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Fan LL, Fang H, Zheng JY, Qiu YH, Wu GL, Cai YF, Chen YB, Zhang SJ. Taohong Siwu decoction alleviates cognitive impairment by suppressing endoplasmic reticulum stress and apoptosis signaling pathway in vascular dementia rats. JOURNAL OF ETHNOPHARMACOLOGY 2024; 333:118407. [PMID: 38824979 DOI: 10.1016/j.jep.2024.118407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/04/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Taohong Siwu Decoction (TSD), a classic traditional Chinese medicine formula, is used for the treatment of vascular diseases, including vascular dementia (VD). However, the mechanisms remain unclear. AIM OF STUDY This study aimed to investigate whether TSD has a positive effect on cognitive impairment in VD rats and to confirm that the mechanism of action is related to the Endoplasmic Reticulum stress (ERs) and cell apoptosis signaling pathway. MATERIALS AND METHODS A total of 40 male adult Sprague-Dawley rats were divided into four groups: sham-operated group (Sham), the two-vessel occlusion group (2VO), the 2VO treated with 4.5 g/kg/d TSD group (2VO + TSD-L), the 2VO treated with 13.5 g/kg/d TSD group (2VO + TSD-H). The rats underwent either 2VO surgery or sham surgery. Postoperative TSD treatment was given for 4 consecutive weeks. Behavioral tests were initiated at the end of gastrulation. Open-field test (OFT) was used to detect the activity level. The New Object Recognition test (NOR) was used to test long-term memory. The Morris water maze (MWM) test was used to examine the foundation of spatial learning and memory. As a final step, the hippocampus was taken for molecular testing. The protein levels of GRP78 (Bip), p-PERK, PERK, IRE1α, p-IRE1α, ATF6, eIF2α, p-eIF2α, ATF4, XBP1, Bcl-2 and Bax were determined by Western blot. Immunofluorescence visualizes molecular expression. RESULTS In the OFT, residence time in the central area was significantly longer in both TSD treatment groups compared to the 2VO group. In the NOR, the recognition index was obviously elevated in both TSD treatment groups. The 2VO group had a significantly longer escape latency and fewer times in crossing the location of the platform compared with the Sham group in MWM. TSD treatment reversed this notion. Pathologically, staining observations confirmed that TSD inhibited hippocampal neuronal loss and alleviated the abnormal reduction of the Nissl body. In parallel, TUNEL staining illustrated that TSD decelerated neuronal apoptosis. Western Blot demonstrated that TSD reduces the expression of ERs and apoptotic proteins. CONCLUSION In this study, the significant ameliorative effect on cognitive impairment of TSD has been determined by comparing the behavioral data of the 4 groups of rats. Furthermore, it was confirmed that this effect of TSD was achieved by suppressing the ERs-mediated apoptosis signaling pathway.
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Affiliation(s)
- Ling-Ling Fan
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Research on Emergency in TCM Guangzhou, 510000, China; Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Hao Fang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jia-Yi Zheng
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yu-Hui Qiu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Guang-Liang Wu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Research on Emergency in TCM Guangzhou, 510000, China
| | - Ye-Feng Cai
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Research on Emergency in TCM Guangzhou, 510000, China.
| | - Yun-Bo Chen
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.
| | - Shi-Jie Zhang
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Research on Emergency in TCM Guangzhou, 510000, China.
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Fujima N, Kameda H, Shimizu Y, Harada T, Tha KK, Yoneyama M, Kudo K. Utility of a diffusion-weighted arterial spin labeling (DW-ASL) technique for evaluating the progression of brain white matter lesions. Magn Reson Imaging 2020; 69:81-87. [PMID: 32217128 DOI: 10.1016/j.mri.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the utility of diffusion-weighted arterial spin labeling (DW-ASL) for detecting the progression of brain white matter lesions. MATERIALS AND METHODS A total of 492 regions of interest (ROIs) in 41 patients were prospectively analyzed. DW-ASL was performed using the diffusion gradient prepulse of five b-values (0, 25, 60, 102, and 189) before the ASL readout. We calculated the water exchange rate (Kw) with post-processing using the ASL signal information for each b-value. The cerebral blood flow (CBF) was also calculated using b0 images. Using the signal information in FLAIR (fluid-attenuated inversion recovery) images, we classified the severity of white matter lesions into three grades: non-lesion, moderate, and severe. In addition, the normal Kw level was measured from DW-ASL data of 60 ROIs in five control subjects. The degree of variance of the Kw values (Kw-var) was calculated by squaring the value of the difference between each Kw value and the normal Kw level. All patient's ROIs were divided into non-progressive and progressive white matter lesions by comparing the present FLAIR images with those obtained 2 years before this acquisition. RESULTS Compared to the non-progressive group, the progressive group had significantly lower CBF, significantly higher severity grades in FLAIR, and significantly greater Kw-var values. In a receiver operator characteristic curve analysis, a high area under the curve (AUC) of 0.89 was obtained with the use of Kw-var. In contrast, the AUCs of 0.59 for CBF and 0.72 for severity grades in FLAIR were obtained. CONCLUSIONS The DW-ASL technique can be useful to detect the progression of brain white matter lesions. This technique will become a clinical tool for patients with various degrees of white matter lesions.
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Affiliation(s)
- Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan.
| | - Hiroyuki Kameda
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - Yukie Shimizu
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - Taisuke Harada
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - Khin Khin Tha
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo 0608638, Japan; The Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, N15 W8, Kita-Ku, Sapporo 0608638, Japan
| | - Masami Yoneyama
- Philips Japan, 3-37 Kohnan 2-chome, Minato-ku, Tokyo 108-8507, Japan
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan; The Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, N15 W8, Kita-Ku, Sapporo 0608638, Japan
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Jee HJ, Shin W, Jung HJ, Kim B, Lee BK, Jung YS. Impact of Sleep Disorder as a Risk Factor for Dementia in Men and Women. Biomol Ther (Seoul) 2020; 28:58-73. [PMID: 31838834 PMCID: PMC6939686 DOI: 10.4062/biomolther.2019.192] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/30/2022] Open
Abstract
Sleep is an essential physiological process, especially for proper brain function through the formation of new pathways and processing information and cognition. Therefore, when sleep is insufficient, this can result in pathophysiologic conditions. Sleep deficiency is a risk factor for various conditions, including dementia, diabetes, and obesity. Recent studies have shown that there are differences in the prevalence of sleep disorders between genders. Insomnia, the most common type of sleep disorder, has been reported to have a higher incidence in females than in males. However, sex/gender differences in other sleep disorder subtypes are not thoroughly understood. Currently, increasing evidence suggests that gender issues should be considered important when prescribing medicine. Therefore, an investigation of the gender-dependent differences in sleep disorders is required. In this review, we first describe sex/gender differences not only in the prevalence of sleep disorders by category but in the efficacy of sleep medications. In addition, we summarize sex/gender differences in the impact of sleep disorders on incident dementia. This may help understand gender-dependent pathogenesis of sleep disorders and develop therapeutic strategies in men and women.
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Affiliation(s)
- Hye Jin Jee
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon 16499, Republic of Korea
| | - Wonseok Shin
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Ho Joong Jung
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Baekgyu Kim
- Graduate School of Global Pharmaceutical Industry and Clinical Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Bo Kyung Lee
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Yi-Sook Jung
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon 16499, Republic of Korea.,Graduate School of Global Pharmaceutical Industry and Clinical Pharmacy, Ajou University, Suwon 16499, Republic of Korea
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Washida K, Hattori Y, Ihara M. Animal Models of Chronic Cerebral Hypoperfusion: From Mouse to Primate. Int J Mol Sci 2019; 20:ijms20246176. [PMID: 31817864 PMCID: PMC6941004 DOI: 10.3390/ijms20246176] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/17/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022] Open
Abstract
Vascular cognitive impairment (VCI) or vascular dementia occurs as a result of brain ischemia and represents the second most common type of dementia after Alzheimer’s disease. To explore the underlying mechanisms of VCI, several animal models of chronic cerebral hypoperfusion have been developed in rats, mice, and primates. We established a mouse model of chronic cerebral hypoperfusion by narrowing the bilateral common carotid arteries with microcoils, eventually resulting in hippocampal atrophy. In addition, a mouse model of white matter infarct-related damage with cognitive and motor dysfunction has also been established by asymmetric common carotid artery surgery. Although most experiments studying chronic cerebral hypoperfusion have been performed in rodents because of the ease of handling and greater ethical acceptability, non-human primates appear to represent the best model for the study of VCI, due to their similarities in much larger white matter volume and amyloid β depositions like humans. Therefore, we also recently developed a baboon model of VCI through three-vessel occlusion (both the internal carotid arteries and the left vertebral artery). In this review, several animal models of chronic cerebral hypoperfusion, from mouse to primate, are extensively discussed to aid in better understanding of pathophysiology of VCI.
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Affiliation(s)
- Kazuo Washida
- Correspondence: ; Tel.: +81-6-6170-1070; Fax: +81-6-6170-1782
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Ihara M, Washida K. Linking Atrial Fibrillation with Alzheimer's Disease: Epidemiological, Pathological, and Mechanistic Evidence. J Alzheimers Dis 2019; 62:61-72. [PMID: 29439352 PMCID: PMC5817903 DOI: 10.3233/jad-170970] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Many studies have shown a relationship between atrial fibrillation (AF) and vascular dementia. AF is a major risk factor for stroke, and stroke is the greatest risk factor for vascular dementia. However, the relationship between Alzheimer's disease (AD), the leading cause of dementia, and AF remains unclear. At least four epidemiological studies have reported AF significantly raises the risk of AD 1.5- to 2.5-fold. Chronic cerebral hypoperfusion, resulting from persistent AF, could explain the link as hypoperfusion may mechanistically exacerbate amyloid-β (Aβ) neuropathology, such as senile plaques and amyloid angiopathy, by upregulating Aβ-producing enzymes and lowering Aβ clearance efficiency. In addition, hypoperfusion may exacerbate tau pathology directly through upregulation of tau-phosphorylating enzymes and indirectly via the amyloid cascade. However, most neuropathological studies do not support the direct link between AD pathology and AF but rather suggests vascular neuropathology is related to, or coexistent with, AF and lowers the threshold for clinically-evident AD. Vascular neuropathology may thus mediate the link between AD and AF. From a treatment perspective, an observational study has shown that catheter ablation is associated with less incidence of AD in AF patients, suggesting rhythm-control suppresses hypoperfusion-induced AD neuropathology. In addition, rate-control may lower the rate of cognitive decline in cognitively impaired elderly subjects with AF. Further studies are warranted to clarify the mechanisms underlying the linkage between AF and AD. However, anticoagulation and rhythm-/rate-control against AF may hold promise even for AD patients.
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Affiliation(s)
- Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan
| | - Kazuo Washida
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan
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Tanaka T, Ihara M. Post-stroke epilepsy. Neurochem Int 2017; 107:219-228. [PMID: 28202284 DOI: 10.1016/j.neuint.2017.02.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 01/17/2023]
Abstract
Post-stroke epilepsy (PSE) is a common complication after stroke, yet treatment options remain limited. While many physicians prescribe antiepileptic drugs (AED) for secondary prevention of PSE, it is unclear which treatments are most effective in the prevention of recurrence of symptoms, or whether such therapy is needed for primary prevention. This review discusses the current understanding of epidemiology, diagnoses, mechanisms, risk factors, and treatments of PSE.
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Affiliation(s)
- Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta Mol Basis Dis 2016; 1862:915-25. [PMID: 26806700 PMCID: PMC4827373 DOI: 10.1016/j.bbadis.2016.01.015] [Citation(s) in RCA: 317] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 12/13/2022]
Abstract
The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. Ischaemic injury is common among long-term stroke survivors About 25% stroke survivors develop dementia with a much greater proportion developing cognitive impairment Risk factors of dementia after stroke include older age, vascular comorbidities, prior stroke and pre-stroke impairment Current imaging and pathological studies suggest 70% of dementia after stroke is vascular dementia Severe white matter changes and medial temporal lobe atrophy as sequelae after ischaemic injury are substrates of dementia Controlling vascular risk factors and prevention strategies related to lifestyle factors would reduce dementia after stroke
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Affiliation(s)
- Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
| | - Rufus Akinyemi
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Masafumi Ihara
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
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Tomimoto H. White matter integrity and cognitive dysfunction: Radiological and neuropsychological correlations. Geriatr Gerontol Int 2015; 15 Suppl 1:3-9. [DOI: 10.1111/ggi.12661] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Hidekazu Tomimoto
- Department of Neurology; Graduate School of Medicine; Mie University; Mie Japan
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Henninger N, Izzy S, Carandang R, Hall W, Muehlschlegel S. Severe leukoaraiosis portends a poor outcome after traumatic brain injury. Neurocrit Care 2015; 21:483-95. [PMID: 24752459 DOI: 10.1007/s12028-014-9980-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE It is now well accepted that traumatic white matter injury constitutes a critical determinant of post-traumatic functional impairment. However, the contribution of preexisting white matter rarefaction on outcome following traumatic brain injury (TBI) is unknown. Hence, we sought to determine whether the burden of preexisting leukoaraiosis of presumed ischemic origin is independently associated with outcome after TBI. METHODS We retrospectively analyzed consecutive, prospectively enrolled patients of ≥50 years (n = 136) who were admitted to a single neurological/trauma intensive care unit. Supratentorial white matter hypoattenuation on head CT was graded on a 5-point scale (range 0-4) reflecting increasing severity of leukoaraiosis. Outcome was ascertained according to the modified Rankin Scale (mRS) and Glasgow outcome scale (GOS) at 3 and 12 months, respectively. RESULTS After adjustment for other factors, leukoaraiosis severity was significantly associated with a poor outcome at 3 and 12 months defined as mRS 3-6 and GOS 1-3, respectively. The independent association between leukoaraiosis and poor outcome remained when the analysis was restricted to patients who survived up to 3 months, had moderate-to-severe TBI [enrollment Glasgow Coma Scale (GCS) ≤12; p = 0.001], or had mild TBI (GCS 13-15; p = 0.002), respectively. CONCLUSION We provide first evidence that preexisting cerebral small vessel disease independently predicts a poor functional outcome after closed head TBI. This association is independent of other established outcome predictors such as age, comorbid state as well as intensive care unit complications and interventions. This knowledge may help improve prognostic accuracy, clinical management, and resource utilization.
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Affiliation(s)
- Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA,
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Ivanets NN, Kinkulkina MA, Avdeeva TI, Sysoeva VP. [Remote consequences of the long-term uncontrolled use of anxiolytic and hypnotic drugs by elderly patients: cognitive disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:50-64. [PMID: 26978494 DOI: 10.17116/jnevro201511511250-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Frequents cases (10-30% of the elderly population) of regular long-term use of anxiolytic and hypnotic drugs, in particular, benzodiazepines, without control of the physician is an urgent problem of medicine worldwide. Severe and irreversible cognitive impairment is a frequent and severe consequence of this use. Authors studied cognitive impairment in these cases. MATERIAL AND METHODS Patients were enrolled in the study from a psychiatric hospital. The study included 56 women, aged over 50 years, admitted to the hospital with the diagnosis of a mental disorder. Before admission, the patients regularly used benzodiazepines without a prescription for more than 2 months. Later on, anxiolytics were withdrawn during 1-5 days. The patients were studied during 4 weeks in the hospital. To assess the severity and dynamics of their condition, authors used MADRS, HAM-A, MMSE. RESULTS AND CONCLUSION Severe cognitive impairment, achieving the level of dementia, was found in 57.2% of the patients, mild or moderate of cognitive impairment was in 32.1% and only 10.7% had normal level of cognitive functioning. After 4 weeks of benzodiazepine withdrawal, the percentage of patients with dementia reduced to 21.4%, the severity of cognitive impairment was estimated as mild or moderate. A number of patients without cognitive impairment increased to 37.5%. The old age of patients was a significant negative predictor of the dynamics. An impact of the high anxiolytic dose was shown on trend level. The duration of a mental disorder and duration of uncontrollable consumption of anxiolytics and hypnotics did not exert an effect on the development and reversibility of cognitive impairment. A combination of anxiolytics with alcohol increased the risk of dementia and did not reverse the cognitive pathology.
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Affiliation(s)
- N N Ivanets
- Kafedra psihiatrii i narkologii GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva, Nauchno-issledovatel'skij otdel 'Psihicheskogo zdorov'ja' Nauchno-issledovatel'skogo tsentra GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva
| | - M A Kinkulkina
- Kafedra psihiatrii i narkologii GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva, Nauchno-issledovatel'skij otdel 'Psihicheskogo zdorov'ja' Nauchno-issledovatel'skogo tsentra GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva
| | - T I Avdeeva
- Kafedra psihiatrii i narkologii GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva, Nauchno-issledovatel'skij otdel 'Psihicheskogo zdorov'ja' Nauchno-issledovatel'skogo tsentra GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva
| | - V P Sysoeva
- Kafedra psihiatrii i narkologii GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva, Nauchno-issledovatel'skij otdel 'Psihicheskogo zdorov'ja' Nauchno-issledovatel'skogo tsentra GBOU VPO 'Pervyj Moskovskij gosudarstvennyj meditsinskij universitet im. I.M. Sechenova' Minzdrava RF, Moskva
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Ihara M, Kalaria RN. Understanding and preventing the development of post-stroke dementia. Expert Rev Neurother 2014; 14:1067-77. [PMID: 25105544 DOI: 10.1586/14737175.2014.947276] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Post-stroke dementia (PSD) is a clinical entity but it now appears that most of PSD may be categorized as vascular dementia. The well-established relationship between vascular factors and dementia provides a rationale for the implementation of intervention and prevention efforts. Larger primary prevention trials related to lifestyle factors are warranted in association with dementia. Published clinical trials have not been promising and there is meager information on whether PSD can be prevented through the use of pharmacological agents. Control of vascular disease risk and prevention of recurrent strokes are obviously key to reducing the burden of cognitive decline and dementia after stroke. However, modern imaging and analysis techniques will help to elucidate the mechanism of PSD and establish better treatment.
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Affiliation(s)
- Masafumi Ihara
- Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
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Henninger N, Khan MA, Zhang J, Moonis M, Goddeau RP. Leukoaraiosis predicts cortical infarct volume after distal middle cerebral artery occlusion. Stroke 2014; 45:689-95. [PMID: 24523039 DOI: 10.1161/strokeaha.113.002855] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Leukoaraiosis (LA) predominantly affects the subcortical white matter, but mounting evidence suggests an association with cortical microvascular dysfunction and potentially decreased cortical ischemic tolerance. Thus, we sought to assess whether preexisting LA is predictive of the cortical infarct volume after middle cerebral artery branch occlusion and whether it relates to a worse outcome. METHODS We analyzed data from 117 consecutive patients with middle cerebral artery branch occlusion as documented by admission computed tomography angiography. Baseline clinical, laboratory, and outcome data, as well as final cortical infarct volumes, were retrospectively analyzed from a prospectively collected database. LA severity was assessed on admission computed tomography using the van Swieten scale grading the supratentorial white matter hypoattenuation. Infarct volume predicting a favorable 90-day outcome (modified Rankin Scale score≤2) was determined by receiver operating characteristic curves. Multivariable linear and logistic regression analyses were used to identify independent predictors of the final infarct volume and outcome. RESULTS Receiver operating characteristic curve analyses indicated that a final infarct volume of ≤27 mL best predicted a favorable 90-day outcome. Severe LA (odds ratio, 11.231; 95% confidence interval, 2.526-49.926; P=0.001) was independently associated with infarct volume>27 mL. Severe LA (odds ratio, 3.074; 95% confidence interval, 1.055-8.961; P=0.040) and infarct volume>27 mL (odds ratio, 9.156; 95% confidence interval, 3.191-26.270; P<0.001) were independent predictors of a poor 90-day outcome (modified Rankin Scale, 3-6). CONCLUSIONS The presence of severe, subcortical LA contributes to larger cortical infarct volumes and worse functional outcomes adding to the notion that the brain is negatively affected beyond LA's macroscopic boundaries.
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Affiliation(s)
- Nils Henninger
- From the Departments of Neurology (N.H., M.A.K., J.Z., M.M., R.P.G.) and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
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Ihara M, Taguchi A, Maki T, Washida K, Tomimoto H. A mouse model of chronic cerebral hypoperfusion characterizing features of vascular cognitive impairment. Methods Mol Biol 2014; 1135:95-102. [PMID: 24510857 DOI: 10.1007/978-1-4939-0320-7_8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vascular dementia or vascular cognitive impairment occurs as a result of persistently compromised blood flow to the brain and represents the second most common type of dementia after Alzheimer's disease. In order to investigate its underlying mechanisms, a mouse model of chronic cerebral hypoperfusion has been developed, which involves the narrowing of the bilateral common carotid arteries with newly designed microcoils. This mouse model provides a unique platform to investigate the mechanisms of angiogenesis following chronic cerebral hypoperfusion and to explore potential drugs or cell therapies designed to enhance angiogenesis as a preclinical step toward developing novel treatments for dementia of vascular origin.
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Affiliation(s)
- Masafumi Ihara
- Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Osaka, Japan
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14
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Abstract
Transcranial magnetic stimulation (TMS) has been used extensively to characterize motor system pathophysiology in Alzheimer's disease (AD) and other forms of dementia, as well to monitor the effects of certain pharmacological agents. Among the studies focusing on motor cortical excitability measures, the most consistent finding is a significant reduction of short-latency afferent inhibition (SAI) in AD and other forms of dementia in which the cholinergic system is affected, such as dementia with Lewy bodies. SAI evaluation may thus provide a reliable biomarker of cortical cholinergic dysfunction in dementias. Moreover, most TMS studies have demonstrated cortical hyperexcitability and asymptomatic motor cortex functional reorganization in the early stages of the disease. Integrated approaches utilizing TMS together with high-density EEG have indicated impaired cortical plasticity and functional connectivity across different neural networks in AD. Paired associative stimulation-induced plasticity has also been found to be abnormal in patients with AD. The development of novel noninvasive methods of brain stimulation, in particular repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS), has increased the interest in neuromodulatory techniques as potential therapeutic tools for cognitive rehabilitation in AD. Preliminary studies have revealed that rTMS and tDCS can induce beneficial effects on specific cognitive functions in AD. Future studies are warranted to replicate and extend the initial findings.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
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15
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Hanyu H, Kume K, Sato T, Hirao K, Kanetaka H, Sakurai H, Iwamoto T. Regional differences in cortical benzodiazepine receptors of Alzheimer, vascular, and mixed dementia patients. J Neurol Sci 2012; 323:71-6. [DOI: 10.1016/j.jns.2012.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/03/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
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16
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Chen PL, Lee WJ, Sun WZ, Oyang YJ, Fuh JL. Risk of dementia in patients with insomnia and long-term use of hypnotics: a population-based retrospective cohort study. PLoS One 2012; 7:e49113. [PMID: 23145088 PMCID: PMC3492301 DOI: 10.1371/journal.pone.0049113] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 10/04/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypnotics have been reported to be associated with dementia. However, the relationship between insomnia, hypnotics and dementia is still controversial. We sought to examine the risk of dementia in patients with long-term insomnia and the contribution of hypnotics. METHODS Data was collected from Taiwan's Longitudinal Health Insurance Database. The study cohort comprised all patients aged 50 years or older with a first diagnosis of insomnia from 2002 to 2007. The comparison cohort consisted of randomly selected patients matched by age and gender. Each patient was individually tracked for 3 years from their insomnia index date to identify whether the patient had a first diagnosis of dementia. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS We identified 5693 subjects with long-term insomnia and 28,465 individuals without. After adjusting for hypertension, diabetes mellitus, hyperlipidemia, and stroke, those with long-term insomnia had significantly higher risks of dementia (HR, 2.34; 95% CI, 1.92-2.85). Patients with long-term insomnia and aged 50 to 65 years had a higher increased risk of dementia (HR, 5.22; 95% CI, 2.62-10.41) than those older than 65 years (HR, 2.33; 95% CI, 1.90-2.88). The use of hypnotics with a longer half-life and at a higher prescribed dose predicted a greater increased risk of dementia. CONCLUSIONS Patients with long-term use of hypnotics have more than a 2-fold increased risk of dementia, especially those aged 50 to 65 years. In addition, the dosage and half-lives of the hypnotics used should be considered, because greater exposure to these medications leads to a higher risk of developing dementia.
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Affiliation(s)
- Pin-Liang Chen
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Wei-Ju Lee
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Zen Sun
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Jen Oyang
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
- Graduate Institutes of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
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List J, Duning T, Kürten J, Deppe M, Wilbers E, Flöel A. Cortical plasticity is preserved in nondemented older individuals with severe ischemic small vessel disease. Hum Brain Mapp 2012; 34:1464-76. [PMID: 22331645 DOI: 10.1002/hbm.22003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/31/2011] [Accepted: 11/03/2011] [Indexed: 11/06/2022] Open
Abstract
Ischemic small vessel disease (SVD) is a common finding on routine scans in older people, but cognitive sequelae vary considerably. To improve understanding of mechanisms underlying decline or preservation of cognitive function in this condition, we assessed cognition and cortical plasticity in 20 elderly subjects with severe SVD and 20 age-matched controls without SVD, as rated on conventional MRI. Cognitive status was determined with a neuropsychological test battery, cortical plasticity induced with a paired associative stimulation protocol. Microstructural white matter changes were further analyzed for fractional anisotrophy using diffusion tensor imaging. We found that cortical plasticity as well as memory functions were preserved in severe SVD, while executive functions showed trendwise or significant decreases. Within the SVD group, lower white matter integrity in parahippocampal regions and posterior parts of the corpus callosum was associated with larger cortical plasticity, an association not seen for prefrontal white matter tracts. Enhanced cortical plasticity in subjects with lower white matter integrity in memory-relevant areas might thus indicate a compensatory mechanism to counteract memory decline in severe SVD.
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Affiliation(s)
- Jonathan List
- Department of Neurology, University Hospital of Münster, Charitéplatz 1, Münster, Germany
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18
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Ihara M, Okamoto Y, Takahashi R. Suitability of the Montreal cognitive assessment versus the mini-mental state examination in detecting vascular cognitive impairment. J Stroke Cerebrovasc Dis 2012; 22:737-41. [PMID: 22306380 DOI: 10.1016/j.jstrokecerebrovasdis.2012.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 12/26/2011] [Accepted: 01/06/2012] [Indexed: 12/22/2022] Open
Abstract
The Mini-Mental State Examination (MMSE) has been criticized as being an insufficient screening test for patients with vascular cognitive impairment because of its insensitivity to visuospatial and executive functional deficits. The Montreal Cognitive Assessment (MoCA) was designed to be more sensitive to such deficits, and thus may be a superior screening instrument for vascular cognitive impairment. Twelve patients with extensive leukoaraiosis detected on magnetic resonance imaging (average age, 76.0 ± 8.7 years) underwent neurologic and cognitive testing, including MMSE and the Japanese version of the MoCA (MoCA-J). Accepted cutoff scores of <27 for the MMSE and <26 for the MoCA-J were taken to indicate cognitive impairment. Z-scores were calculated to evaluate the discriminating ability of individual MMSE and MoCA-J subtest scores. Although there was a strong correlation between the total MMSE and total MoCA-J scores (r = 0.90; P < .0001), MMSE scores were skewed toward the higher end of the range (range, 18-30; median, 28), whereas MoCA-J scores were normally distributed (range, 9-28; median, 21). Of the 7 patients with an unimpaired MMSE score, 6 (86%) had an impaired MoCA-J score. Z-scores were >5 for 4 MMSE subtests (orientation, registration, naming, and language) but for only 1 MoCA-J subtest (naming). The MoCA-J better discriminated cognitive status in subjects with extensive leukoaraiosis. Our findings suggest that the MoCA-J is more sensitive than the MMSE in screening for cognitive impairment in patients with subcortical vascular cognitive impairment.
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Affiliation(s)
- Masafumi Ihara
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Ihara M, Tomimoto H. Lessons from a mouse model characterizing features of vascular cognitive impairment with white matter changes. J Aging Res 2011; 2011:978761. [PMID: 22132331 PMCID: PMC3216359 DOI: 10.4061/2011/978761] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 07/26/2011] [Indexed: 01/13/2023] Open
Abstract
With the demographic shift in age in advanced countries inexorably set to progress in the 21st century, dementia will become one of the most important health problems worldwide. Vascular cognitive impairment is the second most common type of dementia after Alzheimer's disease and is frequently responsible for the cognitive decline of the elderly. It is characterized by cerebrovascular white matter changes; thus, in order to investigate the underlying mechanisms involved in white matter changes, a mouse model of chronic cerebral hypoperfusion has been developed, which involves the narrowing of the bilateral common carotid arteries with newly designed microcoils. The purpose of this paper is to provide a comprehensive summary of the achievements made with the model that shows good reproducibility of the white matter changes characterized by blood-brain barrier disruption, glial activation, oxidative stress, and oligodendrocyte loss following chronic cerebral hypoperfusion. Detailed characterization of this model may help to decipher the substrates associated with impaired memory and move toward a more integrated therapy of vascular cognitive impairment.
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Affiliation(s)
- Masafumi Ihara
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507, Japan
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20
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Tomimoto H. [Subcortical vascular dementia: significance in the differential diagnosis of dementia]. Rinsho Shinkeigaku 2011; 51:940-942. [PMID: 22277428 DOI: 10.5692/clinicalneurol.51.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Subcortical vascular dementia (SVD) is a subtype of vascular dementia which constitutes approximately half of vascular dementia in Japan. It is featured by hypertensive small vessel disease such as white matter lesions and lacunar infarctions. The clinical and pathological features of SVD are relatively uniform. White matter lesions may remain asymptomatic but may develop subcortical dementia and Parkinsonism, if neural network function is impaired severe enough. SVD and CAA are considered to be a subcortical and cortical counterpart of small vessel disease, respectively, and the latter is closely associated with Alzheimer's disease. Therapeutic strategy for SVD is classified to the remedies for vascular risk factors and anti-dementia treatment. Anti-choline esterase inhibitors and memantine may be beneficial for SVD patients, but are not approved as therapeutic agents for vascular dementia.
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21
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Subcortical vascular dementia. Neurosci Res 2011; 71:193-9. [DOI: 10.1016/j.neures.2011.07.1820] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 06/27/2011] [Accepted: 06/29/2011] [Indexed: 02/06/2023]
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22
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Tomimoto H. [Diagnosis and treatment of subcortical vascular dementia]. Rinsho Shinkeigaku 2010; 50:539-546. [PMID: 20803962 DOI: 10.5692/clinicalneurol.50.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Subcortical vascular dementia (SVD) exhibits relatively uniform clinical and pathological features among various subtypes of vascular dementia, and constitutes approximately half of vascular dementia in Japan. This subtype is further classified into Binswanger's type infarction and multiple lacunar infarctions. The former is characterized by diffuse white matter lesions, and the latter by lacunar infarctions. However, the both have common pathologic mechanism related to hypertensive small vessel changes. This paper overview the notion, clinical features, pathogenesis and treatment for SVD, and also refer to the recent topics related to Alzheimer's disease.
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Nishio K, Ihara M, Yamasaki N, Kalaria RN, Maki T, Fujita Y, Ito H, Oishi N, Fukuyama H, Miyakawa T, Takahashi R, Tomimoto H. A mouse model characterizing features of vascular dementia with hippocampal atrophy. Stroke 2010; 41:1278-84. [PMID: 20448204 DOI: 10.1161/strokeaha.110.581686] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE We have previously described effects of chronic cerebral hypoperfusion in mice with bilateral common carotid artery stenosis (BCAS) using microcoils for 30 days. These mice specifically exhibit working memory deficits attributable to frontal-subcortical circuit damage without apparent gray matter changes, indicating similarities with subcortical ischemic vascular dementia. However, as subcortical ischemic vascular dementia progresses over time, the longer-term effects that characterize the mouse model are not known. METHODS Comprehensive behavioral test batteries and histological examinations were performed in mice subjected to BCAS for up to 8 months. Laser speckle flowmetry and (18)F-fluorodeoxyglucose positron emission tomography were performed to assess cerebral blood flow and metabolism at several time points. RESULTS At 2 hours after BCAS, cerebral blood flow in the cerebral cortex temporarily decreased to as much as 60% to 70% of the control value but gradually recovered to >80% at 1 to 3 months. At 5 to 6 months after BCAS, reference and working memory were impaired as demonstrated by the Barnes and radial arm maze tests, respectively. Furthermore, (18)F-fluorodeoxyglucose positron emission tomography demonstrated that hippocampal glucose utilization was impaired at 6 months after BCAS. Consistent with these behavioral and metabolic abnormalities, histological analyses demonstrated hippocampal atrophy with pyknotic and apoptotic cells at 8 months after BCAS. CONCLUSIONS These results suggest that the longer-term BCAS model replicates advanced stages of subcortical ischemic vascular dementia when hippocampal neuronal loss becomes significant.
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Affiliation(s)
- Keiko Nishio
- Department of Neurology, Faculty of Medicine, Kyoto University, Sakyo-Ku, Kyoto 606-8507 Japan.
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Hampstead BM, Libon DJ, Moelter ST, Swirsky-Sacchetti T, Scheffer L, Platek SM, Chute D. Temporal order memory differences in Alzheimer's disease and vascular dementia. J Clin Exp Neuropsychol 2010; 32:645-54. [PMID: 20087810 DOI: 10.1080/13803390903418918] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Determining the order of events is essential for accurate memory recollection: an ability previously linked to both frontal and medial temporal functioning. Frontal-subcortical and medial temporal dysfunction typify vascular dementia (VaD) and Alzheimer's disease (AD), respectively. Therefore, we assessed patients' ordering abilities using a novel sequencing task that progressively increased memory load. VaD patients made more errors and selected more previously encountered stimuli than did AD. Curve analysis revealed a general decline in ordering for VaD whereas error production in AD is more dependent on memory load. These findings generally support the role of frontal-subcortical functioning in temporal order memory.
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Affiliation(s)
- Benjamin M Hampstead
- VA RR&D Center of Excellence, Atlanta VA Medical Center, Decatur, GA 30033, USA.
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25
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Abstract
Investigation of the interplay between the cerebral circulation and brain cellular function is fundamental to understanding both the pathophysiology and treatment of stroke. Currently, PET is the only technique that provides accurate, quantitative in vivo regional measurements of both cerebral circulation and cellular metabolism in human subjects. We review normal human cerebral blood flow and metabolism and human PET studies of ischemic stroke, carotid artery disease, vascular dementia, intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage and discuss how these studies have added to our understanding of the pathophysiology of human cerebrovascular disease.
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Affiliation(s)
- William J. Powers
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Allyson R. Zazulia
- Departments of Neurology and Radiology, Washington University School of Medicine, St. Louis, MO
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26
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The association between dementia and long-term use of benzodiazepine in the elderly: nested case-control study using claims data. Am J Geriatr Psychiatry 2009; 17:614-20. [PMID: 19546656 DOI: 10.1097/jgp.0b013e3181a65210] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to examine the association between long-term benzodiazepines (BZDs) use and the risk of dementia. DESIGN Population-based nested case-control study of dementia. SETTING All subjects were aged 45 and older and enrolled in the National Health Insurance Research Database in Taiwan, 1997-2004. PARTICIPANTS Cases (N = 779) were patients who were identified with dementia at least two times in their outpatient claims. They were individually matched to six comparison subjects (N = 4,626) based on age and gender. MEASUREMENTS BZD usage (average dosage per year, average days per year, and cumulative dose and periods) and potential confounding comobidities, including cardiovascular and psychiatric diseases. RESULTS Subjects with dementia had higher cumulative dose, longer duration of BZDs exposure, and more likelihood to be long-term BZDs users. CONCLUSION Our findings suggest that long-term use of BZDs is associated with an increased risk for dementia, but the underlying mechanisms remain unclear, and further investigations are needed. Long-term use of BZDs should be avoided among the elderly, who may be at a higher risk for developing dementia, in addition to other health problems.
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Tomimoto H, Ihara M, Takahashi R, Fukuyama H. [Functional imaging in Binswanger's disease]. Rinsho Shinkeigaku 2009; 48:947-50. [PMID: 19198127 DOI: 10.5692/clinicalneurol.48.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
White matter lesions are frequently observed in the elderly, and have been postulated to be responsible for dementia and parkinsonism. At first, we revealed that cholinergic pathways are damaged in the external capsule due to white matter lesions in Binswanger's disease. In addition, a flumazenil (FMZ)-PET study, a marker of benzodiazepine/GABAA receptors, revealed that FMZ-binding was decreased in the prefrontal cortex and the insular cortex in demented patients with extensive white matter lesions. In contrast, FMZ-binding was decreased in the premotor cortex and the striatum in the patients with extensive white matter lesions and parkinsonism, as compared to those with white matter lesions but without parkinsonism. These results indicate that subcortical nerve fiber damages may impair neural networks and hence, the neural function in the corresponding gray matter.
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Affiliation(s)
- Hidekazu Tomimoto
- Department of Neurology, Kyoto University, Graduate School of Medicine
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28
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Kinetic modelling of [11C]flumazenil using data-driven methods. Eur J Nucl Med Mol Imaging 2008; 36:659-70. [DOI: 10.1007/s00259-008-0990-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 10/09/2008] [Indexed: 10/21/2022]
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Di Lazzaro V, Pilato F, Dileone M, Profice P, Marra C, Ranieri F, Quaranta D, Gainotti G, Tonali P. In vivo functional evaluation of central cholinergic circuits in vascular dementia. Clin Neurophysiol 2008; 119:2494-500. [DOI: 10.1016/j.clinph.2008.08.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 08/05/2008] [Accepted: 08/21/2008] [Indexed: 11/16/2022]
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30
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Salmi E, Aalto S, Hirvonen J, Långsjö JW, Maksimow AT, Oikonen V, Metsähonkala L, Virkkala J, Någren K, Scheinin H. Measurement of GABAA receptor binding in vivo with [11C]Flumazenil: A test–retest study in healthy subjects. Neuroimage 2008; 41:260-9. [DOI: 10.1016/j.neuroimage.2008.02.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 02/24/2008] [Accepted: 02/26/2008] [Indexed: 11/25/2022] Open
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Pappatà S, Salvatore E, Postiglione A. In Vivo Imaging of Neurotransmission and Brain Receptors in Dementia. J Neuroimaging 2008; 18:111-24. [DOI: 10.1111/j.1552-6569.2007.00194.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Henry-Feugeas MC. Alzheimer’s disease in late-life dementia: A minor toxic consequence of devastating cerebrovascular dysfunction. Med Hypotheses 2008; 70:866-75. [PMID: 17825499 DOI: 10.1016/j.mehy.2007.07.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 07/16/2007] [Indexed: 11/24/2022]
Abstract
Alzheimer's disease (AD) is thought to be the most common cause of late-life dementia. But pure AD is infrequent whereas AD pathology is often insufficient to explain dementia in the elderly. Conversely, cerebrovascular disease is omnipresent and the crucial role of microvascular alterations increasingly recognized in late dementia or "Alzheimer syndrome". Pathomechanisms of vascular cognitive impairment are still debated but recent data indicate that the initial concept of chronic low grade cerebral hypoxia should not have been abandoned. Thus, it is proposed that windkessel dysfunction is the missing link between vascular and craniospinal senescence on the one hand, and chronic low grade cerebral hypoxia, "senile brain degeneration" and "Alzheimer syndrome" on the other hand. An age-related decrease in the buffering capacity of both the vessels and the craniospinal cavity favours cerebral hypoxia; due to increased capillary pulsatility with disturbances in capillary exchanges or due to a marked reduction in craniospinal compliance with a mechanical reduction in cerebral arterial inflow. "Invisible" windkessel dysfunction, most often related to "hardening of the arteries" may be the most frequent pathomechanism of late-onset dementia whereas associated mild or moderate AD may be merely a toxic manifestation of a primarily hypoxic disease. Structural patterns of arteriosclerotic dementia fit well with an underlying arterial windkessel dysfunction: with secondary mechanical damage to the cerebral small vessels and the brain and predominantly deep hypoxia. The clinical significance of leukoaraïosis, small foci of necrosis, ventricular dilatation, hippocampal and cortical atrophy is in good agreement with their value as indirect markers of windkessel dysfunction. An age-related "invisible" reduction in craniospinal compliance may also contribute to the associations between heart failure, arterial hypotension and cognitive impairment in the elderly and to the high percentage of dementia of unknown origin in the very old. Both neuropathological and clinical overlap between AD and windkessel dysfunction can explain that cerebrovascular dysfunction remains misdiagnosed for AD in the elderly. Evidence of the key role of cerebrovascular dysfunction should markedly facilitate and widen therapeutic research in late-life dementia. Routine MRI including direct assessment of intracranial dynamics should be increasingly used to define etiological subtypes of the "Alzheimer syndrome" and develop a well-targeted therapeutic strategy.
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Affiliation(s)
- M C Henry-Feugeas
- Department of Radiology, Bichat-Claude Bernard University Hospital, AP-HP, Paris Cedex 18, France.
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Hoepping A, Scheunemann M, Fischer S, Deuther-Conrad W, Hiller A, Wegner F, Diekers M, Steinbach J, Brust P. Radiosynthesis and biological evaluation of an 18F-labeled derivative of the novel pyrazolopyrimidine sedative-hypnotic agent indiplon. Nucl Med Biol 2007; 34:559-70. [PMID: 17591556 DOI: 10.1016/j.nucmedbio.2007.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 03/19/2007] [Accepted: 03/27/2007] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Gamma amino butyric acid type A (GABA(A)) receptors are involved in a variety of neurological and psychiatric diseases, which have promoted the development and use of radiotracers for positron emission tomography imaging. Radiolabeled benzodiazepine antagonists such as flumazenil have most extensively been used for this purpose so far. Recently, the non-benzodiazepine pyrazolopyrimidine derivative indiplon with higher specificity for the alpha(1) subtype of the GABA(A) receptor has been introduced for treatment of insomnia. The aim of this study was the development and biological evaluation of an (18)F-labeled derivative of indiplon. METHODS Both [(18)F]fluoro-indiplon and its labeling precursor were synthesized by two-step procedures starting from indiplon. The radiosynthesis of [(18)F]fluoro-indiplon was performed using the bromoacetyl precursor followed by multiple-stage purification using semipreparative HPLC and solid phase extraction. Stability, partition coefficients, binding affinities and regional brain binding were determined in vitro. Biodistribution and radiotracer metabolism were studied in vivo. RESULTS [(18)F]Fluoro-indiplon was readily accessible in good yields (38-43%), with high purity and high specific radioactivity (>150 GBq/micromol). It displays high in vitro stability and moderate lipophilicity. [(18)F]Fluoro-indiplon has an affinity to GABA(A) receptors comparable to indiplon (K(i)=8.0 nM vs. 3.4 nM). In vitro autoradiography indicates high [(18)F]fluoro-indiplon binding in regions with high densities of GABA(A) receptors. However, ex vivo autoradiography and organ distribution studies show no evidence of specific binding of [(18)F]fluoro-indiplon. Furthermore, the radiotracer is rapidly metabolized with high accumulation of labeled metabolites in the brain. CONCLUSIONS Although [(18)F]fluoro-indiplon shows good in vitro features, it is not suitable for in vivo imaging studies because of its metabolism. Structural modifications are needed to develop derivatives with higher in vivo stability.
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Kitaguchi H, Ihara M, Saiki H, Takahashi R, Tomimoto H. Capillary beds are decreased in Alzheimer's disease, but not in Binswanger's disease. Neurosci Lett 2007; 417:128-31. [PMID: 17403574 DOI: 10.1016/j.neulet.2007.02.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 01/23/2007] [Accepted: 02/06/2007] [Indexed: 10/23/2022]
Abstract
Morphological abnormalities of the cortical microvessels have been reported in Alzheimer's disease (AD), but not in Binswanger's disease (BD), a form of vascular dementia. Therefore, we compared the capillary beds in AD and BD brains, using a modified Gallyas silver impregnation method and immunohistochemistry for beta amyloid. Eight autopsied brains with AD and seven with BD were compared with six control brains. The cortical microvessels in AD were frequently narrowed, and torn off, especially in close proximity to the senile plaques. The capillary densities in AD were significantly decreased as compared with the control brains. In contrast, there were no significant changes in the capillary densities and their morphologies in BD brains. Immunohistochemistry for beta amyloid revealed numerous deposits in the vascular wall and perivascular neuropil exclusively in AD brains. Cortical microvascular changes in AD and their absence in BD may indicate a role of beta amyloid for the microvessel pathology in AD.
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Affiliation(s)
- Hiroshi Kitaguchi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan
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Ihara M, Tomimoto H, Ishizu K, Yoshida H, Sawamoto N, Hashikawa K, Fukuyama H. Association of vascular parkinsonism with impaired neuronal integrity in the striatum. J Neural Transm (Vienna) 2007; 114:577-84. [PMID: 17225931 DOI: 10.1007/s00702-006-0610-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022]
Abstract
The purpose of this study is to identify the underlying differences between patients with white matter lesions (WMLs) who manifested gait disturbance suggestive of vascular parkinsonism (VaP) and those who did not, using the PET scan. Fourteen patients with extensive WMLs, as determined by MRI, were divided into two groups - 7 with gait disturbance and 7 without it. Neuronal integrity was evaluated with a PET scan using [(11)C]flumazenil (FMZ) by calculating the distribution volume of FMZ (FMZ-V(d)) in various regions of interest by non-linear curve fitting. Additionally, tracer kinetic analysis was applied for voxel-by-voxel quantification of FMZ-V(d) and data analysis was performed using statistical parametric mapping. The striatal FMZ-V(d) values were inversely correlated with the motor UPDRS scores (r = 0.70, p < 0.005), and their reductions were associated with the presence of gait disturbance. Therefore, differences in neuronal integrity in the striatum may determine whether patients with WMLs develop VaP or not.
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Affiliation(s)
- M Ihara
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Yamauchi H, Kudoh T, Kishibe Y, Iwasaki J, Kagawa S. Selective neuronal damage and chronic hemodynamic cerebral ischemia. Ann Neurol 2007; 61:454-65. [PMID: 17380523 DOI: 10.1002/ana.21104] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In atherothrombotic internal carotid artery or middle cerebral artery (MCA) occlusive disease, chronic hemodynamic compromise may increase the risk for cerebral ischemic damage. To determine whether selective neuronal damage demonstrated as a decrease in central benzodiazepine receptor (BZR) in the normal-appearing cerebral cortex is associated with increased oxygen extraction fraction (OEF) (misery perfusion). METHODS We measured BZR and OEF using positron emission tomography in 105 nondisabled patients with atherothrombotic internal carotid artery or MCA occlusive disease and no cortical infarction. By using three-dimensional stereotactic surface projections and the stereotactic extraction estimation method, without correction for partial volume effects, the abnormally decreased BZR index [(the extent of the pixels with Z-score more than 2 compared with controls) x (average Z-score in those pixels)] in the cerebral cortex of the MCA distribution with arterial disease was calculated, and it was found to be correlated with the mean hemispheric value of OEF and several clinical variables. RESULTS All patients had pixels with abnormally decreased BZR, with the extent varying from 0.04 to 60.91%. Multivariate analysis showed that the abnormally decreased BZR index was positively correlated with the value of OEF and the history of stroke, whereas it was negatively correlated with the presence of hypercholesterolemia with statin treatment. Follow-up examinations of 17 patients without ischemic episode showed that a decrease of BZR was associated with an increase of OEF. INTERPRETATION In atherothrombotic internal carotid artery or MCA occlusive disease, misery perfusion may cause selective neuronal damage, and statins might have beneficial effects against neuronal damage.
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Guadagno JV, Warburton EA, Jones PS, Fryer TD, Day DJ, Gillard JH, Carpenter TA, Aigbirhio FI, Price CJ, Baron JC. The diffusion-weighted lesion in acute stroke: heterogeneous patterns of flow/metabolism uncoupling as assessed by quantitative positron emission tomography. Cerebrovasc Dis 2005; 19:239-46. [PMID: 15741718 DOI: 10.1159/000084087] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 11/02/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To investigate what the hyperintense lesion in diffusion-weighted imaging (DWI) of acute ischaemic stroke represents metabolically, we prospectively imaged acute carotid-territory stroke patients with DWI along with fully quantitative positron emission tomography (PET), which gives physiological maps of cerebral blood flow (CBF), the cerebral metabolic rate of oxygen (CMRO2) and the oxygen extraction fraction (OEF). METHOD Of 10 patients who consented, 5 (3 males, 2 females, 53-84 years, NIHSS 6-16) completed the imaging protocol of back-to-back DWI and PET within 21 (mean 15.7, range 7-21) h of stroke onset. All images were co-registered with the DWI lesion forming a region of interest (ROI) that was transferred to the PET parametric maps (OEF, CBF, CMRO2). Patterns of blood flow and metabolism were assessed within the DWI ROI. RESULTS Within the DWI lesions, the following patterns were observed: very low CBF and CMRO2/variable OEF; low CBF/high OEF, and high CBF/low OEF. There was a heterogeneity of patterns between and within DWI lesions. In addition, areas of hyperperfusion (with low OEF) and areas of hypoperfusion (with high OEF) were seen outside the DWI lesions. CONCLUSION The DWI lesion does not have a single flow/metabolism counterpart, suggesting that it reflects various stages of the ischaemic process.
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Affiliation(s)
- Joseph V Guadagno
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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