1
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Gardiner SL, Trompet S, Sabayan B, Boogaard MW, Jukema JW, Slagboom PE, Roos RAC, van der Grond J, Aziz NA. Repeat variations in polyglutamine disease-associated genes and cognitive function in old age. Neurobiol Aging 2019; 84:236.e17-236.e28. [PMID: 31522753 DOI: 10.1016/j.neurobiolaging.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/03/2019] [Accepted: 08/04/2019] [Indexed: 02/03/2023]
Abstract
Although the heritability of cognitive function in old age is substantial, genome-wide association studies have had limited success in elucidating its genetic basis, leaving a considerable amount of "missing heritability." Aside from single nucleotide polymorphisms, genome-wide association studies are unable to assess other large sources of genetic variation, such as tandem repeat polymorphisms. Therefore, here, we studied the association of cytosine-adenine-guanine (CAG) repeat variations in polyglutamine disease-associated genes (PDAGs) with cognitive function in older adults. In a large cohort consisting of 5786 participants, we found that the CAG repeat number in 3 PDAGs (TBP, HTT, and AR) were significantly associated with the decline in cognitive function, which together accounted for 0.49% of the variation. Furthermore, in an magnetic resonance imaging substudy, we found that CAG repeat polymorphisms in 4 PDAGs (ATXN2, CACNA1A, ATXN7, and AR) were associated with different imaging characteristics, including brain stem, putamen, globus pallidus, thalamus, and amygdala volumes. Our findings indicate that tandem repeat polymorphisms are associated with cognitive function in older adults and highlight the importance of PDAGs in elucidating its missing heritability.
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Affiliation(s)
- Sarah L Gardiner
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Behnam Sabayan
- The Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Merel W Boogaard
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - P Eline Slagboom
- Department of Molecular Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - N Ahmad Aziz
- Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Neurology, University of Bonn, Bonn, Germany
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2
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Repeat length variations in ATXN1 and AR modify disease expression in Alzheimer's disease. Neurobiol Aging 2019; 73:230.e9-230.e17. [DOI: 10.1016/j.neurobiolaging.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/07/2018] [Accepted: 09/07/2018] [Indexed: 02/06/2023]
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3
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Smit RA, Trompet S, Sabayan B, le Cessie S, van der Grond J, van Buchem MA, de Craen AJ, Jukema JW. Higher Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is Associated With Lower Cognitive Performance, Lower Cerebral Blood Flow, and Greater White Matter Hyperintensity Load in Older Subjects. Circulation 2016; 134:212-21. [DOI: 10.1161/circulationaha.115.020627] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 05/27/2016] [Indexed: 11/16/2022]
Abstract
Background:
Recently, it was shown that intraindividual variation in low-density lipoprotein cholesterol (LDL-C) predicts both cerebrovascular and cardiovascular events. We aimed to examine whether this extends to cognitive function and examined possible pathways using a magnetic resonance imaging substudy.
Methods:
We investigated the association between LDL-C variability and 4 cognitive domains at month 30 in 4428 participants of PROSPER (PROspective Study of Pravastatin in the Elderly at Risk). Additionally, we assessed the association of LDL-C variability with neuroimaging outcomes in a subset of 535 participants. LDL-C variability was defined as the intraindividual standard deviation over 4 postbaseline LDL-C measurements, and all analyses were adjusted for mean LDL-C levels and cardiovascular risk factors.
Results:
Higher LDL-C variability was associated with lower cognitive function in both the placebo and pravastatin treatment arms. Associations were present for selective attention (
P
=0.017 and
P
=0.11, respectively), processing speed (
P
=0.20 and
P
=0.029), and memory (immediate recall,
P
=0.002 and
P
=0.006; delayed recall,
P
=0.001 and
P
≤0.001). Furthermore, higher LDL-C variability was associated with lower cerebral blood flow in both trial arms (
P
=0.031 and
P
=0.050) and with greater white matter hyperintensity load in the pravastatin arm (
P
=0.046). No evidence was found for interaction between LDL-C variability and pravastatin treatment for both cognitive and magnetic resonance imaging outcomes.
Conclusions:
We found that higher visit-to-visit variability in LDL-C, independently of mean LDL-C levels and statin treatment, is associated with lower cognitive performance, lower cerebral blood flow, and greater white matter hyperintensity load.
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Affiliation(s)
- Roelof A.J. Smit
- From Department of Cardiology (R.A.J.S., S.T., J.W.J.), Section of Gerontology and Geriatrics, Department of Internal Medicine (R.A.J.S., S.T., B.S., A.J.M.d.C.), Department of Radiology (B.S., J.v.d.G., M.A.v.B.), Department of Clinical Epidemiology (S.l.C.), Department of Medical Statistics and Bioinformatics (S.l.C.), and Einthoven Laboratory for Experimental Vascular Medicine (J.W.J.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute Netherlands
| | - Stella Trompet
- From Department of Cardiology (R.A.J.S., S.T., J.W.J.), Section of Gerontology and Geriatrics, Department of Internal Medicine (R.A.J.S., S.T., B.S., A.J.M.d.C.), Department of Radiology (B.S., J.v.d.G., M.A.v.B.), Department of Clinical Epidemiology (S.l.C.), Department of Medical Statistics and Bioinformatics (S.l.C.), and Einthoven Laboratory for Experimental Vascular Medicine (J.W.J.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute Netherlands
| | - Behnam Sabayan
- From Department of Cardiology (R.A.J.S., S.T., J.W.J.), Section of Gerontology and Geriatrics, Department of Internal Medicine (R.A.J.S., S.T., B.S., A.J.M.d.C.), Department of Radiology (B.S., J.v.d.G., M.A.v.B.), Department of Clinical Epidemiology (S.l.C.), Department of Medical Statistics and Bioinformatics (S.l.C.), and Einthoven Laboratory for Experimental Vascular Medicine (J.W.J.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute Netherlands
| | - Saskia le Cessie
- From Department of Cardiology (R.A.J.S., S.T., J.W.J.), Section of Gerontology and Geriatrics, Department of Internal Medicine (R.A.J.S., S.T., B.S., A.J.M.d.C.), Department of Radiology (B.S., J.v.d.G., M.A.v.B.), Department of Clinical Epidemiology (S.l.C.), Department of Medical Statistics and Bioinformatics (S.l.C.), and Einthoven Laboratory for Experimental Vascular Medicine (J.W.J.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute Netherlands
| | - Jeroen van der Grond
- From Department of Cardiology (R.A.J.S., S.T., J.W.J.), Section of Gerontology and Geriatrics, Department of Internal Medicine (R.A.J.S., S.T., B.S., A.J.M.d.C.), Department of Radiology (B.S., J.v.d.G., M.A.v.B.), Department of Clinical Epidemiology (S.l.C.), Department of Medical Statistics and Bioinformatics (S.l.C.), and Einthoven Laboratory for Experimental Vascular Medicine (J.W.J.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute Netherlands
| | - Mark A. van Buchem
- From Department of Cardiology (R.A.J.S., S.T., J.W.J.), Section of Gerontology and Geriatrics, Department of Internal Medicine (R.A.J.S., S.T., B.S., A.J.M.d.C.), Department of Radiology (B.S., J.v.d.G., M.A.v.B.), Department of Clinical Epidemiology (S.l.C.), Department of Medical Statistics and Bioinformatics (S.l.C.), and Einthoven Laboratory for Experimental Vascular Medicine (J.W.J.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute Netherlands
| | - Anton J.M. de Craen
- From Department of Cardiology (R.A.J.S., S.T., J.W.J.), Section of Gerontology and Geriatrics, Department of Internal Medicine (R.A.J.S., S.T., B.S., A.J.M.d.C.), Department of Radiology (B.S., J.v.d.G., M.A.v.B.), Department of Clinical Epidemiology (S.l.C.), Department of Medical Statistics and Bioinformatics (S.l.C.), and Einthoven Laboratory for Experimental Vascular Medicine (J.W.J.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute Netherlands
| | - J. Wouter Jukema
- From Department of Cardiology (R.A.J.S., S.T., J.W.J.), Section of Gerontology and Geriatrics, Department of Internal Medicine (R.A.J.S., S.T., B.S., A.J.M.d.C.), Department of Radiology (B.S., J.v.d.G., M.A.v.B.), Department of Clinical Epidemiology (S.l.C.), Department of Medical Statistics and Bioinformatics (S.l.C.), and Einthoven Laboratory for Experimental Vascular Medicine (J.W.J.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute Netherlands
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4
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Sala M, de Roos A, Blauw GJ, Middelkoop HAM, Jukema JW, Mooijaart SP, van Buchem MA, de Craen AJM, van der Grond J. Association between changes in brain microstructure and cognition in older subjects at increased risk for vascular disease. BMC Neurol 2015; 15:133. [PMID: 26249665 PMCID: PMC4545822 DOI: 10.1186/s12883-015-0396-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 07/28/2015] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study is to investigate whether changes in brain microstructure, detected by magnetization transfer imaging, are associated with cognition in older subjects at increased risk for vascular disease. Methods One hundred ninety three nondemented subjects (105 men, mean age 77 ± 3 years) from the Prospective Study of Pravastatin in the Elderly at Risk were included. To assess cross-sectional associations between magnetization transfer ratio (MTR) peak height and cognitive test scores, general linear model multivariate analysis was performed. Models were adjusted for age, sex, education level, vascular risk factors, individual white matter lesion volume, and brain atrophy. A repeated measures general linear model was used to investigate whether MTR peak height relates to cognitive test performance at baseline and 3.3-year follow-up. Results Cross-sectionally, MTR peak height was associated with performance on the STROOP test (unstandardized β = −0.27, p = 0.045), delayed Picture Word Learning (PWL) test (β = 0.48, p = 0.007), and the Letter Digit Coding test (β = 1.1, p = 0.006). Repeated measures general linear model analysis showed that individuals with low MTR peak height at baseline performed worse on the STROOP test compared to subjects with intermediate MTR peak height (mean time to complete the test at baseline and follow-up, lower versus middle tertile of MTR peak height: 61.6 versus 52.7 s, p = 0.019) or compared to subjects with high MTR peak height (p = 0.046). Similarly, low MTR peak height was associated with worse performance on the immediate (lower versus middle tertile, p = 0.023; lower versus higher tertile, p = 0.032) and delayed PWL test (lower versus middle, p = 0.004; lower versus higher, p = 0.012) at baseline and follow-up testing. Conclusions MTR peak height is associated with cognitive function in older subjects at increased risk for vascular disease. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0396-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michiel Sala
- Department of Radiology, C3-Q, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
| | - Albert de Roos
- Department of Radiology, C3-Q, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
| | | | | | - J Wouter Jukema
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Simon P Mooijaart
- Gerontology and Geriatrics, Leiden, The Netherlands. .,Consortium for Healthy Ageing, Leiden, The Netherlands.
| | - Mark A van Buchem
- Department of Radiology, C3-Q, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands. .,Consortium for Healthy Ageing, Leiden, The Netherlands.
| | - Anton J M de Craen
- Gerontology and Geriatrics, Leiden, The Netherlands. .,Consortium for Healthy Ageing, Leiden, The Netherlands.
| | - Jeroen van der Grond
- Department of Radiology, C3-Q, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands. .,Consortium for Healthy Ageing, Leiden, The Netherlands.
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5
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Willette AA, Kapogiannis D. Does the brain shrink as the waist expands? Ageing Res Rev 2015; 20:86-97. [PMID: 24768742 DOI: 10.1016/j.arr.2014.03.007] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 12/20/2022]
Abstract
Recent studies suggest that being overweight or obese is related to worse cognitive performance, particularly executive function. Obesity may also increase the risk of Alzheimer's disease. Consequently, there has been increasing interest in whether adiposity is related to gray or white matter (GM, WM) atrophy. In this review, we identified and critically evaluated studies assessing obesity and GM or WM volumes either globally or in specific regions of interest (ROIs). Across all ages, higher adiposity was consistently associated with frontal GM atrophy, particularly in prefrontal cortex. In children and adults <40 years of age, most studies found no relationship between adiposity and occipital or parietal GM volumes, whereas findings for temporal lobe were mixed. In middle-aged and aged adults, a majority of studies found that higher adiposity is associated with parietal and temporal GM atrophy, whereas results for precuneus, posterior cingulate, and hippocampus were mixed. Higher adiposity had no clear association with global or regional WM in any age group. We conclude that higher adiposity may be associated with frontal GM atrophy across all ages and parietal and temporal GM atrophy in middle and old age.
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Affiliation(s)
- Auriel A Willette
- Laboratory of Neurosciences, National Institute on Aging, 3001 S. Hanover St, NM531, Baltimore, MD 21225, USA
| | - Dimitrios Kapogiannis
- Laboratory of Neurosciences, National Institute on Aging, 3001 S. Hanover St, NM531, Baltimore, MD 21225, USA.
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6
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Henriksen OM, Jensen LT, Krabbe K, Guldberg P, Teerlink T, Rostrup E. Resting brain perfusion and selected vascular risk factors in healthy elderly subjects. PLoS One 2014; 9:e97363. [PMID: 24840730 PMCID: PMC4026139 DOI: 10.1371/journal.pone.0097363] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/18/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Both cerebral hypoperfusion and vascular risk factors have been implicated in early aging of the brain and the development of neurodegenerative disease. However, the current knowledge of the importance of cardiovascular health on resting brain perfusion is limited. The aim of the present study was to elucidate the relation between brain perfusion variability and risk factors of endothelial dysfunction and atherosclerosis in healthy aged subjects. Methods Thirty-eight healthy subjects aged 50–75 years old were included. Mean global brain perfusion was measured using magnetic resonance phase contrast mapping and regional brain perfusion by use of arterial spin labeling. Results Mean global brain perfusion was inversely correlated with caffeine and hematocrit, and positively with end-tidal PCO2. Furthermore, the mean global brain perfusion was inversely correlated with circulating homocysteine, but not with asymmetric dimethylarginine, dyslipidemia or the carotid intima-media thickness. The relative regional brain perfusion was associated with circulating homocysteine, with a relative parietal hypoperfusion and a frontal hyperperfusion. No effect on regional brain perfusion was observed for any of the other risk factors. A multiple regression model including homocysteine, caffeine, hematocrit and end-tidal PCO2, explained nearly half of the observed variability. Conclusion Both intrinsic and extrinsic factors influenced global cerebral perfusion variation between subjects. Further, the results suggest that the inverse relation between homocysteine and brain perfusion is owing to other mechanisms, than reflected by asymmetric dimethylarginine, and that homocysteine may be a marker of cerebral perfusion in aging brains.
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Affiliation(s)
- Otto M. Henriksen
- Functional Imaging Unit, Section of Clinical Physiology and Nuclear Medicine, Department of Diagnostics, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Lars T. Jensen
- Department Clinical Physiology and Nuclear Medicine, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Katja Krabbe
- Section of Radiology, Department of Diagnostics, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark
| | - Per Guldberg
- Institute of Cancer Biology, Danish Cancer Society, Copenhagen, Denmark
| | - Tom Teerlink
- Metabolic Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, the Netherlands
| | - Egill Rostrup
- Functional Imaging Unit, Section of Clinical Physiology and Nuclear Medicine, Department of Diagnostics, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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7
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Sabayan B, van der Grond J, Westendorp RG, Jukema JW, Ford I, Buckley BM, Sattar N, van Osch MJP, van Buchem MA, de Craen AJM. Total cerebral blood flow and mortality in old age: a 12-year follow-up study. Neurology 2013; 81:1922-9. [PMID: 24174588 DOI: 10.1212/01.wnl.0000436618.48402.da] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To examine the association of total cerebral blood flow (CBF) with all-cause, noncardiovascular, and cardiovascular mortality in older subjects at risk of cardiovascular disease. METHODS We included 411 subjects with a mean age of 74.5 years from the MRI substudy of the Prospective Study of Pravastatin in the Elderly at Risk. Total CBF was measured at baseline, and occurrence of death was recorded in an average follow-up period of 11.8 years. For each participant, total CBF was standardized for brain parenchymal volume. Cox regression models were used to estimate risk of all-cause, noncardiovascular, and cardiovascular mortality in relation to CBF. RESULTS Mortality rates among participants in low, middle, and high thirds of total CBF were 52.1, 41.5, and 28.7 per 1,000 person-years, respectively. Compared with participants in the high third of CBF, participants in the low third had 1.88-fold (95% confidence interval [CI]: 1.30-2.72) higher risk of all-cause mortality, 1.66-fold (95% CI: 1.06-2.59) higher risk of noncardiovascular mortality, and 2.50-fold (95% CI: 1.28-4.91) higher risk of cardiovascular mortality. Likewise, compared with participants in the high third of CBF, participants in the middle third had 1.44-fold (95% CI: 0.98-2.11) higher risk of all-cause mortality, 1.29-fold (95% CI: 0.82-2.04) higher risk of noncardiovascular mortality, and 1.86-fold (95% CI: 0.93-3.74) higher risk of cardiovascular mortality. These associations were independent of prevalent vascular status and risk factors. CONCLUSIONS Low total CBF is linked with higher risk of all-cause, noncardiovascular, and cardiovascular mortality in older people independent of clinical cardiovascular status.
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Affiliation(s)
- Behnam Sabayan
- From the Departments of Radiology (B.S., J.v.d.G., M.J.P.v.O., M.A.v.B.), Gerontology and Geriatrics (B.S., R.G.W., A.J.M.d.C.), and Cardiology (J.W.J.), Leiden University Medical Center; Netherlands Consortium for Healthy Ageing (R.G.W., A.J.M.d.C.), Leiden, the Netherlands; Robertson Center for Biostatistics (I.F.), and Glasgow Cardiovascular Research Centre (N.S.), University of Glasgow, UK; and Department of Pharmacology and Therapeutics (B.M.B.), University College Cork, Ireland
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8
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Sabayan B, Westendorp RG, Grond JVD, Stott DJ, Sattar N, van Osch MJP, van Buchem MA, de Craen AJM. Markers of endothelial dysfunction and cerebral blood flow in older adults. Neurobiol Aging 2013; 35:373-7. [PMID: 24054993 DOI: 10.1016/j.neurobiolaging.2013.08.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/22/2013] [Accepted: 08/18/2013] [Indexed: 11/29/2022]
Abstract
We investigated the association of 2 markers of endothelial dysfunction, tissue plasminogen activator (t-PA) and Von Willebrand factor (VWF), with cerebral blood flow (CBF) in 541 older participants at high risk for cardiovascular disease. Serum levels of t-PA and VWF were measured at baseline. Participants underwent 2 successive brain magnetic resonance imaging scans, first at baseline and the then after a mean follow-up of 33 months. Total CBF was determined in each scan and also standardized for brain parenchymal volume. At baseline, higher t-PA was associated with lower CBF (p = 0.034). In the longitudinal analysis, higher levels of VWF were associated with a steeper decline in CBF (p = 0.043). There was no association between t-PA and decrease in CBF. These associations were independent of sociodemographic and cardiovascular factors. In conclusion, elevated markers of endothelial dysfunction are associated with lower CBF in older adults at risk for cardiovascular disease.
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Affiliation(s)
- Behnam Sabayan
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
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9
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Abstract
HMG-CoA reductase inhibitors (statins) are associated with improved stroke outcome. This observation has been attributed in part to the palliative effect of statins on cerebral hemodynamics and cerebral autoregulation (CA), which are mediated mainly through the upregulation of endothelium nitric oxide synthase (eNOS). Several animal studies indicate that statin pretreatment enhances cerebral blood flow after ischemic stroke, although this finding is not further supported in clinical settings. Cerebral vasomotor reactivity, however, is significantly improved after long-term statin administration in most patients with severe small vessel disease, aneurysmal subarachnoid hemorrhage, or impaired baseline CA.
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10
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Flow-gated radial phase-contrast imaging in the presence of weak flow. Int J Cardiovasc Imaging 2012; 29:131-40. [DOI: 10.1007/s10554-012-0056-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 04/17/2012] [Indexed: 11/26/2022]
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11
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Beer C, Blacker D, Bynevelt M, Hankey GJ, Puddey IB. A Randomized Placebo Controlled Trial of Early Treatment of Acute Ischemic Stroke with Atorvastatin and Irbesartan. Int J Stroke 2011; 7:104-11. [DOI: 10.1111/j.1747-4949.2011.00653.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background Cholesterol and blood pressure lowering therapies are effective in the secondary prevention of ischemic stroke. Aim To determine whether 30 days of treatment with atorvastatin, or irbesartan, initiated within 96 h of symptom onset improves recovery from acute ischemic stroke. Methods Eighty-one patients with acute ischemic stroke participated in this double-blind, placebo-controlled, randomized trial of atorvastatin (80 mg) vs. placebo, and/or irbesartan (150 mg) vs. placebo. Fifty-two patients (randomized 53 ± 22 h after onset of symptoms) completed the 30-day primary outcome follow-up. Results The primary outcome, maximal brain infarct size at days 3 and 30 measured by perfusion computed tomography, was not significantly altered by random assignment to irbesartan (1088 (IQR 216, 2594) mm2 at day 3, compared with 398 (144, 2053) mm2 among the placebo group, P=0·79 controlling for baseline values; and 822 (159, 1717) mm2 at day 30, cf 280 (76, 1330) mm2; P=0·63); or atorvastatin (454 (107, 1765) mm2 cf 825 (265, 2509) mm2 at day 3; P=0·33; and 462 (43, 1399) mm2 cf 280 (128, 1559) mm2 at day 30, P=0·79). There were no other significant differences among the treatment groups with the exception of: • high sensitivity C-reactive protein concentrations, which were lower in the irbesartan treatment group at day 30 (mean difference 12·6 mg/L; 95% CI: −25·1, −0·1; P=0·048); and • the mean cerebral blood flow in the affected cerebral hemisphere at 30 days after stroke, which was significantly reduced by random assignment to irbesartan compared with placebo in both the affected cerebral hemisphere (−7·5 mL/100 mL/min (95% CI: −1·7 to −13·4, P=0·01)) and in the unaffected hemisphere (−7·3 mL/100 mL/min (95% CI: −1·3, −13·4; P=0·02)). Atorvastatin therapy was well tolerated, but irbesartan therapy was associated with an increased rate of withdrawal from therapy ( n=10 (29%), compared with n=3 (9%) who withdrew from placebo, P=0·04). Conclusions Treatment with atorvastatin and irbesartan, initiated on day 3 after acute ischemic stroke, did not appear to substantially modify infarct growth.
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Affiliation(s)
- Christopher Beer
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
- Centre for Medical Research, Western Australian Institute for Medical Research
- Royal Perth Hospital, Perth, WA, Australia
| | - David Blacker
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Michael Bynevelt
- Royal Perth Hospital, Perth, WA, Australia
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Graeme J. Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
| | - Ian B. Puddey
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
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12
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Hyperglycaemia, microangiopathy, diabetes and dementia risk. DIABETES & METABOLISM 2011; 36 Suppl 3:S112-8. [PMID: 21211732 DOI: 10.1016/s1262-3636(10)70477-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Brain microangiopathy increases in frequency and severity with older age, with the presence of hypertension and to a lesser extent with diabetes. Magnetic resonance imaging is used to provide anatomical descriptions, but at this time only clinical examination and neuropsychological testing can assess white matter functioning. Clinical correlates of microangiopathy appear as subcortical cognitive alterations, but data are controversial about dementia risk. Brain microangiopathy seems to be however a complication of chronic hyperglycaemia, probably due to similar mechanisms occurring in retinopathy and other microvascular complications. To date, many questions have been raised: How can brain microangiopathy progression be monitored? Is there a reversible stage of brain microangiopathy? Which preventive actions should be implemented in aging patients with diabetes? Finally, what type of care should be provided for people with diabetes and mild cognitive impairment or overt dementia to slow down cognitive worsening?
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Farhoudi M, Mehrvar K, Aslanabadi N, Ghabili K, Baghmishe NR, Ilkhchoei F. Doppler study of cerebral arteries in hypercholesterolemia. Vasc Health Risk Manag 2011; 7:203-7. [PMID: 21490946 PMCID: PMC3072744 DOI: 10.2147/vhrm.s18663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Indexed: 11/30/2022] Open
Abstract
Background: Hypercholesterolemia is one of the major modifiable risk factors for atherosclerosis of the coronary and carotid arteries. Although transcranial Doppler (TCD) studies of the cerebral arteries are indicative of decreased cerebral blood flow velocities in patients with hypercholesterolemia, the number of these studies has been limited. The aim of this study was to assess the hemodynamic status of the cerebral arteries in patients with hypercholesterolemia using TCD. Methods: In a case-control study, 60 individuals, including 30 hypercholesterolemic cases (low-density lipoprotein [LDL] > 160 mg/dL) and 30 healthy controls were enrolled. Other arterial risk factors, including diabetes mellitus, hypertension, smoking, and obesity (body mass index > 30), were evaluated and matched as well. TCD was used to assess the hemodynamics of the intracranial arteries as well as the internal carotid arteries. The mean blood flow velocity, pulsatility index, and resistance index were recorded in all the arteries. Results: The mean blood flow velocity, pulsatility index, and resistance index of the intracranial arteries and internal carotid arteries were not significantly different between the two groups (P > 0.05). However, those with higher levels of LDL (>180 mg/dL) showed significantly lower mean blood flow velocity and resistance index of the internal carotid arteries than the healthy controls. In addition, individuals with high-density lipoprotein (HDL) <35 mg/dL had significantly lower mean blood flow velocity in the internal carotid arteries. Conclusion: Hypercholesterolemia (LDL >160 mg/dL) does not seem to have a detrimental effect on the hemodynamic status of the intracranial arteries and internal carotid arteries. However, in cases of higher LDL (>180 mg/dL) and lower HDL, decreased TCD parameters in the internal carotid arteries, as a surrogate of the peripheral arteries, are prominent.
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Affiliation(s)
- Mehdi Farhoudi
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Altmann-Schneider I, Trompet S, de Craen AJ, van Es AC, Jukema JW, Stott DJ, Sattar N, Westendorp RG, van Buchem MA, van der Grond J. Cerebral Microbleeds Are Predictive of Mortality in the Elderly. Stroke 2011; 42:638-44. [DOI: 10.1161/strokeaha.110.595611] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Irmhild Altmann-Schneider
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
| | - Stella Trompet
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
| | - Anton J.M. de Craen
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
| | - Adriaan C.G.M. van Es
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
| | - J. Wouter Jukema
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
| | - David J. Stott
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
| | - Naveed Sattar
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
| | - Rudi G.J. Westendorp
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
| | - Mark A. van Buchem
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
| | - Jeroen van der Grond
- From the Department of Radiology (I.A.S., A.C.G.M.v.E., M.A.v.B., J.v.d.G.), Department of Gerontology and Geriatrics (S.T., A.J.M.d.C., R.G.J.W.), and Department of Cardiology (J.W.J.), Leiden University Medical Center, Leiden, the Netherlands; Durrer Center for Cardiogenetic Research (J.W.J.), Interuniversity Cardiology Institute, Amsterdam, the Netherlands; Department of Geriatric Medicine (D.J.S.), University of Glasgow, Glasgow, United Kingdom; British Heart Foundation (N.S.), Glasgow
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Xu G, Fitzgerald ME, Wen Z, Fain SB, Alsop DC, Carroll T, Ries ML, Rowley HA, Sager MA, Asthana S, Johnson SC, Carlsson CM. Atorvastatin therapy is associated with greater and faster cerebral hemodynamic response. Brain Imaging Behav 2008; 2:94. [PMID: 20157644 DOI: 10.1007/s11682-007-9019-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hypercholesterolemia in midlife increases the risk of subsequent cognitive decline, neurovascular disease, and Alzheimer's disease (AD), and statin use is associated with reduced prevalence of these outcomes. While statins improve vasoreactivity in peripheral arteries and large cerebral arteries, little is known about the effects of statins on cerebral hemodynamic responses and cognition in healthy asymptomatic adults. At the final visit of a 4-month randomized, controlled, double-blind study comparing atorvastatin 40 mg daily to placebo, 16 asymptomatic middle-aged adults (15 had useable data) underwent blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI), arterial spin labeling (ASL) quantitative cerebral blood flow (qCBF), dynamic susceptibility contrast (DSC) and structural imagings of the brain. Using a memory recognition task requiring discrimination of previously viewed (PV) and novel (NV) human faces, fMRI was used to elicit activation from brain regions known to be vulnerable to changes associated with AD. The BOLD signal amplitude (PV > NV) and latency to each stimulus were tested on a voxel basis between the atorvastatin (n=8) and placebo (n=7) groups. Persons randomized to atorvastatin not only showed significantly greater BOLD amplitude in the right angular gyrus, left superior parietal lobule, right middle temporal and superior sulcus than the placebo group, but also decreased hemodynamic response latencies in the right middle frontal gyrus, left precentral gyrus, left cuneus and right posterior middle frontal gyrus. However, neither the resting cerebral blood flow (CBF) measured with ASL nor the mean transit time (MTT) of cerebral perfusion calculated from DSC showed differences in these regions in either group. The drug related BOLD differences during memory recognition suggest that atorvastatin may have improved cerebral small vessel vasoreactivity, possibly through an effect on endothelial function. Furthermore, these results suggest that the effect of atorvastatin on the task-induced BOLD signal may not be a simple consequence of baseline flow change.
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Affiliation(s)
- Guofan Xu
- William S. Middleton VA Hospital, Madison, WI
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Abstract
BACKGROUND AND PURPOSE Leukoaraiosis is used interchangeably with the term white matter lesions on MRI and seen to some degree in more than half of the routine scans in older persons. Clinicians often struggle to explain the implications of these findings to their patients. Recent data on the progression rate of ischemic white matter damage and its cognitive consequences may help in patient counseling and have implications on treatment trials in vascular cognitive impairment. Summary of Review-Leukoaraiosis progresses over time. Its extent at baseline is an important predictor for the subsequent rate of lesion progression. Subjects with punctate abnormalities on MRI have a low tendency for progression, individuals with early confluent and confluent changes tend to progress rapidly. Differences in measurement methods and cohort composition make it difficult to compare progression rates reported by different studies. Nevertheless, in community-dwelling cohorts, white matter lesions volume increased by as much as one quarter per year in subjects with confluent abnormalities at baseline. Progression of leukoaraiosis relates to cognitive decline, but this association is complex and modulated by other morphological factors like brain atrophy. CONCLUSIONS Evidence for rapid progression of widespread leukoaraiosis and the associated cognitive decline in domains particularly affected by cerebral small vessel disease has set the stage for exploratory clinical trials in vascular cognitive impairment using white matter lesions progression as a surrogate marker.
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Affiliation(s)
- Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria.
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ten Dam VH, van den Heuvel DMJ, de Craen AJM, Bollen ELEM, Murray HM, Westendorp RGJ, Blauw GJ, van Buchem MA. Decline in Total Cerebral Blood Flow Is Linked with Increase in Periventricular but Not Deep White Matter Hyperintensities. Radiology 2007; 243:198-203. [PMID: 17329688 DOI: 10.1148/radiol.2431052111] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively investigate the association between changes in total cerebral blood flow and progression of total, periventricular, and deep white matter hyperintensities over time. MATERIALS AND METHODS The institutional ethics review board approved the protocol for the prospective magnetic resonance (MR) imaging study, and all participants gave written informed consent. Participants also agreed to future retrospective analysis of their MR data for research purposes. In this substudy of the Prospective Study of Pravastatin in the Elderly at Risk, investigators performed a repeated MR imaging examination after an average interval of 33 months (standard deviation, 1.4) in 390 elderly men and women (ages 70-82 years at baseline) without dementia who were at high vascular risk. White matter hyperintensities were quantified with a semiautomatic method, and total cerebral blood flow was measured with a gradient-echo phase-contrast MR imaging technique. The association between total cerebral blood flow and volume of white matter hyperintensities was analyzed with logistic regression. RESULTS There was no association between baseline cerebral blood flow and prevalence of total, periventricular, or deep white matter hyperintensities at baseline MR imaging. Moreover, decline in cerebral blood flow was not associated with increase in total load of white matter hyperintensities. When the total volume of white matter hyperintensities was separated into periventricular and deep hyperintensities, for every 50 mL/min decrease in total cerebral blood flow there was a 1.32 (95% confidence interval: 1.06, 1.66; P = .015) increase in risk for developing periventricular white matter hyperintensities; there was no association, however, between decrease in total cerebral blood flow and risk of developing deep white matter hyperintensities (odds ratio, 1.00 [95% confidence interval: 0.79, 1.25]; P = .98). CONCLUSION Decline in total cerebral blood flow is associated with increase in volume of periventricular but not deep white matter hyperintensities.
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Affiliation(s)
- V Hester ten Dam
- Department of Gerontology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
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Box FMA, van der Geest RJ, van der Grond J, van Osch MJP, Zwinderman AH, Palm-Meinders IH, Doornbos J, Blauw GJ, van Buchem MA, Reiber JHC. Reproducibility of wall shear stress assessment with the paraboloid method in the internal carotid artery with velocity encoded MRI in healthy young individuals. J Magn Reson Imaging 2007; 26:598-605. [PMID: 17729354 DOI: 10.1002/jmri.21086] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To verify whether wall shear stress (WSS) can be assessed in a reproducible manner using automatic model-based segmentation of phase-contrast MR images by determination of flow volume and maximum flow velocity (Vmax) in cross-sections of these vessels. MATERIALS AND METHODS The approach is based on fitting a 3D paraboloid to the actual velocity profiles and on determining Vmax. WSS was measured in the internal carotid arteries of two groups of healthy young volunteers. The reproducibility of rescanning and repositioning was studied in the first group. In the second group a 1-week and a 1-month interval was investigated. Reproducibility was calculated by the intraclass correlation (ICC). RESULTS The flow volume, Vmax, and WSS averaged over the cardiac cycle were found to be 287.8 +/- 29.7 mL/min, 37.0 +/- 4.6 cm/s, and 1.13 +/- 0.16 Pa, respectively. The diastolic WSS varied between 1.00 +/- 0.21 Pa without averaging to 0.88 +/- 0.16 Pa with temporal and spatial averaging. Systolic WSS was 1.67 +/- 0.33 Pa without averaging and 1.67 +/- 0.25 Pa with averaging. ICC varied between 0.58 and 0.87 without averaging and between 0.75 and 0.90 with averaging for WSS. CONCLUSION WSS in MR images of the internal carotid artery can be assessed semiautomatically with good to excellent reproducibility without inter- or intraobserver variability using model-based postprocessing.
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Affiliation(s)
- Frieke M A Box
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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