression symptoms. A mechanism under debate is focused on the restoration of the Ca2+ homeostasis. Indeed, previous studies of our own have correlated Ca2+ and cAMP signalling pathways (Ca2+/cAMP signalling) in controlling both the neurotransmitter release and neuronal death. These studies also observed that CCBs can affect Ca2+/cAMP signalling. CONCLUSION This review discussed the plausible role of Ca2+/cAMP signalling in the neuroprotective effects of CCBs, including the participation of Ca2+/cAMP signalling in the interactions between major depression and AD. Considering both AD and major depression have become highly prevalent medical problems in the world, the comprehension of the interactions between these diseases could improve drug development.
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Affiliation(s)
- Leandro Bueno Bergantin
- Department of Pharmacology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo; Rua Pedro de Toledo 669, Vila Clementino, Sao Paulo - SP, Brazil
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18
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Miller KL, Pedelty L, Testai FD. The relationship between heart disease and cognitive impairment. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:377-391. [PMID: 33632454 DOI: 10.1016/b978-0-12-819814-8.00023-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neurodegenerative dementias, such as Alzheimer's disease, and vascular cognitive impairment were once considered unrelated processes. Emerging evidence, however, shows that both conditions often coexist and that vascular risk factors in midlife predispose to the development of cognitive decline later in older adults. In addition, recent advanced in basic science research have elucidated key underpinnings of this association. In this chapter, we review the clinical and basic science data that explain the relationship between vascular risk factors, heart disease, and cognitive decline.
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Affiliation(s)
- Kristin L Miller
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States.
| | - Laura Pedelty
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
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19
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Huang LC, Hsieh SW, Tsai CC, Chen CH, Yang YH. The Role of Cilostazol and Inflammation in Cognitive Impairment After Ischemic Stroke. Am J Alzheimers Dis Other Demen 2021; 36:15333175211016185. [PMID: 34008421 PMCID: PMC10624089 DOI: 10.1177/15333175211016185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of this study is to examine the potential effect of cilostazol and inflammation on cognitive impairment after stroke in an Asian population. METHODS Forty-five patients with cognitive impairment after ischemic stroke using cilostazol were enrolled as the study group and 45 patients using aspirin or clopidogrel were enrolled as the control group. Neuropsychiatric assessments were administered at the start of the study and after 6 months. Multiple logistic regression analysis was used to estimate the association between the cognitive change and cilostazol use. Macrophage polarization were assessed using flow cytometry in 7 patients. RESULTS There were a significantly higher number of patients with peripheral arterial occlusive disease in the cilostazol group. No significant differences were observed in the cognitive change between the cilostazol and control groups. M1 macrophage subset increment were observed in the patient having a declined cognitive change. CONCLUSION Cilostazol did not make a significant difference in cognitive change after ischemic stroke. M1 macrophage subset increment may indicate post stroke cognitive decline. Due to limited number of subjects, these findings should be examined further in large-scale randomized clinical trials.
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Affiliation(s)
- Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chia-Chan Tsai
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Chun-Hung Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Department of Master’s Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung City, Taiwan
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20
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Posada-Duque RA, Cardona-Gómez GP. CDK5 Targeting as a Therapy for Recovering Neurovascular Unit Integrity in Alzheimer's Disease. J Alzheimers Dis 2020; 82:S141-S161. [PMID: 33016916 DOI: 10.3233/jad-200730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The neurovascular unit (NVU) is responsible for synchronizing the energetic demand, vasodynamic changes, and neurochemical and electrical function of the brain through a closed and interdependent interaction of cell components conforming to brain tissue. In this review, we will focus on cyclin-dependent kinase 5 (CDK5) as a molecular pivot, which plays a crucial role in the healthy function of neurons, astrocytes, and the endothelium and is implicated in the cross-talk of cellular adhesion signaling, ion transmission, and cytoskeletal remodeling, thus allowing the individual and interconnected homeostasis of cerebral parenchyma. Then, we discuss how CDK5 overactivation affects the integrity of the NVU in Alzheimer's disease (AD) and cognitive impairment; we emphasize how CDK5 is involved in the excitotoxicity spreading of glutamate and Ca2+ imbalance under acute and chronic injury. Additionally, we present pharmacological and gene therapy strategies for producing partial depletion of CDK5 activity on neurons, astrocytes, or endothelium to recover neuroplasticity and neurotransmission, suggesting that the NVU should be the targeted tissue unit in protective strategies. Finally, we conclude that CDK5 could be effective due to its intervention on astrocytes by its end feet on the endothelium and neurons, acting as an intermediary cell between systemic and central communication in the brain. This review provides integrated guidance regarding the pathogenesis of and potential repair strategies for AD.
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Affiliation(s)
- Rafael Andrés Posada-Duque
- Cellular and Molecular Neurobiology Area, Group of Neuroscience of Antioquia, SIU, University of Antioquia, Medellín, Colombia.,Institute of Biology, Faculty of Exact and Natural Sciences, University of Antioquia, Medellín, Colombia
| | - Gloria Patricia Cardona-Gómez
- Cellular and Molecular Neurobiology Area, Group of Neuroscience of Antioquia, SIU, University of Antioquia, Medellín, Colombia
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21
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Miceli V, Russelli G, Iannolo G, Gallo A, Lo Re V, Agnese V, Sparacia G, Conaldi PG, Bulati M. Role of non-coding RNAs in age-related vascular cognitive impairment: An overview on diagnostic/prognostic value in Vascular Dementia and Vascular Parkinsonism. Mech Ageing Dev 2020; 191:111332. [PMID: 32805261 DOI: 10.1016/j.mad.2020.111332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
Age is the pivotal risk factor for different common medical conditions such as cardiovascular diseases, cancer and dementia. Among age-related disorders, cardiovascular and cerebrovascular diseases, represent the leading causes of premature mortality strictly related to vascular ageing, a pathological condition characterized by endothelial dysfunction, atherosclerosis, hypertension, heart disease and stroke. These features negatively impact on the brain, owing to altered cerebral blood flow, neurovascular coupling and impaired endothelial permeability leading to cerebrovascular diseases (CVDs) as Vascular Dementia (VD) and Parkinsonism (VP). It is an increasing opinion that neurodegenerative disorders and cerebrovascular diseases are associated from a pathogenetic point of view, and in this review, we discuss how cerebrovascular dysfunctions, due to epigenetic alterations, are linked with neuronal degeneration/dysfunction that lead to cognitive impairment. The relation between neurodegenerative and cerebrovascular diseases are reviewed with a focus on role of ncRNAs in age-related vascular diseases impairing the endothelium in the blood-brain barrier with consequent dysfunction of cerebral blood flow. In this review we dissert about different regulatory mechanisms of gene expression implemented by ncRNAs in the pathogenesis of age-related neurovascular impairment, aiming to highlight the potential use of ncRNAs as biomarkers for diagnostic/prognostic purposes as well as novel therapeutic targets.
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Affiliation(s)
- V Miceli
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - G Russelli
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - G Iannolo
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - A Gallo
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - V Lo Re
- Neurology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - V Agnese
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - G Sparacia
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - P G Conaldi
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - M Bulati
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy.
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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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Troili F, Cipollini V, Moci M, Morena E, Palotai M, Rinaldi V, Romano C, Ristori G, Giubilei F, Salvetti M, Orzi F, Guttmann CRG, Cavallari M. Perivascular Unit: This Must Be the Place. The Anatomical Crossroad Between the Immune, Vascular and Nervous System. Front Neuroanat 2020; 14:17. [PMID: 32372921 PMCID: PMC7177187 DOI: 10.3389/fnana.2020.00017] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/23/2020] [Indexed: 12/25/2022] Open
Abstract
Most neurological disorders seemingly have heterogenous pathogenesis, with overlapping contribution of neuronal, immune and vascular mechanisms of brain injury. The perivascular space in the brain represents a crossroad where those mechanisms interact, as well as a key anatomical component of the recently discovered glymphatic pathway, which is considered to play a crucial role in the clearance of brain waste linked to neurodegenerative diseases. The pathological interplay between neuronal, immune and vascular factors can create an environment that promotes self-perpetration of mechanisms of brain injury across different neurological diseases, including those that are primarily thought of as neurodegenerative, neuroinflammatory or cerebrovascular. Changes of the perivascular space can be monitored in humans in vivo using magnetic resonance imaging (MRI). In the context of glymphatic clearance, MRI-visible enlarged perivascular spaces (EPVS) are considered to reflect glymphatic stasis secondary to the perivascular accumulation of brain debris, although they may also represent an adaptive mechanism of the glymphatic system to clear them. EPVS are also established correlates of dementia and cerebral small vessel disease (SVD) and are considered to reflect brain inflammatory activity. In this review, we describe the “perivascular unit” as a key anatomical and functional substrate for the interaction between neuronal, immune and vascular mechanisms of brain injury, which are shared across different neurological diseases. We will describe the main anatomical, physiological and pathological features of the perivascular unit, highlight potential substrates for the interplay between different noxae and summarize MRI studies of EPVS in cerebrovascular, neuroinflammatory and neurodegenerative disorders.
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Affiliation(s)
- Fernanda Troili
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Virginia Cipollini
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Moci
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
| | - Emanuele Morena
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Miklos Palotai
- Harvard Medical School, Center for Neurological Imaging, Brigham and Women's Hospital, Boston, MA, United States
| | - Virginia Rinaldi
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Carmela Romano
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giovanni Ristori
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Franco Giubilei
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Salvetti
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesco Orzi
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Charles R G Guttmann
- Harvard Medical School, Center for Neurological Imaging, Brigham and Women's Hospital, Boston, MA, United States
| | - Michele Cavallari
- Harvard Medical School, Center for Neurological Imaging, Brigham and Women's Hospital, Boston, MA, United States
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Potential Role of Venular Amyloid in Alzheimer's Disease Pathogenesis. Int J Mol Sci 2020; 21:ijms21061985. [PMID: 32183293 PMCID: PMC7139584 DOI: 10.3390/ijms21061985] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
Insurmountable evidence has demonstrated a strong association between Alzheimer's disease (AD) and cerebral amyloid angiopathy (CAA), along with various other cerebrovascular diseases. One form of CAA, which is the accumulation of amyloid-beta peptides (Aβ) along cerebral vessel walls, impairs perivascular drainage pathways and contributes to cerebrovascular dysfunction in AD. To date, CAA research has been primarily focused on arterial Aβ, while the accumulation of Aβ in veins and venules were to a lesser extent. In this review, we describe preclinical models and clinical studies supporting the presence of venular amyloid and potential downstream pathological mechanisms that affect the cerebrovasculature in AD. Venous collagenosis, impaired cerebrovascular pulsatility, and enlarged perivascular spaces are exacerbated by venular amyloid and increase Aβ deposition, potentially through impaired perivascular clearance. Gaining a comprehensive understanding of the mechanisms involved in venular Aβ deposition and associated pathologies will give insight to how CAA contributes to AD and its association with AD-related cerebrovascular disease. Lastly, we suggest that special consideration should be made to develop Aβ-targeted therapeutics that remove vascular amyloid and address cerebrovascular dysfunction in AD.
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25
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Suemoto CK, Gibbons LE, Thacker EL, Jackson JD, Satizabal CL, Bettcher BM, Launer L, Phillips C, White LR, Power MC. Incident prolonged QT interval in midlife and late-life cognitive performance. PLoS One 2020; 15:e0229519. [PMID: 32097438 PMCID: PMC7041789 DOI: 10.1371/journal.pone.0229519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Measures of cardiac ventricular electrophysiology have been associated with cognitive performance in cross-sectional studies. We sought to evaluate the association of worsening ventricular repolarization in midlife, as measured by incident prolonged QT interval, with cognitive decline in late life. METHODS Midlife QT interval was assessed by electrocardiography during three study visits from 1965/68 to 1971/74 in a cohort of Japanese American men aged 46-68 at Exam 1 from the Honolulu Heart Study. We defined incident prolonged QT as the QT interval in the upper quartile at Exam 2 or 3 after QT interval in lower three quartiles at Exam 1. Cognitive performance was assessed at least once using the Cognitive Abilities Screening Instrument (CASI), scored using item response theory (CASI-IRT), during four subsequent visits from 1991/93 to 1999/2000 among 2,511 of the 4,737 men in the Honolulu-Asia Aging Study otherwise eligible for inclusion in analyses. We used marginal structural modeling to determine the association of incident prolonged QT with cognitive decline, using weighting to account for confounding and attrition. RESULTS Incident prolonged QT interval in midlife was not associated with late-life CASI-IRT at cognitive baseline (estimated difference in CASI-IRT: 0.04; 95% CI: -0.28, 0.35; p = 0.81), or change in CASI-IRT over time (estimated difference in annual change in CASI-IRT: -0.002; 95%CI: -0.013, 0.010; p = 0.79). Findings were consistent across sensitivity analyses. CONCLUSIONS Although many midlife cardiovascular risk factors and cardiac structure and function measures are associated with late-life cognitive decline, incident prolonged QT interval in midlife was not associated with late-life cognitive performance or cognitive decline.
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Affiliation(s)
- Claudia K. Suemoto
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Laura E. Gibbons
- Harborview Medical Center, University of Washington, Seattle, Washington, United States of America
| | - Evan L. Thacker
- Department of Public Health, Brigham Young University, Provo, Utah, United States of America
| | - Jonathan D. Jackson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Claudia L. Satizabal
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- UT Health San Antonio, San Antonio, Texas, United States of America
| | - Brianne M. Bettcher
- Departments of Neurosurgery and Neurology, Rocky Mountain Alzheimer’s Disease Center, University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States of America
| | - Lenore Launer
- National Institute on Aging, Bethesda, Maryland, United States of America
| | - Caroline Phillips
- National Institute on Aging, Bethesda, Maryland, United States of America
| | - Lon R. White
- Departments of Medicine and Geriatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, DC, United States of America
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Marmarelis VZ, Shin DC, Zhang R. Closed-loop modeling of the heart-rate reflex for improved diagnosis and monitoring of Mild Cognitive Impairment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1879-1882. [PMID: 31946264 DOI: 10.1109/embc.2019.8856837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Analysis of beat-to-beat spontaneous cerebral hemodynamic data has yielded predictive dynamic models of cerebral hemodynamics and has shown previously that patients with Mild Cognitive Impairment (MCI) exhibit significantly reduced cerebral vasomotor reactivity to CO2 relative to cognitively normal control subjects [1]. The present work examines the heart-rate reflex (HRR) dynamics of 46 MCI patients compared to 20 control subjects, using closed-loop modeling of HRR under resting conditions of spontaneous variations of arterial blood pressure (baroreflex) and end-tidal CO2 (chemoreflex). These subject-specific predictive dynamic models are obtained via the methodology of Principal Dynamic Modes [2] and allow the computation of model-based markers of baroreflex and chemoreflex function. We found that the chemoreflex gain is significantly weakened in MCI patients relative to controls (p=0.0086), while the baroreflex is not significantly affected. These findings offer another tool for diagnosis and monitoring of MCI (via model-based markers), when used in conjunction with current methods.
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27
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Marmarelis VZ, Shin DC, Zhang R. Dysregulation of CO2-Driven Heart-Rate Chemoreflex Is Related Closely to Impaired CO2 Dynamic Vasomotor Reactivity in Mild Cognitive Impairment Patients. J Alzheimers Dis 2020; 75:855-870. [PMID: 32333588 PMCID: PMC7369119 DOI: 10.3233/jad-191238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Significant reduction of dynamic vasomotor reactivity (DVR) was recently reported in patients with amnestic mild cognitive impairment (MCI) relative to age-matched controls. These results were obtained via a novel approach that utilizes data-based predictive dynamic models to quantify DVR. OBJECTIVE Using the same methodological approach, we seek to quantify the dynamic effects of the CO2-driven chemoreflex and baroreflex upon heart-rate in order to examine their possible correlation with the observed DVR impairment in each MCI patient. METHODS The employed approach utilizes time-series data to obtain subject-specific predictive input-output models of the dynamic effects of changes in arterial blood pressure and end-tidal CO2 (putative "inputs") upon cerebral blood flow velocity in large cerebral arteries, cortical tissue oxygenation, and heart-rate (putative "outputs"). RESULTS There was significant dysregulation of CO2-driven heart-rate chemoreflex (p = 0.0031), but not of baroreflex (p = 0.5061), in MCI patients relative to age-matched controls. The model-based index of CO2-driven heart-rate chemoreflex gain (CRG) correlated significantly with the DVR index in large cerebral arteries (p = 0.0146), but not with the DVR index in small/micro-cortical vessels (p = 0.1066). This suggests that DVR impairment in small/micro-cortical vessels is not mainly due to CO2-driven heart-rate chemoreflex dysregulation, but to other factors (possibly dysfunction of neurovascular coupling). CONCLUSION Improved delineation between MCI patients and controls is achieved by combining the DVR index for small/micro-cortical vessels with the CRG index (p = 2×10-5). There is significant correlation (p < 0.01) between neuropsychological test scores and model-based DVR indices. Combining neuropsychological scores with DVR indices reduces the composite diagnostic index p-value (p∼10-10).
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Affiliation(s)
| | - Dae C. Shin
- Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Rong Zhang
- Internal Medicine, Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
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28
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Cortes N, Posada-Duque R, Cardona-Gómez GP, Bastida J, Osorio E. Amaryllidaceae alkaloids and neuronal cell protection. Pathology 2020. [DOI: 10.1016/b978-0-12-815972-9.00013-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Uddin MS, Kabir MT. Emerging Signal Regulating Potential of Genistein Against Alzheimer's Disease: A Promising Molecule of Interest. Front Cell Dev Biol 2019; 7:197. [PMID: 31620438 PMCID: PMC6763641 DOI: 10.3389/fcell.2019.00197] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/02/2019] [Indexed: 01/05/2023] Open
Abstract
Alzheimer’s disease (AD) is a progressive, irreversible brain disorder characterized by pathological aggregation of the amyloid-β peptide (Aβ) and tau protein; both of these are toxic to neurons. Currently, natural products are regarded as an alternative approach to discover novel multipotent drugs against AD. Dietary soy isoflavone genistein is one of the examples of such agents that occurs naturally and is known to exert a number of beneficial health effects. It has been observed that genistein has the capacity to improve the impairments triggered by Aβ and also it possesses the antioxidant potential to scavenge the AD-mediated generation of free radicals. Furthermore, genistein can interact directly with the targeted signaling proteins and also can stabilize their activity to combat AD. In order to advance the development of AD treatment, a better comprehension of the direct interactions of target proteins and genistein might prove beneficial. Therefore, this article focuses on the therapeutic effects and molecular targets of genistein, which has been found to target directly the Aβ and tau to control the intracellular signaling pathways responsible for neurons death in the AD brain.
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Affiliation(s)
- Md Sahab Uddin
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh.,Pharmakon Neuroscience Research Network, Dhaka, Bangladesh
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30
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Zheng F, Yan L, Zhong B, Yang Z, Xie W. Progression of cognitive decline before and after incident stroke. Neurology 2019; 93:e20-e28. [PMID: 31127071 DOI: 10.1212/wnl.0000000000007716] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 02/13/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the trajectory of cognitive decline before and after incident stroke. METHODS By using data from the English Longitudinal Study of Ageing, we studied 9,278 participants without dementia with no history of stroke who underwent cognitive assessment at baseline (wave 1) and at least 1 other time point (waves 2-7). We used linear mixed models to analyze repeated measures and longitudinal data. RESULTS Among the 9,278 participants (56.8% women, mean age 63.1 ± 10.3 years), 471 (5.1%) incident stroke events were identified. Compared with stroke-free participants, multivariable-adjusted rates of prestroke cognitive decline in global cognition, memory, semantic fluency, and temporal orientation of participants who later experienced an incident stroke were increased by -0.029 , -0.016, -0.022, and -0.024 SD/y, respectively. Among the 471 stroke survivors, the multivariable-adjusted acute changes in the 4 cognitive domains were -0.257, -0.150, -0.121, and -0.272 SD, respectively. In the years after stroke, global cognition declined over time and was steeper than its prestroke slope, that is, by -0.064 SD/y after multivariable adjustment. The rates of memory, semantic fluency, and temporal orientation decline were -0.046, -0.033, and -0.037 SD/y, respectively. CONCLUSIONS Accelerated prestroke cognitive decline and poststroke cognitive decline were associated with incident stroke over a follow-up period of 12 years. Attention should be paid to the long-term cognitive problems of stroke survivors, and intervention and management of major vascular risk factors should start from early life or midlife to reduce the risk of cerebrovascular disease and the associated cognitive impairment.
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Affiliation(s)
- Fanfan Zheng
- From the Brainnetome Center (F.Z.), Institute of Automation, Chinese Academy of Sciences, Beijing, China; Institute of Cognitive Neuroscience (F.Z.), University College London; Department of Epidemiology and Biostatistics (L.Y., Z.Y., W.X.), School of Public Health, Imperial College London, UK; Department of Geriatric Psychiatry (B.Z.), Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan; and Peking University Clinical Research Institute (W.X.), Peking University Health Science Center, Beijing, China
| | - Li Yan
- From the Brainnetome Center (F.Z.), Institute of Automation, Chinese Academy of Sciences, Beijing, China; Institute of Cognitive Neuroscience (F.Z.), University College London; Department of Epidemiology and Biostatistics (L.Y., Z.Y., W.X.), School of Public Health, Imperial College London, UK; Department of Geriatric Psychiatry (B.Z.), Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan; and Peking University Clinical Research Institute (W.X.), Peking University Health Science Center, Beijing, China
| | - Baoliang Zhong
- From the Brainnetome Center (F.Z.), Institute of Automation, Chinese Academy of Sciences, Beijing, China; Institute of Cognitive Neuroscience (F.Z.), University College London; Department of Epidemiology and Biostatistics (L.Y., Z.Y., W.X.), School of Public Health, Imperial College London, UK; Department of Geriatric Psychiatry (B.Z.), Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan; and Peking University Clinical Research Institute (W.X.), Peking University Health Science Center, Beijing, China
| | - Zhenchun Yang
- From the Brainnetome Center (F.Z.), Institute of Automation, Chinese Academy of Sciences, Beijing, China; Institute of Cognitive Neuroscience (F.Z.), University College London; Department of Epidemiology and Biostatistics (L.Y., Z.Y., W.X.), School of Public Health, Imperial College London, UK; Department of Geriatric Psychiatry (B.Z.), Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan; and Peking University Clinical Research Institute (W.X.), Peking University Health Science Center, Beijing, China
| | - Wuxiang Xie
- From the Brainnetome Center (F.Z.), Institute of Automation, Chinese Academy of Sciences, Beijing, China; Institute of Cognitive Neuroscience (F.Z.), University College London; Department of Epidemiology and Biostatistics (L.Y., Z.Y., W.X.), School of Public Health, Imperial College London, UK; Department of Geriatric Psychiatry (B.Z.), Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan; and Peking University Clinical Research Institute (W.X.), Peking University Health Science Center, Beijing, China.
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31
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Liang X, Shan Y, Ding D, Zhao Q, Guo Q, Zheng L, Deng W, Luo J, Tse LA, Hong Z. Hypertension and High Blood Pressure Are Associated With Dementia Among Chinese Dwelling Elderly: The Shanghai Aging Study. Front Neurol 2018; 9:664. [PMID: 30233479 PMCID: PMC6131189 DOI: 10.3389/fneur.2018.00664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022] Open
Abstract
Background: To explore the association between blood pressure and cognition in older participants in the Shanghai Aging Study. Methods: Data were drawn from 3,327 participants at the baseline of Shanghai Aging Study. History of hypertension was inquired and confirmed from participants' medical records. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by research nurses in the early morning. Participants were diagnosed with “cognitive normal,” “mild cognitive impairment (MCI),” or “dementia” by neurologists using DSM-IV and Petersen criteria. Multivariate logistic regression was used to evaluate the association between history of hypertension, duration of hypertension, SBP, DBP, or classification of blood pressure and cognitive function. Generalized linear model was used to assess the relation between duration of hypertension, SBP, or DBP and Mini Mental State Examination (MMSE). Results: A significantly higher proportion of hypertension [78 (76.5%)] was found in participants with dementia than in those with MCI [347 (59.3%)] and cognitive normal [1,350 (51.1%)] (P < 0.0001). Participants with dementia had significantly higher SBP [157.6 (26.1) mmHg] than those with MCI [149.0 (23.7) mmHg] and cognitive normal [143.7 (22.6) mmHg] (P < 0.0001). After adjusting for sex, age, education, living alone, body mass index, anxiety, depression, heart disease, diabetes, and stroke, the likelihood of having dementia was positively associated with history of hypertension (OR = 2.10; 95% CI: 1.22, 3.61), duration of hypertension (OR = 1.02 per increment year; 95% CI: 1.01, 1.04), higher SBP (OR = 1.14 per increment of 10 mmHg; 95% CI: 1.04, 1.25), higher DBP (OR = 1.22 per increment of 10 mmHg; 95% CI: 1.02, 1.45), moderate hypertension (OR = 2.09; 95% CI: 1.10, 3.99), or severe hypertension (OR = 2.45; 95% CI: 1.20, 4.99). The MMSE score was inversely correlated to duration of hypertension (β = −0.0088 per increment year; 95% CI: −0.0158, −0.0018, P = 0.0132), SBP (β = −0.0655 per increment of 10 mmHg; 95% CI: −0.1022, −0.0288, P = 0.0005), and DBP (β = −0.1230 per increment of 10 mmHg; 95% CI: −0.1915, −0.0545, P = 0.0004). Conclusion: Our results suggest that hypertension and high blood pressure may be potential risk factors for dementia. Blood pressure management for the elderly may be important for maintaining cognitive vitality.
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Affiliation(s)
- Xiaoniu Liang
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Shan
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qihao Guo
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Zheng
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Deng
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Lap A Tse
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Zhen Hong
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Lim EY, Yang DW, Cho AH, Shim YS. Cerebrovascular Hemodynamics on Transcranial Doppler Ultrasonography and Cognitive Decline in Mild Cognitive Impairment. J Alzheimers Dis 2018; 65:651-657. [DOI: 10.3233/jad-180026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eun-Ye Lim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Won Yang
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - A-Hyun Cho
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong S. Shim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Becerra-Calixto A, Posada-Duque R, Cardona-Gómez GP. Recovery of Neurovascular Unit Integrity by CDK5-KD Astrocyte Transplantation in a Global Cerebral Ischemia Model. Mol Neurobiol 2018; 55:8563-8585. [PMID: 29564811 DOI: 10.1007/s12035-018-0992-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/06/2018] [Indexed: 12/16/2022]
Abstract
Astrocytes play metabolic and structural support roles and contribute to the integrity of the blood-brain barrier (BBB), linking communication between neurons and the endothelium. Cyclin-dependent kinase 5 (CDK5) likely exerts a dual effect on the endothelium and astrocytes due to its involvement in migration and angiogenesis; the overactivation of CDK5 is associated with dysfunction in glutamate recapture and hypoxia. Recently, we proposed that CDK5-targeted astrocytes facilitate the recovery of neurological and motor function in transplanted ischemic rats. In the current study, we treated cerebral ischemic rats and endothelial cells exposed to glutamate toxicity with CDK5 knock-down (CDK5-KD) astrocytes to determine the role of CDK5 in neurovascular integrity. We found that the effects of CDK5-KD were sustained for 4 months, preventing neuronal and astrocyte loss, facilitating the recovery of the BBB via the production of BDNF by endogenous astrocytes (GFP-) surrounding vessels in the motor cortex and the corpus callosum of global ischemic rats, and improving neurological performance. These findings were supported by the in vitro findings of increased transendothelial resistance, p120-ctn+ adhesion and reduced intercellular gaps induced by a CDK5 inhibitor (roscovitine) in bEnd.3 cells in a glutamate-toxicity model. Additionally, CDK5-KD astrocytes in co-culture protected the endothelial cell viability, increased BDNF release from astrocytes, increased BDNF immunoreactivity in neighboring astrocytes and endothelial cells and enhanced cell adhesion in a glutamate-toxicity model. Altogether, these findings suggest that a CDK5 reduction in astrocytes protects the endothelium, which promotes BDNF release, endothelial adhesion, and the recovery of neurovascular unit integrity and brain function in ischemic rats.
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Affiliation(s)
- Andrea Becerra-Calixto
- Neuroscience Group of Antioquia, Cellular and Molecular Neurobiology Area, Faculty of Medicine, SIU, University of Antioquia, Calle 70, No. 52-21, Medellin, Colombia
| | - Rafael Posada-Duque
- Neuroscience Group of Antioquia, Cellular and Molecular Neurobiology Area, Faculty of Medicine, SIU, University of Antioquia, Calle 70, No. 52-21, Medellin, Colombia.,Institute of Biology, Faculty of Exact and Natural Sciences, University of Antioquia, Medellin, Colombia
| | - Gloria Patricia Cardona-Gómez
- Neuroscience Group of Antioquia, Cellular and Molecular Neurobiology Area, Faculty of Medicine, SIU, University of Antioquia, Calle 70, No. 52-21, Medellin, Colombia. .,Universidad de Antioquia, Sede de Investigación Universitaria (SIU), Calle 62 # 52 - 59; Torre 1, Piso 4, Laboratorio 412, Medellín, Colombia.
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Ye Q, Bai F. Contribution of diffusion, perfusion and functional MRI to the disconnection hypothesis in subcortical vascular cognitive impairment. Stroke Vasc Neurol 2018; 3:131-139. [PMID: 30294468 PMCID: PMC6169607 DOI: 10.1136/svn-2017-000080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 01/26/2018] [Accepted: 02/14/2018] [Indexed: 11/29/2022] Open
Abstract
Vascular cognitive impairment (VCI) describes all forms of cognitive impairment caused by any type of cerebrovascular disease. Early identification of VCI is quite difficult due to the lack of both sensitive and specific biomarkers. Extensive damage to the white matter tracts, which connect the cortical and subcortical regions, has been shown in subcortical VCI (SVCI), the most common subtype of VCI that is caused by small vessel disease. Two specific MRI sequences, including diffusion tensor imaging (DTI) and functional MRI (fMRI), have emerged as useful tools for identifying subtle white matter changes and the intrinsic connectivity between distinct cortical regions. This review describes the advantages of these two modalities in SVCI research and the current DTI and fMRI findings on SVCI. Using DTI technique, a variety of studies found that white matter microstructural damages in the anterior and superior areas are more specific to SVCI. Similarly, functional brain abnormalities detected by fMRI have also been mainly shown in anterior brain areas in SVCI. The characteristic distribution of brain abnormalities in SVCI interrupts the prefrontal-subcortical loop that results in cognitive impairments in particular domains, which further confirms the ‘disconnection syndrome’ hypothesis. In addition, another MRI technique, arterial spin labelling (ASL), has been used to describe the disconnection patterns in a variety of conditions by measuring cerebral blood flow. The role of the ASL technique in SVCI research is also assessed. Finally, the review proposes the application of multimodality fusion in the investigation of SVCI pathogenesis.
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Affiliation(s)
- Qing Ye
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
| | - Feng Bai
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
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35
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Ishibashi M, Kimura N, Aso Y, Matsubara E. Effects of white matter lesions on brain perfusion in patients with mild cognitive impairment. Clin Neurol Neurosurg 2018; 168:7-11. [PMID: 29499394 DOI: 10.1016/j.clineuro.2018.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/07/2018] [Accepted: 02/19/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the effects of white matter lesions on regional cerebral blood flow in subjects with amnestic mild cognitive impairment. PATIENTS AND METHODS Seventy-five subjects with mild cognitive impairment (36 men and 39 women; mean age, 78.1 years) were included in the study. We used the Mini-Mental State Examination to assess cognitive function. All subjects underwent brain magnetic resonance imaging and 99mTc ethylcysteinate dimer single photon emission computed tomography. Subjects were stratified based on the presence or absence of white matter lesions on magnetic resonance imaging. Statistical parametric mapping of differences in regional cerebral blood flow between the two groups were assessed by voxel-by-voxel group analysis using SPM8. RESULTS Of all 75 subjects with mild cognitive impairment, 46 (61.3%) had mild to moderate white matter lesions. The prevalence of hypertension tended to be higher in subjects with white matter lesions than in those without white matter lesions. Mini-Mental State Examination scores were significantly lower in subjects with white matter lesions than in those without white matter lesions. Subjects with white matter lesions had decreased regional cerebral blood flow mainly in the frontal, parietal, and medial temporal lobes, as well as the putamen, compared to those without white matter lesions. CONCLUSION In subjects with mild cognitive impairment, white matter lesions were associated with cognitive impairment and mainly frontal lobe brain function.
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Affiliation(s)
- Masato Ishibashi
- Department of Neurology, Oita University, Faculty of Medicine, Japan
| | - Noriyuki Kimura
- Department of Neurology, Oita University, Faculty of Medicine, Japan.
| | - Yasuhiro Aso
- Department of Neurology, Oita University, Faculty of Medicine, Japan
| | - Etsuro Matsubara
- Department of Neurology, Oita University, Faculty of Medicine, Japan
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36
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Neurovascular dysfunction in dementia - human cellular models and molecular mechanisms. Clin Sci (Lond) 2018; 132:399-418. [PMID: 29444850 DOI: 10.1042/cs20160720] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/15/2018] [Accepted: 01/19/2018] [Indexed: 02/08/2023]
Abstract
From the earliest stages of development, when cerebral angiogenesis and neurogenesis are entwined, to the end of life, the interplay between vascular and neural systems of the brain is critical in health and disease. Cerebral microvascular endothelial cells constitute the blood-brain barrier and in concert with pericytes or smooth muscle cells, glia and neurons, integrate into a functional neurovascular unit (NVU). This multicellular NVU maintains homoeostasis of the brain's microenvironment by restricting the entry of systemic pathogens and neurotoxins as well as meeting the metabolic demands of neural activity. Recent evidence of cerebral microvascular pathologies in vascular diseases and dementia, including Alzheimer's disease, has challenged the notion that vascular events are merely the consequence of neuronal pathology. This review focuses on molecular mechanisms of neurovascular dysfunction in dementia and outlines currently employed in vitro models to decode such mechanisms. Deciphering neurovascular crosstalk is likely to be more important in understanding the molecular mechanisms of disease than previously anticipated and may offer novel therapeutic opportunities for dementia and related conditions.
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37
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Cho K, Kim J, Kim GW. Changes in Blood Factors and Ultrasound Findings in Mild Cognitive Impairment and Dementia. Front Aging Neurosci 2018; 9:427. [PMID: 29311909 PMCID: PMC5742568 DOI: 10.3389/fnagi.2017.00427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 12/12/2017] [Indexed: 01/16/2023] Open
Abstract
The present study aimed to assess the changes in blood factors and ultrasound measures of atherosclerosis burden patient with mild cognitive impairment (MCI) and dementia. Peripheral blood samples and ultrasonography findings were obtained for 53 enrolled participants. Flow cytometry was used to evaluate levels of activated platelets and platelet-leukocyte aggregates (PLAs). The number of platelets expressing p-selectin was correlated with intima media thickness (IMT) and plaque number in both the MCI and dementia groups. The number of platelets expressing p-selectin glycoprotein ligand (PSGL) was strongly correlated with IMT in patients with MCI, whereas the number of platelets expressing PGSL was correlated with plaque number rather than IMT in patients with dementia. PLAs was associated with both IMT and plaque number in patients with MCI but not in those with dementia. Our findings demonstrate that alterations in IMT and plaque number are associated with an increased risk of cognitive decline as well as conversion from MCI to dementia and that blood factor analysis may aid to detect the severity of cognitive decline.
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Affiliation(s)
- Kyoungjoo Cho
- Department of Life Science, Kyonggi University, Suwon, South Korea
| | - Jihye Kim
- Department of Neurology, College of Medicine, Yonsei University, Seoul, South Korea
| | - Gyung W Kim
- Department of Neurology, College of Medicine, Yonsei University, Seoul, South Korea
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38
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Bordeleau M, ElAli A, Rivest S. Severe chronic cerebral hypoperfusion induces microglial dysfunction leading to memory loss in APPswe/PS1 mice. Oncotarget 2017; 7:11864-80. [PMID: 26918610 PMCID: PMC4914254 DOI: 10.18632/oncotarget.7689] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/05/2016] [Indexed: 12/12/2022] Open
Abstract
Cerebral vasculature plays a key role in controlling brain homeostasis. Cerebral vasculature dysfunction, associated to irregularities in cerebral blood perfusion, has been proposed to directly contribute to Alzheimer's disease (AD) pathogenesis. More precisely, chronic cerebral hypoperfusion, which impairs brain homeostasis, was demonstrated to take place even before cognitive decline. However, the mechanisms underlying the implication of chronic cerebral hypoperfusion in AD pathogenesis remain elusive. Therefore, this study aims at investigating the role of severe chronic cerebral hypoperfusion (SCCH) in AD pathogenesis. For this purpose, SCCH was induced in young APPswe/PS1 in order to evaluate the progression of AD-like pathology in these mice. We observed that SCCH accelerated the cognitive decline of young APPswe/PS1 mice, which was associated with an increased amyloid plaque number in brain parenchyma. In addition, SCCH reduced the activity of extracellular signal-regulated kinases 1/2 (ERK1/2), which has been shown to play an important role in the adaptive responses of neurons. Importantly, SCCH impaired the function of microglial cells, which are implicated in amyloid-β (Aβ) elimination. In vitro approaches underlined the ability of a low-glucose microenvironment to decrease the general activity and phagocytic capacity of microglia. By using a new model of SCCH, our study unravels new insights into the implication of severe chronic cerebral hypoperfusion in AD pathogenesis, mainly by altering microglial cell activity and consequently Aβ clearance.
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Affiliation(s)
- Maude Bordeleau
- Neuroscience Laboratory, CHU de Québec Research Center (CHUL), Department of Molecular Medicine, Faculty of Medicine, Laval University, Québec, Canada
| | - Ayman ElAli
- Neuroscience Laboratory, CHU de Québec Research Center (CHUL), Department of Psychiatry and Neuroscience, Faculty of Medicine, Laval University, Québec, Canada
| | - Serge Rivest
- Neuroscience Laboratory, CHU de Québec Research Center (CHUL), Department of Molecular Medicine, Faculty of Medicine, Laval University, Québec, Canada
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Tsai TH, Lin CJ, Chua S, Chung SY, Yang CH, Tong MS, Hang CL. Melatonin attenuated the brain damage and cognitive impairment partially through MT2 melatonin receptor in mice with chronic cerebral hypoperfusion. Oncotarget 2017; 8:74320-74330. [PMID: 29088788 PMCID: PMC5650343 DOI: 10.18632/oncotarget.20382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background Vascular cognitive impairment (VCI) is a spectrum of cognitive impairment caused by various chronic diseases including aging, hypertension, and diabetes mellitus. Oxidative and inflammatory reactions induced by chronic cerebral hypoperfusion (CHP) are believed to cause VCI. Melatonin is reported to possess anti-oxidation and anti-inflammation effects. This study was designed to investigate the effect and mechanisms of melatonin in CHP mice model. Results The behavioral function results revealed that CHP mice were significantly impaired when compared with the control. Melatonin improved the cognitive function, but the addition of MT2 receptor antagonist reversed the improvement. The IHC staining showed melatonin significantly improved WM lesions and gliosis in CHP mice. Again, the addition of MT2 receptor antagonist to melatonin worsened the WM lesion and gliosis. Similar results were also found for mRNA and protein expressions of oxidative reaction and inflammatory cytokines. Materials and Method Forty C57BL/6 mice were divided into four groups: Group 1: sham control; Group 2: CHP mice; Group 3: CHP with melatonin treatment; Group 4: CHP-melatonin and MT2 receptor antagonist (all groups n = 10). Working memory was assessed with Y–arm test at day-28 post-BCAS (bilateral carotid artery stenosis). All mice were sacrificed at day-30 post-BCAS. The immunohistochemical (IHC) staining was used for white matter (WM) damage and gliosis. The expression of mRNA and proteins about inflammatory and oxidative reaction were measured and compared between groups. Conclusions Partially through MT2 receptor, melatonin is effective for CHP-induced brain damage.
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Affiliation(s)
- Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Jei Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sarah Chua
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Ying Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Shen Tong
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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40
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Gorelick PB. Prevention of cognitive impairment: scientific guidance and windows of opportunity. J Neurochem 2017; 144:609-616. [PMID: 28677324 DOI: 10.1111/jnc.14113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/30/2017] [Accepted: 06/16/2017] [Indexed: 11/26/2022]
Abstract
Cognitive impairment of later life is an important medical and public health challenge. Worldwide it is estimated that the number of persons with dementia will continue to increase, especially in low- and middle-income countries. An important public health challenge relates to the prevention of cognitive decline and dementia. Specifically, is it possible to maintain cognitive vitality or prevent or slow cognitive decline? In this opinion-based piece, I review United States-based guidance statements for maintenance of cognition and select single and multidomain trials designed to preserve cognitive function. Guidance statements now recommend that we treat or prevent cardiovascular risks in hopes of preventing cognitive impairment or decline. I discuss potential gaps between guidance statements and interventional studies, and provide comments on where windows of opportunity may exist to close potential gaps in our quest to maintain cognitive vitality. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Philip B Gorelick
- Mercy Health Hauenstein Neurosciences, Department Translational Science & Molecular Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
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41
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Wiesmann M, Roelofs M, van der Lugt R, Heerschap A, Kiliaan AJ, Claassen JAHR. Angiotensin II, hypertension and angiotensin II receptor antagonism: Roles in the behavioural and brain pathology of a mouse model of Alzheimer's disease. J Cereb Blood Flow Metab 2017; 37:2396-2413. [PMID: 27596834 PMCID: PMC5531339 DOI: 10.1177/0271678x16667364] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/26/2016] [Accepted: 08/08/2016] [Indexed: 12/11/2022]
Abstract
Elevated angiotensin II causes hypertension and contributes to Alzheimer's disease by affecting cerebral blood flow. Angiotensin II receptor blockers may provide candidates to reduce (vascular) risk factors for Alzheimer's disease. We studied effects of two months of angiotensin II-induced hypertension on systolic blood pressure, and treatment with the angiotensin II receptor blockers, eprosartan mesylate, after one month of induced hypertension in wild-type C57bl/6j and AβPPswe/PS1ΔE9 (AβPP/PS1/Alzheimer's disease) mice. AβPP/PS1 showed higher systolic blood pressure than wild-type. Subsequent eprosartan mesylate treatment restored this elevated systolic blood pressure in all mice. Functional connectivity was decreased in angiotensin II-infused Alzheimer's disease and wild-type mice, and only 12 months of Alzheimer's disease mice showed impaired cerebral blood flow. Only angiotensin II-infused Alzheimer's disease mice exhibited decreased spatial learning in the Morris water maze. Altogether, angiotensin II-induced hypertension not only exacerbated Alzheimer's disease-like pathological changes such as impairment of cerebral blood flow, functional connectivity, and cognition only in Alzheimer's disease model mice, but it also induced decreased functional connectivity in wild-type mice. However, we could not detect hypertension-induced overexpression of Aβ nor increased neuroinflammation. Our findings suggest a link between midlife hypertension, decreased cerebral hemodynamics and connectivity in an Alzheimer's disease mouse model. Eprosartan mesylate treatment restored and beneficially affected cerebral blood flow and connectivity. This model could be used to investigate prevention/treatment strategies in early Alzheimer's disease.
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Affiliation(s)
- Maximilian Wiesmann
- Department of Anatomy, Radboud Alzheimer Center, Donders Institute for Brain, Cognition & Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Radboud Alzheimer Center, Donders Institute for Brain, Cognition & Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Monica Roelofs
- Department of Anatomy, Radboud Alzheimer Center, Donders Institute for Brain, Cognition & Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Robert van der Lugt
- Department of Anatomy, Radboud Alzheimer Center, Donders Institute for Brain, Cognition & Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Radiology & Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Amanda J Kiliaan
- Department of Anatomy, Radboud Alzheimer Center, Donders Institute for Brain, Cognition & Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Jurgen AHR Claassen
- Department of Geriatric Medicine, Radboud Alzheimer Center, Donders Institute for Brain, Cognition & Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Hilal S, Xu X, Ikram MK, Vrooman H, Venketasubramanian N, Chen C. Intracranial stenosis in cognitive impairment and dementia. J Cereb Blood Flow Metab 2017; 37:2262-2269. [PMID: 27488908 PMCID: PMC5464715 DOI: 10.1177/0271678x16663752] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intracranial stenosis is a common vascular lesion observed in Asian and other non-Caucasian stroke populations. However, its role in cognitive impairment and dementia has been under-studied. We, therefore, examined the association of intracranial stenosis with cognitive impairment, dementia and their subtypes in a memory clinic case-control study, where all subjects underwent detailed neuropsychological assessment and 3 T neuroimaging including three-dimensional time-of-flight magnetic resonance angiography. Intracranial stenosis was defined as ≥50% narrowing in any of the intracranial arteries. A total of 424 subjects were recruited of whom 97 were classified as no cognitive impairment, 107 as cognitive impairment no dementia, 70 vascular cognitive impairment no dementia, 121 Alzheimer's Disease, and 30 vascular dementia. Intracranial stenosis was associated with dementia (age/gender/education - adjusted odds ratios (OR): 4.73, 95% confidence interval (CI): 1.93-11.60) and vascular cognitive impairment no dementia (OR: 3.98, 95% CI: 1.59-9.93). These associations were independent of cardiovascular risk factors and MRI markers. However, the association with Alzheimer's Disease and vascular dementia became attenuated in the presence of white matter hyperintensities. Intracranial stenosis is associated with vascular cognitive impairment no dementia independent of MRI markers. In Alzheimer's Disease and vascular dementia, this association is mediated by cerebrovascular disease. Future studies focusing on perfusion and functional markers are needed to determine the pathophysiological mechanism(s) linking intracranial stenosis and cognition so as to identify treatment strategies.
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Affiliation(s)
- Saima Hilal
- 1 Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore, Singapore.,2 Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Xin Xu
- 1 Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore, Singapore.,2 Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - M Kamran Ikram
- 3 Academic Medicine Research Institute, Duke-NUS Graduate Medical School, Singapore, Singapore.,4 Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henri Vrooman
- 5 Departments of Radiology & Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Christopher Chen
- 1 Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore, Singapore.,2 Department of Pharmacology, National University of Singapore, Singapore, Singapore
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Yoon CY, Steffen LM, Gross MD, Launer LJ, Odegaard A, Reiner A, Sanchez O, Yaffe K, Sidney S, Jacobs DR. Circulating Cellular Adhesion Molecules and Cognitive Function: The Coronary Artery Risk Development in Young Adults Study. Front Cardiovasc Med 2017; 4:37. [PMID: 28596958 PMCID: PMC5442165 DOI: 10.3389/fcvm.2017.00037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/05/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Higher circulating concentrations of cellular adhesion molecules (CAMs) can be used as markers of endothelial dysfunction. Given that the brain is highly vascularized, we assessed whether endothelial function is associated with cognitive performance. METHOD Within the Coronary Artery Risk Development in Young Adults (CARDIA) Study, excluding N = 54 with stroke before year 25, we studied CAMs among N = 2,690 black and white men and women in CARDIA year 7 (1992-1993, ages 25-37) and N = 2,848 in CARDIA year 15 (2000-2001, ages 33-45). We included subjects with levels of circulating soluble CAMs measured in year 7 or 15 and cognitive function testing in year 25 (2010-2011, ages 43-55). Using multiple regression analysis, we evaluated the association between CAMs and year 25 cognitive test scores: Rey Auditory Verbal Learning Test (RAVLT, memory), Digit Symbol Substitution Test (DSST, speed of processing), and the Stroop Test (executive function). RESULT All CAM concentrations were greater in year 15 vs. year 7. Adjusting for age, race, sex, education, smoking, alcohol, diet, physical activity, participants in the fourth vs. the first quartile of CARDIA year 7 of circulating intercellular adhesion molecule-1 (ICAM-1) scored worse on RAVLT, DSST, and Stroop Test (p ≤ 0.05) in CARDIA year 25. Other CAMs showed little association with cognitive test scores. Findings were similar for ICAM-1 assessed at year 15. Adjustment for possibly mediating physical factors attenuated the findings. CONCLUSION Higher circulating ICAM-1 at average ages 32 and 40 was associated with lower cognitive skills at average age 50. The study is consistent with the hypothesis that endothelial dysfunction is associated with worse short-term memory, speed of processing, and executive function.
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Affiliation(s)
- Cynthia Yursun Yoon
- Division of Epidemiology and Community Heath, University of Minnesota, Minneapolis, MN, USA
| | - Lyn M. Steffen
- Division of Epidemiology and Community Heath, University of Minnesota, Minneapolis, MN, USA
| | - Myron D. Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Lenore J. Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD, USA
| | - Andrew Odegaard
- Department of Epidemiology, University of California, Irvine, CA, USA
| | - Alexander Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Otto Sanchez
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, MN, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Oakland, Oakland, CA, USA
| | - David R. Jacobs
- Division of Epidemiology and Community Heath, University of Minnesota, Minneapolis, MN, USA
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Park L, Uekawa K, Garcia-Bonilla L, Koizumi K, Murphy M, Pistik R, Younkin L, Younkin S, Zhou P, Carlson G, Anrather J, Iadecola C. Brain Perivascular Macrophages Initiate the Neurovascular Dysfunction of Alzheimer Aβ Peptides. Circ Res 2017; 121:258-269. [PMID: 28515043 DOI: 10.1161/circresaha.117.311054] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
RATIONALE Increasing evidence indicates that alterations of the cerebral microcirculation may play a role in Alzheimer disease, the leading cause of late-life dementia. The amyloid-β peptide (Aβ), a key pathogenic factor in Alzheimer disease, induces profound alterations in neurovascular regulation through the innate immunity receptor CD36 (cluster of differentiation 36), which, in turn, activates a Nox2-containing NADPH oxidase, leading to cerebrovascular oxidative stress. Brain perivascular macrophages (PVM) located in the perivascular space, a major site of brain Aβ collection and clearance, are juxtaposed to the wall of intracerebral resistance vessels and are a powerful source of reactive oxygen species. OBJECTIVE We tested the hypothesis that PVM are the main source of reactive oxygen species responsible for the cerebrovascular actions of Aβ and that CD36 and Nox2 in PVM are the molecular substrates of the effect. METHODS AND RESULTS Selective depletion of PVM using intracerebroventricular injection of clodronate abrogates the reactive oxygen species production and cerebrovascular dysfunction induced by Aβ applied directly to the cerebral cortex, administered intravascularly, or overproduced in the brain of transgenic mice expressing mutated forms of the amyloid precursor protein (Tg2576 mice). In addition, using bone marrow chimeras, we demonstrate that PVM are the cells expressing CD36 and Nox2 responsible for the dysfunction. Thus, deletion of CD36 or Nox2 from PVM abrogates the deleterious vascular effects of Aβ, whereas wild-type PVM reconstitute the vascular dysfunction in CD36-null mice. CONCLUSIONS The data identify PVM as a previously unrecognized effector of the damaging neurovascular actions of Aβ and unveil a new mechanism by which brain-resident innate immune cells and their receptors may contribute to the pathobiology of Alzheimer disease.
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Affiliation(s)
- Laibaik Park
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.).
| | - Ken Uekawa
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - Lidia Garcia-Bonilla
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - Kenzo Koizumi
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - Michelle Murphy
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - Rose Pistik
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - Linda Younkin
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - Steven Younkin
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - Ping Zhou
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - George Carlson
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - Josef Anrather
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.)
| | - Costantino Iadecola
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (L.P., K.U., L.G.B., K.K., M.M., P.Z., J.A., C.I.); McLaughlin Research Institute, Great Falls, MT (R.P., G.C.); and Mayo Clinic Jacksonville, FL (L.Y., S.Y.).
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45
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Chen TB, Yiao SY, Sun Y, Lee HJ, Yang SC, Chiu MJ, Chen TF, Lin KN, Tang LY, Lin CC, Wang PN. Comorbidity and dementia: A nationwide survey in Taiwan. PLoS One 2017; 12:e0175475. [PMID: 28403222 PMCID: PMC5389824 DOI: 10.1371/journal.pone.0175475] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/14/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Comorbid medical diseases are highly prevalent in the geriatric population, imposing hardship on healthcare services for demented individuals. Dementia also complicates clinical care for other co-existing medical conditions. This study investigated the comorbidities associated with dementia in the elderly population aged 65 years and over in Taiwan. METHODS We conducted a nationwide, population-based, cross-sectional survey; participants were selected by computerized random sampling from all 19 Taiwan counties between December 2011 and March 2013. After exclusion of incomplete or erroneous data, 8,456 subjects were enrolled. Of them, 6,183 were cognitively normal (control group), 1,576 had mild cognitive impairment (MCI), and 697 had dementia. We collected information about types of comorbidities (i.e., vascular risk factors, lung diseases, liver diseases, gastrointestinal diseases, and cancers), Charlson comorbidity index score, and demographic variables to compare subjects with normal cognition, MCI, and dementia. RESULTS Regardless of the cognitive condition, over 60% of the individuals in each group had at least one comorbid disease. The proportion of subjects possessing at least three comorbidities was higher in those with cognitive impairment (MCI 20.9%, dementia 27.3%) than in control group (15%). Hypertension and diabetes mellitus were the most common comorbidities. The mean number of comorbidities and Charlson comorbidity index score were greater in MCI and dementia groups than in control group. Logistic regression demonstrated that the comorbidities significantly associated with MCI and dementia were cerebrovascular disease (OR 3.35, CI 2.62-4.28), cirrhosis (OR 3.29, CI 1.29-8.41), asthma (OR 1.56, CI 1.07-2.27), and diabetes mellitus (OR 1.24, CI 1.07-1.44). CONCLUSION Multiple medical comorbid diseases are common in older adults, especially in those with cognitive impairment. Cerebrovascular disease, cirrhosis, asthma, and diabetes mellitus are important contributors to cognitive deterioration in the elderly. Efforts to lower cumulative medical burden in the geriatric population may benefit cognitive function.
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Affiliation(s)
- Ting-Bin Chen
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Szu-Yu Yiao
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Yu Sun
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Huey-Jane Lee
- Taiwan Alzheimer’s Disease Association, Taipei, Taiwan
| | | | - Ming-Jang Chiu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Ta-Fu Chen
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ker-Neng Lin
- Department of Psychology, Soo-Chow University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Yu Tang
- Taiwan Alzheimer’s Disease Association, Taipei, Taiwan
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chung Gung University, Tao-Yuan, Taiwan
| | - Pei-Ning Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
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Wiesmann M, Zerbi V, Jansen D, Lütjohann D, Veltien A, Heerschap A, Kiliaan AJ. Hypertension, cerebrovascular impairment, and cognitive decline in aged AβPP/PS1 mice. Theranostics 2017; 7:1277-1289. [PMID: 28435465 PMCID: PMC5399593 DOI: 10.7150/thno.18509] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 01/18/2017] [Indexed: 11/05/2022] Open
Abstract
Cardiovascular risk factors, especially hypertension, are also major risk factors for Alzheimer's disease (AD). To elucidate the underlying vascular origin of neurodegenerative processes in AD, we investigated the relation between systolic blood pressure (SBP) cerebral blood flow (CBF) and vasoreactivity with brain structure and function in a 16-18 months old double transgenic AβPPswe/PS1dE9 (AβPP/PS1) mouse model for AD. These aging AβPP/PS1 mice showed an increased SBP linked to a declined regional CBF. Furthermore, using advanced MRI techniques, decline of functional and structural connectivity was revealed in the AD-like mice coupled to impaired cognition, increased locomotor activity, and anxiety-related behavior. Post mortem analyses demonstrated also increased neuroinflammation, and both decreased synaptogenesis and neurogenesis in the AβPP/PS1 mice. Additionally, deviant levels of fatty acids and sterols were present in the brain tissue of the AβPP/PS1 mice indicating maladapted brain fatty acid metabolism. Our findings suggest a link between increased SBP, decreased cerebral hemodynamics and connectivity in an AD mouse model during aging, leading to behavioral and cognitive impairments. As these results mirror the complex clinical symptomatology in the prodromal phase of AD, we suggest that this AD-like murine model could be used to investigate prevention and treatment strategies for early AD patients. Moreover, this study helps to develop more efficient therapies and diagnostics for this very early stage of AD.
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47
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Marmarelis VZ, Shin DC, Tarumi T, Zhang R. Comparison of Model-Based Indices of Cerebral Autoregulation and Vasomotor Reactivity Using Transcranial Doppler versus Near-Infrared Spectroscopy in Patients with Amnestic Mild Cognitive Impairment. J Alzheimers Dis 2017; 56:89-105. [PMID: 27911329 PMCID: PMC5240580 DOI: 10.3233/jad-161004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 01/24/2023]
Abstract
We recently introduced model-based "physiomarkers" of dynamic cerebral autoregulation and CO2 vasomotor reactivity as an aid for diagnosis of early-stage Alzheimer's disease (AD) [1], where significant impairment of dynamic vasomotor reactivity (DVR) was observed in early-stage AD patients relative to age-matched controls. Milder impairment of DVR was shown in patients with amnestic mild cognitive impairment (MCI) using the same approach in a subsequent study [2]. The advocated approach utilizes subject-specific data-based models of cerebral hemodynamics to quantify the dynamic effects of resting-state changes in arterial blood pressure and end-tidal CO2 (the putative inputs) upon cerebral blood flow velocity (the putative output) measured at the middle cerebral artery via transcranial Doppler (TCD). The obtained input-output models are then used to compute model-based indices of DCA and DVR from model-predicted responses to an input pressure pulse or an input CO2 pulse, respectively. In this paper, we compare these model-based indices of DVR and DCA in 46 amnestic MCI patients, relative to 20 age-matched controls, using TCD measurements with their counterparts using Near-Infrared Spectroscopy (NIRS) measurements of blood oxygenation at the lateral prefrontal cortex in 43 patients and 22 age-matched controls. The goal of the study is to assess whether NIRS measurements can be used instead of TCD measurements to obtain model-based physiomarkers with comparable diagnostic utility. The results corroborate this view in terms of the ability of either output to yield model-based physiomarkers that can differentiate the group of aMCI patients from age-matched healthy controls.
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Affiliation(s)
- Vasilis Z. Marmarelis
- Biomedical Simulations Resource Center, University of Southern California, Los Angeles, CA, USA
| | - Dae C. Shin
- Biomedical Simulations Resource Center, University of Southern California, Los Angeles, CA, USA
| | - Takashi Tarumi
- Exercise Physiology & Rehabilitation Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rong Zhang
- Exercise Physiology & Rehabilitation Center, UT Southwestern Medical Center, Dallas, TX, USA
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48
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Molecular and Therapeutic Targets of Genistein in Alzheimer's Disease. Mol Neurobiol 2016; 54:7028-7041. [PMID: 27796744 DOI: 10.1007/s12035-016-0215-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/11/2016] [Indexed: 12/18/2022]
Abstract
Alzheimer's disease (AD) is a devastating brain disorder characterized by an increased level of amyloid-beta (Aβ) peptide deposition and neuronal cell death leading to an impairment of learning and thinking skills. The Aβ deposition is a key factor in senile plaques of the AD brain which cause the elevation of intracellular calcium ions and the production of formidable free radicals, both of which greatly contribute to the AD-associated cascade, leading to unstoppable neuronal loss in the hippocampal region of the brain. Natural products are currently considered as an alternative strategy for the discovery of novel multipotent drugs against AD. They include the naturally occurring dietary soy isoflavone genistein which has been recognized to possess several health-promoting effects. Genistein has been mainly focused because of its potential on amelioration of Aβ-induced impairment and its antioxidant capacity to scavenge the free radicals produced in AD. It can also directly interact with the targeted signaling proteins and stabilize their activity to prevent AD. An improved understanding of the direct interactions between genistein and target proteins would contribute to the further development of AD treatment. This review mainly focuses on molecular targets and the therapeutic effects regulated by genistein, which has the ability to directly target the Aβ peptide and to control its activity involved in intracellular signaling pathways, which otherwise would lead to neuronal death in the hippocampal region of the AD brain.
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49
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Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB, Gulati M, Kamel H, Knopman DS, Launer LJ, Saczynski JS, Seshadri S, Zeki Al Hazzouri A. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension 2016; 68:e67-e94. [PMID: 27977393 DOI: 10.1161/hyp.0000000000000053] [Citation(s) in RCA: 404] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. METHODS Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. CONCLUSIONS After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.
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50
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Jansson D, Scotter EL, Rustenhoven J, Coppieters N, Smyth LCD, Oldfield RL, Bergin PS, Mee EW, Graham ES, Faull RLM, Dragunow M. Interferon-γ blocks signalling through PDGFRβ in human brain pericytes. J Neuroinflammation 2016; 13:249. [PMID: 27654972 PMCID: PMC5031293 DOI: 10.1186/s12974-016-0722-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/13/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Neuroinflammation and blood-brain barrier (BBB) disruption are common features of many brain disorders, including Alzheimer's disease, epilepsy, and motor neuron disease. Inflammation is thought to be a driver of BBB breakdown, but the underlying mechanisms for this are unclear. Brain pericytes are critical cells for maintaining the BBB and are immunologically active. We sought to test the hypothesis that inflammation regulates the BBB by altering pericyte biology. METHODS We exposed primary adult human brain pericytes to chronic interferon-gamma (IFNγ) for 4 days and measured associated functional aspects of pericyte biology. Specifically, we examined the influence of inflammation on platelet-derived growth factor receptor-beta (PDGFRβ) expression and signalling, as well as pericyte proliferation and migration by qRT-PCR, immunocytochemistry, flow cytometry, and western blotting. RESULTS Chronic IFNγ treatment had marked effects on pericyte biology most notably through the PDGFRβ, by enhancing agonist (PDGF-BB)-induced receptor phosphorylation, internalization, and subsequent degradation. Functionally, chronic IFNγ prevented PDGF-BB-mediated pericyte proliferation and migration. CONCLUSIONS Because PDGFRβ is critical for pericyte function and its removal leads to BBB leakage, our results pinpoint a mechanism linking chronic brain inflammation to BBB dysfunction.
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Affiliation(s)
- Deidre Jansson
- Department of Pharmacology and Clinical Pharmacology, The University of Auckland, 1023, Auckland, New Zealand.,Gravida National Centre for Growth and Development, The University of Auckland, 1023, Auckland, New Zealand.,Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand
| | - Emma L Scotter
- Department of Pharmacology and Clinical Pharmacology, The University of Auckland, 1023, Auckland, New Zealand.,Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand
| | - Justin Rustenhoven
- Department of Pharmacology and Clinical Pharmacology, The University of Auckland, 1023, Auckland, New Zealand.,Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand
| | - Natacha Coppieters
- Department of Anatomy and Medical Imaging, The University of Auckland, 1023, Auckland, New Zealand.,Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand
| | - Leon C D Smyth
- Department of Pharmacology and Clinical Pharmacology, The University of Auckland, 1023, Auckland, New Zealand.,Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand
| | | | - Peter S Bergin
- Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand.,Auckland City Hospital, 1023, Auckland, New Zealand
| | - Edward W Mee
- Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand.,Auckland City Hospital, 1023, Auckland, New Zealand
| | - E Scott Graham
- Department of Pharmacology and Clinical Pharmacology, The University of Auckland, 1023, Auckland, New Zealand.,Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand
| | - Richard L M Faull
- Department of Anatomy and Medical Imaging, The University of Auckland, 1023, Auckland, New Zealand.,Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand
| | - Mike Dragunow
- Department of Pharmacology and Clinical Pharmacology, The University of Auckland, 1023, Auckland, New Zealand. .,Gravida National Centre for Growth and Development, The University of Auckland, 1023, Auckland, New Zealand. .,Centre for Brain Research, The University of Auckland, 1023, Auckland, New Zealand. .,Department of Pharmacology and Clinical Pharmacology, The University of Auckland, Private Bag 92019, 1142, Auckland, New Zealand.
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