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Leijenaar JF, Groeneveld GJ, van der Flier WM, Scheltens P, Klaassen ES, Weinstein HC, Biessels GJ, Barkhof F, Prins ND. Symptomatic Treatment of Vascular Cognitive Impairment (STREAM-VCI): Protocol for a Cross-Over Trial. JMIR Res Protoc 2018; 7:e80. [PMID: 29559423 PMCID: PMC5883073 DOI: 10.2196/resprot.9192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/24/2017] [Accepted: 12/24/2017] [Indexed: 01/16/2023] Open
Abstract
Background People with vascular cognitive impairment (VCI) constitute a clinically heterogeneous group, but previous symptomatic drug trials in VCI did not take this clinical heterogeneity into account. Executive dysfunction and memory impairment are the cognitive domains that are most frequently impaired in VCI, and these impairments are likely to reflect vascular damage to specific neurotransmitter systems, which opens the possibility for targeted symptomatic treatment directed at specific neurotransmitters. Objective Here we describe the design of the “Symptomatic Treatment of Vascular Cognitive Impairment” (STREAM-VCI) trial. In this proof-of-concept study, we investigate whether people with VCI with executive dysfunction due to vascular damage to the monoaminergic neurotransmitter system differentially respond to a monoaminergic challenge, whereas people with VCI with memory dysfunction associated with vascular damage to the cholinergic system will in turn respond to a cholinergic challenge. Methods The STREAM-VCI is a single center, double blind, three-way cross-over trial among 30 people with VCI, in which subjects received a single dose of galantamine, methylphenidate, or placebo on separate occasions. The most important inclusion criteria were a diagnosis of VCI with a Mini-Mental State Examination score of ≥16 and a Clinical Dementia Rating of 0.5-1.0. For each person, the challenges consisted of a single 16 mg dose of galantamine, 10 mg of methylphenidate, and placebo, in random order on three separate visits. Change in performance in executive functioning and memory was assessed directly after the challenge using standardized neuropsychological tests. We will correlate a positive response to the cholinergic and monoaminergic treatment with differences in structural and functional connectivity at baseline using structural magnetic resonance imaging (MRI), diffusion tension MRI, and resting-state functional MRI. Results The protocol of this study is approved by the Medical Ethics Committee of VU University Medical Center and the competent authority. The first participant was enrolled in April 2014. In September 2017, enrolment for the study was completed. We expect to publish the results in 2018. Conclusions STREAM-VCI is the first study to investigate the association of a response to a cholinergic and monoaminergic treatment with structural and functional connectivity of the monoaminergic and/or cholinergic systems on MRI. We aim to predict on an individual basis which individuals show a positive response to a cholinergic and/or monoaminergic challenge in people with VCI. This may be instrumental in moving in the direction of individually-tailored pharmacological interventions based on MRI measures in people with VCI. Trial Registration ClinicalTrials.gov NCT02098824; https://clinicaltrials.gov/ct2/show/NCT02098824 (Archived by WebCite at http://www.webcitation.org/6xhO7Ya1q)
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Affiliation(s)
- Jolien Fleur Leijenaar
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands
| | - Geert Jan Groeneveld
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands.,Centre for Human Drug Research, Leiden, Netherlands
| | - Wiesje Maria van der Flier
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands
| | | | | | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Niels Daniël Prins
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands.,Brain Research Center, Amsterdam, Netherlands
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Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, FitzMaurice E, Wendell L, Goldstein JN, Greenberg SM, Rosand J. Prediction of Functional Outcome in Patients With Primary Intracerebral Hemorrhage. Stroke 2008; 39:2304-9. [DOI: 10.1161/strokeaha.107.512202] [Citation(s) in RCA: 308] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Natalia S. Rost
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Eric E. Smith
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Yuchiao Chang
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Ryan W. Snider
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Rishi Chanderraj
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Kristin Schwab
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Emily FitzMaurice
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Lauren Wendell
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Joshua N. Goldstein
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Steven M. Greenberg
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
| | - Jonathan Rosand
- From Vascular and Critical Care Neurology (N.S.R., E.E.S., S.M.G., J.R.), the Hemorrhagic Stroke Research Program (N.S.R., E.E.S., R.W.S., R.C., K.S., E.F., L.W., S.M.G., J.R.), the Center for Human Genetic Research (N.S.R., R.C., J.R.), the Department of Medicine (Y.C.), and the Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, Mass
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Mok VCT, Liu T, Lam WWM, Wong A, Hu X, Guo L, Chen XY, Tang WK, Wong KS, Wong S. Neuroimaging predictors of cognitive impairment in confluent white matter lesion: volumetric analyses of 99 brain regions. Dement Geriatr Cogn Disord 2008; 25:67-73. [PMID: 18042992 DOI: 10.1159/000111692] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although confluent white matter lesion (WML) is associated with cognitive impairment, the mechanism explaining this association is controversial. We aimed to investigate comprehensively the MRI predictors of cognitive impairment in confluent WML. METHODS Among 45 lacunar stroke patients who had confluent WML, we evaluated the association of executive function [Mattis Dementia Rating Scale - Initiation/Perseveration subscale (MDRS I/P)] and global cognition [Mini-Mental State Examination (MMSE)] with the volume of WML, measures of lacunes and microbleeds, and the volumes of 99 other specific brain regions. RESULTS Regression analyses showed that WML volume predicted performance on the MDRS I/P (beta = -0.34, p = 0.016) independent of age. Volumes of cortical gray matter (cGM; beta = 0.41, p = 0.003), the lateral fronto-orbital gyrus (beta = 0.38, p = 0.01), superior frontal gyrus (beta = 0.29, p = 0.04), lateral ventricle (beta = -0.30, p = 0.04), and posterior limb of the internal capsule (beta = 0.43, p = 0.002) predicted MDRS I/P performance independent of WML volume. Volumes of cGM, and the lateral fronto-orbital gyrus predicted MMSE performance as well. CONCLUSION Atrophy along the frontosubcortical pathways and cGM predict cognition in confluent WML independent of WML volume.
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Affiliation(s)
- Vincent C T Mok
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
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