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Okawa R, Hayashi N, Takahashi T, Atarashi R, Yasui G, Mihara B. Comparison of qualitative and fully automated quantitative tools for classifying severity of white matter hyperintensity. J Stroke Cerebrovasc Dis 2024; 33:107772. [PMID: 38761849 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/15/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVE In this study, we aimed to compare the Fazekas scoring system and quantitative white matter hyperintensity volume in the classification of white matter hyperintensity severity using a fully automated analysis software to investigate the reliability of quantitative evaluation. MATERIALS AND METHODS Patients with suspected cognitive impairment who underwent medical examinations at our institution between January 2010 and May 2021 were retrospectively examined. White matter hyperintensity volumes were analyzed using fully automated analysis software and Fazekas scoring (scores 0-3). Using one-way analysis of variance, white matter hyperintensity volume differences across Fazekas scores were assessed. We employed post-hoc pairwise comparisons to compare the differences in the mean white matter hyperintensity volume between each Fazekas score. Spearman's rank correlation test was used to investigate the association between Fazekas score and white matter hyperintensity volume. RESULTS Among the 839 patients included in this study, Fazekas scores 0, 1, 2, and 3 were assigned to 68, 198, 217, and 356 patients, respectively. White matter hyperintensity volumes significantly differed according to Fazekas score (F=623.5, p<0.001). Post-hoc pairwise comparisons revealed significant differences in mean white matter hyperintensity volume between all Fazekas scores (p<0.05). We observed a significantly positive correlation between the Fazekas scores and white matter hyperintensity volume (R=0.823, p<0.01). CONCLUSIONS Quantitative white matter hyperintensity volume and the Fazekas scores are highly correlated and may be used as indicators of white matter hyperintensity severity. In addition, quantitative analysis may be more effective in classifying advanced white matter hyperintensity lesions than the Fazekas classification.
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Affiliation(s)
- Ryuya Okawa
- Department of Diagnostic Imaging, Institute of Brain and Blood Vessels Mihara Memorial Hospital; Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences.
| | - Norio Hayashi
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences.
| | - Tetsuhiko Takahashi
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences.
| | - Ryo Atarashi
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences.
| | - Go Yasui
- Department of Diagnostic Imaging, Institute of Brain and Blood Vessels Mihara Memorial Hospital.
| | - Ban Mihara
- Department of Neurology, Institute of Brain and Blood Vessels Mihara Memorial Hospital.
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2
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Huang WQ, Lin Q, Tzeng CM. Leukoaraiosis: Epidemiology, Imaging, Risk Factors, and Management of Age-Related Cerebral White Matter Hyperintensities. J Stroke 2024; 26:131-163. [PMID: 38836265 PMCID: PMC11164597 DOI: 10.5853/jos.2023.02719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
Leukoaraiosis (LA) manifests as cerebral white matter hyperintensities on T2-weighted magnetic resonance imaging scans and corresponds to white matter lesions or abnormalities in brain tissue. Clinically, it is generally detected in the early 40s and is highly prevalent globally in individuals aged >60 years. From the imaging perspective, LA can present as several heterogeneous forms, including punctate and patchy lesions in deep or subcortical white matter; lesions with periventricular caps, a pencil-thin lining, and smooth halo; as well as irregular lesions, which are not always benign. Given its potential of having deleterious effects on normal brain function and the resulting increase in public health burden, considerable effort has been focused on investigating the associations between various risk factors and LA risk, and developing its associated clinical interventions. However, study results have been inconsistent, most likely due to potential differences in study designs, neuroimaging methods, and sample sizes as well as the inherent neuroimaging heterogeneity and multi-factorial nature of LA. In this article, we provided an overview of LA and summarized the current knowledge regarding its epidemiology, neuroimaging classification, pathological characteristics, risk factors, and potential intervention strategies.
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Affiliation(s)
- Wen-Qing Huang
- Department of Central Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Lin
- Department of Neurology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Clinical Research Center for Brain Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- The Third Clinical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Chi-Meng Tzeng
- Translational Medicine Research Center, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian, China
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3
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Pei YF, Li XD, Liu QY, Zhang CW, Wang YH, Chen MR, Chen HS. A nomogram for predicting cerebral white matter lesions in elderly men. Front Neurol 2024; 15:1343654. [PMID: 38751887 PMCID: PMC11094237 DOI: 10.3389/fneur.2024.1343654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Objective This study aimed to develop a nomogram tool to predict cerebral white matter lesions (WMLs) in elderly men. Methods Based on a retrospective cohort from January 2017 to December 2019, a multivariate logistic analysis was performed to construct a nomogram for predicting WMLs. The nomogram was further validated using a follow-up cohort between January 2020 and December 2022. The calibration curve, receiver operating characteristics (ROC) curves, and the decision curves analysis (DCA) were used to evaluate discrimination and calibration of this nomogram. Result A total of 436 male patients were enrolled in this study, and all 436 patients were used as the training cohort and 163 follow-up patients as the validation cohort. A multivariate logistic analysis showed that age, cystatin C, uric acid, total cholesterol, platelet, and the use of antiplatelet drugs were independently associated with WMLs. Based on these variables, a nomogram was developed. The nomogram displayed excellent predictive power with the area under the ROC curve of 0.951 [95% confidence interval (CI), 0.929-0.972] in the training cohort and 0.915 (95% CI, 0.864-0.966) in the validation cohort. The calibration of the nomogram was also good, as indicated by the Hosmer-Lemeshow test with p-value of 0.594 in the training cohort and 0.178 in the validation cohort. The DCA showed that the nomogram holds good clinical application value. Conclusion We have developed and validated a novel nomogram tool for identifying elderly men at high risk of WMLs, which exhibits excellent predictive power, discrimination, and calibration.
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Affiliation(s)
| | | | | | | | | | | | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
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4
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Ma G, Worthy KH, Liu C, Rosa MG, Atapour N. Parvalbumin as a neurochemical marker of the primate optic radiation. iScience 2023; 26:106608. [PMID: 37168578 PMCID: PMC10165026 DOI: 10.1016/j.isci.2023.106608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 05/13/2023] Open
Abstract
Parvalbumin (PV) is a calcium-binding protein that labels neuronal cell bodies in the magno and parvocellular layers of the primate lateral geniculate nucleus (LGN). Here we demonstrate that PV immunohistochemistry can also be used to trace the optic radiation (OR) of the marmoset monkey (Callithrix jacchus) from its LGN origin to its destinations in the primary visual cortex (V1), thus providing a high-resolution method for identification of the OR with single axon resolution. The emergence of fibers from LGN, their entire course and even the entry points to V1 were clearly defined in coronal, parasagittal, and horizontal sections of marmoset brain. In all cases, the trajectory revealed by PV staining paralleled that defined by high-resolution diffusion tensor imaging (DTI). We found that V1 was the exclusive target for the PV-containing fibers, with abrupt transitions in staining observed in the white matter at the border with area V2, and no evidence of PV-labeled axons feeding into other visual areas. Changes in the pattern of PV staining in the OR were detected following V1 lesions, demonstrating that this method can be used to assess the progress of retrograde degeneration of geniculocortical projections. These results suggest a technically simple approach to advance our understanding of a major white matter structure, which provides a cellular resolution suitable for the detection of microstructural variations during development, health and disease. Understanding the relationship between PV staining and DTI in non-human primates may also offer clues for improving the specificity and sensitivity of OR tractography for clinical purposes.
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Affiliation(s)
- Gaoyuan Ma
- Neuroscience Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, VIC 3800, Australia
| | - Katrina H. Worthy
- Neuroscience Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, VIC 3800, Australia
| | - Cirong Liu
- Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, CAS Key Laboratory of Primate Neurobiology, Chinese Academy of Sciences, Shanghai, China
| | - Marcello G.P. Rosa
- Neuroscience Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, VIC 3800, Australia
| | - Nafiseh Atapour
- Neuroscience Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, VIC 3800, Australia
- Corresponding author
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5
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Chung CP, Ihara M, Hilal S, Chen LK. Targeting cerebral small vessel disease to promote healthy aging: Preserving physical and cognitive functions in the elderly. Arch Gerontol Geriatr 2023; 110:104982. [PMID: 36868073 DOI: 10.1016/j.archger.2023.104982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
Cerebral small vessel disease (SVD), which is highly age-related, is the most common neuroimaging finding in community-dwelling elderly individuals. In addition to increasing the risk of dementia and stroke, SVD is associated with cognitive and physical (particularly gait speed) functional impairments in the elderly. Here, we provide evidence suggesting covert SVD, e.g. without clinically evident stroke or dementia, as a critical target to preserve the functional ability that enables well-being in older age. First, we discuss the relationship between covert SVD and geriatric syndrome. SVD lesions found in non-demented, stroke-free elderly are actually not "silent" but are associated with accelerated age-related functional decline. We also review the brain structural and functional abnormalities associated with covert SVD and the possible mechanisms underlying their contributions to SVD-related cognitive and physical functional impairments. Finally, we reveal current data, though limited, on the management of elderly patients with covert SVD to prevent SVD lesion progression and functional decline. Although it is important in aging health, covert SVD is still under-recognized or misjudged by physicians in both neurological and geriatric professions. Improving the acknowledgment, detection, interpretation, and understanding of SVD would be a multidisciplinary priority to maintain cognitive and physical functions in the elderly. The dilemmas and future directions of clinical practice and research for the elderly with covert SVD are also included in the present review.
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Affiliation(s)
- Chih-Ping Chung
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Center for Health Longevity and Aging Sciences, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Memory Aging and Cognition Center, National University Health System, Singapore
| | - Liang-Kung Chen
- Center for Health Longevity and Aging Sciences, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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6
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Fu Y, Sun Y, Wang ZB, Zhang DD, Tan L, Feng JF, Cheng W, Yu JT. Associations of Life's Simple 7 with cerebral white matter hyperintensities and microstructural integrity: UK Biobank cohort study. Eur J Neurol 2023; 30:1200-1208. [PMID: 36794682 DOI: 10.1111/ene.15750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/26/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND PURPOSE The American Heart Association Life's Simple 7 (LS7) metric was used to define optimal cardiovascular and brain health, but the associations with macrostructural hyperintensities and microstructural white matter damage are unclear. The objective was to determine the association of LS7 ideal cardiovascular health factors with macrostructural and microstructural integrity. METHOD A total of 37,140 participants with available LS7 and imaging data from UK Biobank were included in this study. Linear associations were implemented to examine the associations of LS7 score and subscores with white matter hyperintensity load (WMH) (WMH volume normalized by total white matter volume and logit-transformed) and diffusion imaging indices (fractional anisotropy [FA], mean diffusivity, orientation dispersion index [OD], intracellular volume fraction, isotropic volume fraction [ISOVF]). RESULTS In individuals (mean age 54.76 years; 19,697 females, 52.4%), higher LS7 score and subscores were strongly associated with lower WMH and microstructural white matter injury, including OD, ISOVF, FA. Both interaction analyses and stratified analyses of LS7 score and subscores with age and sex showed a strong association with microstructural damage markers, with remarkable age and sex differences. The association of OD was pronounced in females and populations younger than 50 years and FA, mean diffusivity and ISOVF were pronounced in males and populations older than 50 years. CONCLUSION These findings suggest that healthier LS7 profiles are associated with better profiles of both macrostructural and microstructural markers of brain health, and indicate that ideal cardiovascular health is associated with improved brain health.
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Affiliation(s)
- Yan Fu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yan Sun
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Zhi-Bo Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Dan-Dan Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), China.,Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China.,MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.,Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), China.,Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China.,Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
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7
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Zhang X, An H, Chen Y, Shu N. Neurobiological Mechanisms of Cognitive Decline Correlated with Brain Aging. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1419:127-146. [PMID: 37418211 DOI: 10.1007/978-981-99-1627-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Cognitive decline has emerged as one of the greatest health threats of old age. Meanwhile, aging is the primary risk factor for Alzheimer's disease (AD) and other prevalent neurodegenerative disorders. Developing therapeutic interventions for such conditions demands a greater understanding of the processes underlying normal and pathological brain aging. Despite playing an important role in the pathogenesis and incidence of disease, brain aging has not been well understood at a molecular level. Recent advances in the biology of aging in model organisms, together with molecular- and systems-level studies of the brain, are beginning to shed light on these mechanisms and their potential roles in cognitive decline. This chapter seeks to integrate the knowledge about the neurological mechanisms of age-related cognitive changes that underlie aging.
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Affiliation(s)
- Xiaxia Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China
| | - Haiting An
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yuan Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, China.
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Rosenberg GA. Willis Lecture: Biomarkers for Inflammatory White Matter Injury in Binswanger Disease Provide Pathways to Precision Medicine. Stroke 2022; 53:3514-3523. [PMID: 36148658 PMCID: PMC9613611 DOI: 10.1161/strokeaha.122.039211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Binswanger disease is the small vessel form of vascular cognitive impairment and dementia. Deposition of Alzheimer disease proteins can begin in midlife and progress slowly, whereas aging of the vasculature also can begin in midlife, continuing to progress into old age, making mixed dementia the most common type of dementia. Biomarkers facilitate the early diagnosis of dementias. It is possible to diagnose mixed dementia before autopsy with biomarkers for vascular disease derived from diffusor tensor images on magnetic resonance imaging and Alzheimer disease proteins, Aβ (amyloid β), and phosphorylated tau, in cerebrospinal fluid or in brain with positron emission tomography. The presence of vascular disease accelerates cognitive decline. Both misfolded proteins and vascular disease promote inflammation, which can be detected in cerebrospinal fluid by the presence of MMPs (matrix metalloproteinases), angiogenic growth factors, and cytokines. MMPs disrupt the blood-brain barrier and break down myelin, producing Binswanger disease's 2 main pathological features. Advances in detecting biomarkers in plasma will provide early detection of dementia and aided by machine learning and artificial intelligence, will enhance diagnosis and form the basis for early treatments.
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Affiliation(s)
- Gary A Rosenberg
- Center for Memory and Aging, Departments of Neurology, Neurosciences, Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque
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Sun L, Hui L, Li Y, Chen X, Liu R, Ma J. Pathogenesis and research progress in leukoaraiosis. Front Hum Neurosci 2022; 16:902731. [PMID: 36061509 PMCID: PMC9437627 DOI: 10.3389/fnhum.2022.902731] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
Leukoaraiosis is a common imaging marker of cerebral small vessel disease. In recent years, with the continuous advances in brain imaging technology, the detection rate of leukoaraiosis is higher and its clinical subtypes are gradually gaining attention. Although leukoaraiosis has long been considered an incidental finding with no therapeutic necessity, there is now growing evidence linking it to, among other things, cognitive impairment and a high risk of death after stroke. Due to different research methods, some of the findings are inconsistent and even contradictory. Therefore, a comprehensive and in-depth study of risk factors for leukoaraiosis is of great clinical significance. In this review, we summarize the literature on leukoaraiosis in recent years with the aim of elucidating the disease in terms of various aspects (including pathogenesis, imaging features, and clinical features, etc.).
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Affiliation(s)
- Lingqi Sun
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Lin Hui
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Li
- Department of Ultrasound Medicine, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Xian Chen
- Department of Neurology, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Rong Liu
- Department of Neurology, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Ji Ma
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
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Badji A, Pereira JB, Shams S, Skoog J, Marseglia A, Poulakis K, Rydén L, Blennow K, Zetterberg H, Kern S, Zettergren A, Wahlund LO, Girouard H, Skoog I, Westman E. Cerebrospinal Fluid Biomarkers, Brain Structural and Cognitive Performances Between Normotensive and Hypertensive Controlled, Uncontrolled and Untreated 70-Year-Old Adults. Front Aging Neurosci 2022; 13:777475. [PMID: 35095467 PMCID: PMC8791781 DOI: 10.3389/fnagi.2021.777475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Hypertension is an important risk factor for Alzheimer's disease (AD). The pathophysiological mechanisms underlying the relationship between AD and hypertension are not fully understood, but they most likely involve microvascular dysfunction and cerebrovascular pathology. Although previous studies have assessed the impact of hypertension on different markers of brain integrity, no study has yet provided a comprehensive comparison of cerebrospinal fluid (CSF) biomarkers and structural brain differences between normotensive and hypertensive groups in a single and large cohort of older adults in relationship to cognitive performances. Objective: The aim of the present work was to investigate the differences in cognitive performances, CSF biomarkers and magnetic resonance imaging (MRI) of brain structure between normotensive, controlled hypertensive, uncontrolled hypertensive, and untreated hypertensive older adults from the Gothenburg H70 Birth Cohort Studies. Methods: As an indicator of vascular brain pathology, we measured white matter hyperintensities (WMHs), lacunes, cerebral microbleeds, enlarged perivascular space (epvs), and fractional anisotropy (FA). To assess markers of AD pathology/neurodegeneration, we measured hippocampal volume, temporal cortical thickness on MRI, and amyloid-β42, phosphorylated tau, and neurofilament light protein (NfL) in cerebrospinal fluid. Various neuropsychological tests were used to assess performances in memory, attention/processing speed, executive function, verbal fluency, and visuospatial abilities. Results: We found more white matter pathology in hypertensive compared to normotensive participants, with the highest vascular burden in uncontrolled participants (e.g., lower FA, more WMHs, and epvs). No significant difference was found in any MRI or CSF markers of AD pathology/neurodegeneration when comparing normotensive and hypertensive participants, nor among hypertensive groups. No significant difference was found in most cognitive functions between groups. Conclusion: Our results suggest that good blood pressure control may help prevent cerebrovascular pathology. In addition, hypertension may contribute to cognitive decline through its effect on cerebrovascular pathology rather than AD-related pathology. These findings suggest that hypertension is associated with MRI markers of vascular pathology in the absence of a significant decline in cognitive functions.
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Affiliation(s)
- Atef Badji
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Joana B. Pereira
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Stanford Medicine, Stanford, CA, United States
| | - Johan Skoog
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Anna Marseglia
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Konstantinos Poulakis
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lina Rydén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
- UK Dementia Research Institute at UCL, Mölndal, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong SAR, China
| | - Silke Kern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Anna Zettergren
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Hélène Girouard
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Groupe de Recherche sur le Systéme Nerveux Central (GRSNC), Université de Montréal, Montréal, QC, Canada
- Centre Interdisciplinaire de Recherche sur le Cerveau et l’Apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Ingmar Skoog
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
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Zachariou V, Bauer CE, Powell DK, Gold BT. Ironsmith: An Automated Pipeline for QSM-based Data Analyses. Neuroimage 2021; 249:118835. [PMID: 34936923 PMCID: PMC8935985 DOI: 10.1016/j.neuroimage.2021.118835] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/27/2021] [Accepted: 12/17/2021] [Indexed: 12/13/2022] Open
Abstract
Quantitative susceptibility mapping (QSM) is an MRI-based, computational method for anatomically localizing and measuring concentrations of specific biomarkers in tissue such as iron. Growing research suggests QSM is a viable method for evaluating the impact of iron overload in neurological disorders and on cognitive performance in aging. Several software toolboxes are currently available to reconstruct QSM maps from 3D GRE MR Images. However, few if any software packages currently exist that offer fully automated pipelines for QSM-based data analyses: from DICOM images to region-of-interest (ROI) based QSM values. Even less QSM-based software exist that offer quality control measures for evaluating the QSM output. Here, we address these gaps in the field by introducing and demonstrating the reliability and external validity of Ironsmith; an open-source, fully automated pipeline for creating and processing QSM maps, extracting QSM values from subcortical and cortical brain regions (89 ROIs) and evaluating the quality of QSM data using SNR measures and assessment of outlier regions on phase images. Ironsmith also features automatic filtering of QSM outlier values and precise CSF-only QSM reference masks that minimize partial volume effects. Testing of Ironsmith revealed excellent intra- and inter-rater reliability. Finally, external validity of Ironsmith was demonstrated via an anatomically selective relationship between motor performance and Ironsmith-derived QSM values in motor cortex. In sum, Ironsmith provides a freely-available, reliable, turn-key pipeline for QSM-based data analyses to support research on the impact of brain iron in aging and neurodegenerative disease.
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Affiliation(s)
- Valentinos Zachariou
- Department of Neuroscience, College of Medicine, University of Kentucky, Lexington, KY 40536-0298 United States.
| | - Christopher E Bauer
- Department of Neuroscience, College of Medicine, University of Kentucky, Lexington, KY 40536-0298 United States
| | - David K Powell
- Department of Neuroscience, Magnetic Resonance Imaging and Spectroscopy Center, College of Medicine, University of Kentucky, Lexington, KY 40536-0298 United States
| | - Brian T Gold
- Department of Neuroscience, Sanders-Brown Center on Aging, Magnetic Resonance Imaging and Spectroscopy Center, College of Medicine, University of Kentucky, Lexington, KY 40536-0298 United States.
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12
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Abstract
INTRODUCTION The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized by acquired clinically significant changes in one or more cognitive domains despite preserved independence. Mild impairment has significant medicolegal consequences for an affected person and their care system. We review the more common etiologies of MiND and provide a systematic review of its medicolegal implications. METHODS We conducted a systematic review of the peer-reviewed English literature on medicolegal aspects of MCI or MiND using comprehensive search terms and expanding our review to include sources cited by these reports. RESULTS Impairment of memory, executive function, social cognition, judgment, insight or abstraction can alter an individual's abilities in a variety of areas that include decision making, informed consent, designation of a surrogate decision-maker such as a health care proxy, understanding and management of financial affairs, execution of a will, or safe driving. CONCLUSION Even mild cognitive impairment can have significant behavioral consequences. Clinicians can assist care partners and persons with MCI or MiND by alerting them to the medicolegal concerns that often accompany cognitive decline. Early recognition and discussion can help a care system manage medicolegal risk more effectively and promote thoughtful advance planning.
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Affiliation(s)
- Anca Bejenaru
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA
| | - James M Ellison
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA.,Department of Family and Community Medicine, Christiana Care, Wilmington, DE, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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13
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An observational study of T2-weighted white matter hyperintensities on magnetic resonance imaging of the internal auditory meatus and brain: ignore or not? J Laryngol Otol 2021; 135:964-969. [PMID: 34558395 DOI: 10.1017/s0022215121001845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Magnetic resonance imaging of the internal auditory meatus frequently detects incidental white matter hyperintensities. This study investigated the association between these and the risk of stroke and transient ischaemic attack, or myocardial infarction. METHODS The records of patients with incidental white matter hyperintensities were reviewed, and data were collected on: age, sex, cardiovascular risk factors, and incidence of stroke and transient ischaemic attack, or myocardial infarction, five years later. The risk factors associated with vascular events were explored. RESULTS Of 6978 patients, 309 (4.4 per cent) had incidental white matter hyperintensities. Of these, 20 (6.5 per cent) had a stroke or transient ischaemic attack within five years, and 5 (1.7 per cent) had a myocardial infarction. The number of cardiovascular risk factors was significantly associated with the incidence of stroke and transient ischaemic attack (p = 0.004), and myocardial infarction (p = 0.023). CONCLUSION The number of cardiovascular risk factors predicts the likelihood of vascular events; appropriate risk factor management is recommended for patients with incidental white matter hyperintensities of presumed vascular origin.
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14
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Cao S, Zhang J, Chen C, Wang X, Ji Y, Nie J, Tian Y, Qiu B, Wei Q, Wang K. Decline in executive function in patients with white matter hyperintensities from the static and dynamic perspectives of amplitude of low-frequency fluctuations. J Neurosci Res 2021; 99:2793-2803. [PMID: 34510531 DOI: 10.1002/jnr.24956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/29/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022]
Abstract
Cognitive impairments are characteristics of patients with white matter hyperintensities (WMHs), and hypoperfusion is currently a relatively recognized mechanism of WMHs. Brain activity is closely coupled to the regulation of local blood flow. This study aimed to investigate the abnormal local brain activity of patients with WMHs from the viewpoint of the static amplitude of low-frequency fluctuations (sALFF) and dynamic amplitude of low-frequency fluctuations (dALFF). Seventy-four patients with WMHs and 35 healthy controls (HCs) were included. Based on the Fazekas scale, patients with WMHs were further divided into a mild WMH group (n = 33, Fazekas score 1-2) and moderate-severe WMH group (n = 41, Fazekas score 3-6). The sALFF and dALFF values were calculated separately and neuropsychological tests including the Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test (AVLT), Trail Making Test (TMT), and Boston Naming Test (BNT) were completed by all participants. Patients with WMHs showed increased sALFF and dALFF values in the bilateral thalamus and decreased performance in the MoCA test, AVLT-immediate, AVLT-delay, AVLT-recognition, TMT-A, and BNT. The dALFF values in the bilateral thalamus was correlated with the MoCA in HCs. The sALFF values in the bilateral thalamus correlated with TMT-B in patients with WMHs. Patients with WMHs showed abnormal brain activity and decreased functional stability of the bilateral thalamus, which may be a potential mechanism of decreased executive function.
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Affiliation(s)
- Shanshan Cao
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Jun Zhang
- Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chen Chen
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Xiaojing Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Yang Ji
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Jiajia Nie
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Yanghua Tian
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,The College of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
| | - Bensheng Qiu
- Hefei National Lab for Physical Sciences at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Qiang Wei
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,The College of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
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15
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Bauer CE, Zachariou V, Seago E, Gold BT. White Matter Hyperintensity Volume and Location: Associations With WM Microstructure, Brain Iron, and Cerebral Perfusion. Front Aging Neurosci 2021; 13:617947. [PMID: 34290597 PMCID: PMC8287527 DOI: 10.3389/fnagi.2021.617947] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/31/2021] [Indexed: 11/29/2022] Open
Abstract
Cerebral white matter hyperintensities (WMHs) represent macrostructural brain damage associated with various etiologies. However, the relative contributions of various etiologies to WMH volume, as assessed via different neuroimaging measures, is not well-understood. Here, we explored associations between three potential early markers of white matter hyperintensity volume. Specifically, the unique variance in total and regional WMH volumes accounted for by white matter microstructure, brain iron concentration and cerebral blood flow (CBF) was assessed. Regional volumes explored were periventricular and deep regions. Eighty healthy older adults (ages 60–86) were scanned at 3 Tesla MRI using fluid-attenuated inversion recovery, diffusion tensor imaging (DTI), multi-echo gradient-recalled echo and pseudo-continuous arterial spin labeling sequences. In a stepwise regression model, DTI-based radial diffusivity accounted for significant variance in total WMH volume (adjusted R2 change = 0.136). In contrast, iron concentration (adjusted R2 change = 0.043) and CBF (adjusted R2 change = 0.027) made more modest improvements to the variance accounted for in total WMH volume. However, there was an interaction between iron concentration and location on WMH volume such that iron concentration predicted deep (p = 0.034) but not periventricular (p = 0.414) WMH volume. Our results suggest that WM microstructure may be a better predictor of WMH volume than either brain iron or CBF but also draws attention to the possibility that some early WMH markers may be location-specific.
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Affiliation(s)
- Christopher E Bauer
- Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Valentinos Zachariou
- Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Elayna Seago
- Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Brian T Gold
- Department of Neuroscience, University of Kentucky, Lexington, KY, United States.,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States
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16
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Balestrieri A, Lucatelli P, Suri HS, Montisci R, Suri JS, Wintermark M, Serra A, Cheng X, Jinliang C, Sanfilippo R, Saba L. Volume of White Matter Hyperintensities, and Cerebral Micro-Bleeds. J Stroke Cerebrovasc Dis 2021; 30:105905. [PMID: 34107418 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE In the past years the significance of white matter hyperintensities (WMH) has gained raising attention because it is considered a marker of severity of different pathologies. Another condition that in the last years has been assessed in the neuroradiology field is cerebral microbleeds (CMB). The purpose of this work was to evaluate the association between the volume of WMH and the presence and characteristics of CMB. MATERIAL AND METHODS Sixty-five consecutive (males 45; median age 70) subjects were retrospectively analyzed with a 1.5 Tesla scanner. WMH volume was quantified with a semi-automated procedure considering the FLAIR MR sequences whereas the CMB were studied with the SWI technique and CMBs were classified as absent (grade 1), mild (grade 2; total number of CMBs: 1-2), moderate (grade 3; total number of CMBs: 3-10), and severe (grade 4; total number of CMBs: >10). Moreover, overall number of CMBs and the maximum diameter were registered. RESULTS Prevalence of CMBs was 30.76% whereas WMH 81.5%. Mann-Whitney test showed a statistically significant difference in WMH volume between subjects with and without CMBs (p < 0.001). Pearson analysis showed significant correlation between CMB grade, number and maximum diameter and WMH. The better ROC area under the curve (Az) was obtained by the hemisphere volume with a 0.828 (95% CI from 0.752 to 0,888; SD = 0.0427; p value = 0.001). The only parameters that showed a statistically significant association in the logistic regression analysis were Hemisphere volume of WMH (p = 0.001) and Cholesterol LDL (p = 0.0292). CONCLUSION In conclusion, the results of this study suggest the presence of a significant correlation between CMBs and volume of WMH. No differences were found between the different vascular territories.
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Affiliation(s)
- Antonella Balestrieri
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045, Italy
| | | | - Harman S Suri
- Stroke Diagnosis and Monitoring Division, AtheroPoint™, Roseville, CA, USA; Point-of-Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA; Department of Electrical Engineering, University of Idaho (Affl.), ID, USA
| | - Roberto Montisci
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato Cagliari 09045, Italy
| | - Jasjit S Suri
- Stroke Diagnosis and Monitoring Division, AtheroPoint™, Roseville, CA, USA; Point-of-Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA; Department of Electrical Engineering, University of Idaho (Affl.), ID, USA
| | | | - Alessandra Serra
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045, Italy
| | | | - Cheng Jinliang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Roberto Sanfilippo
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato Cagliari 09045, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045, Italy.
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17
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Lee JW, Kim D, Lee S, Choi SW, Kong SK, Hwangbo L, Lee JI, Oh SJ. The Clinical Value of Periventricular White Matter Hyperintensity on MRI in Sudden Sensorineural Hearing Loss. Ann Otol Rhinol Laryngol 2021; 131:244-251. [PMID: 34032144 DOI: 10.1177/00034894211018925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the clinical value of periventricular white matter hyperintensity (PWMH) found on brain magnetic resonance imaging (MRI) in patients with sudden sensorineural hearing loss (SSNHL). METHODS In this prospective study, 115 patients who were diagnosed with SSNHL aged between 55 and 75 years were analyzed. All subjects underwent brain MRI and were divided into a PWMH and control groups, depending on the presence of PWMH on MRI. PWMH was subdivided into 3 groups according to severity. Pure-tone average results and hearing gain were compared between the 2 groups before treatment and 2 months after treatment. Hearing improvement was assessed using Sigel's criteria. RESULTS A total of 106 patients (43 in the PWMH group and 63 in the control group) finally completed the 2-month follow-up. Average hearing gain in the PWMH group was significantly higher than in the control group (34.8 ± 20.3 and 25.9 ± 20.3, respectively, P = .029). PWMH score 1 showed significantly better hearing levels and hearing gain compared to PWMH score 3 and the control group. Multivariate analysis revealed that younger age, better initial hearing level, and the presence of PVWM score 1 were associated with good recovery. CONCLUSIONS The presence of PWMH score 1 on brain MRI in patients with SSNHL was associated with better treatment response and was a good prognostic factor in a multivariate analysis while the hearing recovery in more severe PWMH (scores 2, 3) was not different from the control group.
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Affiliation(s)
- Jung Woo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Deoksu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seokhwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sung-Won Choi
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University, Busan, South Korea
| | - Lee Hwangbo
- Department of Diagnostic Radiology, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jae Il Lee
- Department of Neurosurgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, South Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University, Busan, South Korea
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18
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Liu H, Liu J, Zhao H, Wang H. Association of brain white matter lesions with arterial stiffness assessed by cardio-ankle vascular index. The Beijing Vascular Disease Evaluation STudy (BEST). Brain Imaging Behav 2021; 15:1025-1032. [PMID: 33068268 DOI: 10.1007/s11682-020-00309-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background-The association of brain white matter lesions with arterial stiffness, as assessed by the cardio-ankle vascular index, is not well characterized in the population. OBJECTIVE The aim of this study was to quantify the cross-sectional association of brain white matter lesions with arterial stiffness assessed by the cardio-ankle vascular index among 1176 adults. METHODS We used logistic regression to evaluate the associations of the cardio-ankle vascular index with brain white matter lesions, detected by computed tomography or magnetic resonance imaging, versus normal brain white matter. RESULTS After adjustment for age, sex, systolic blood pressure, blood lipid level, C reactive protein level, homocysteine level, uric acid level, urea nitrogen level, creatinine level, hypertension, diabetes, coronary artery disease, peripheral artery disease, and stroke, the multivariable analysis showed that age, sex, systolic blood pressure, stroke and the cardio-ankle vascular index were independently associated with the presence of brain white matter lesions. Age range (odds ratio: from 2.48 to 33.64, all p < 0.05) showed the strongest association, followed by stroke (odds ratio: 7.16, 95% confidence interval: 4.59 to 11.16), male sex (odds ratio: 1.80, 95% confidence interval: 1.18 to 2.75), cardio-ankle vascular index (odds ratio: 1.26, 95% confidence interval: 1.06 to 1.50) and systolic blood pressure (odds ratio: 1.01, 95% confidence interval: 1.00 to 1.02). CONCLUSION Higher arterial stiffness assessed by the cardio-ankle vascular index was associated with the presence of brain white matter lesions. Longitudinal characterization of the observed associations is warranted to assess whether arterial stiffness predicts brain white matter lesions.
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Affiliation(s)
- Huan Liu
- Vascular Medicine Center, Peking University Shougang Hospital, NO.9, Jinyuanzhuang Road, Shijingshan District, Beijing, 100144, China
| | - Jinbo Liu
- Vascular Medicine Center, Peking University Shougang Hospital, NO.9, Jinyuanzhuang Road, Shijingshan District, Beijing, 100144, China
| | - Hongwei Zhao
- Vascular Medicine Center, Peking University Shougang Hospital, NO.9, Jinyuanzhuang Road, Shijingshan District, Beijing, 100144, China
| | - Hongyu Wang
- Vascular Medicine Center, Peking University Shougang Hospital, NO.9, Jinyuanzhuang Road, Shijingshan District, Beijing, 100144, China.
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Liu J, Ke X, Lai Q. Increased tortuosity of bilateral distal internal carotid artery is associated with white matter hyperintensities. Acta Radiol 2021; 62:515-523. [PMID: 32551801 DOI: 10.1177/0284185120932386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although the pathophysiology of white matter hyperintensities remains unclear, we can recently explore the possible relationship with white matter hyperintensities by using quantitative parameter. PURPOSE To demonstrate the relationship between bilateral distal internal carotid arterial tortuosity and total brain white matter hyperintensities volume in elderly individuals. MATERIAL AND METHODS A total of 345 patients (age > 65 years) with brain magnetic resonance (MR) examinations were retrospectively included (44.1% men; mean age = 72.1 ± 6.25 years; 55.9% ≥ 70 years). We measured the Tortuosity Index (TI) of the bilateral distal internal carotid artery and basilar artery on MR angiography imaging, and white matter hyperintensities volume on fluid-attenuated inversion recovery MR sequence. Multiple linear regression was used to assess the association of the TI with quantitatively derived brain white matter hyperintensity volume, after adjusting for demographics (age, sex), vascular risk factors (hypertension, diabetes, heart disease), and vessel diameters, total intracranial volume (TIV). RESULTS Increased tortuosity of bilateral distal internal carotid artery was associated with greater burden of white matter hyperintensity volume (right: β = 11.223, P = 0.016; left: β = 20.701, P < 0.001). This relationship was independent of age and hypertension, both of which have been considered the strongest risk factors for white matter hyperintensities. CONCLUSION Our results suggest that tortuosity of the bilateral distal internal carotid artery is associated with white matter hyperintensities, independent of age and hypertension.
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Affiliation(s)
- Jiyang Liu
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
| | - Xiaoting Ke
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
| | - Qingquan Lai
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
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Xiao A, Ge QM, Zhong HF, Zhang LJ, Shu HY, Liang RB, Shao Y, Zhou Q. White Matter Hyperintensities of Bilateral Lenticular Putamen in Patients with Proliferative Diabetic Retinopathy: A Voxel-based Morphometric Study. Diabetes Metab Syndr Obes 2021; 14:3653-3665. [PMID: 34408460 PMCID: PMC8366956 DOI: 10.2147/dmso.s321270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To explore the changes in gray matter volume (GMV) and white matter volume (WMV) in proliferative diabetic retinopathy (PDR) patients using voxel-based morphometry (VBM). PARTICIPANTS AND METHODS In total, 15 patients (10 males, 5 females) with PDR were enrolled to the patient group and 15 healthy controls (10 males, 5 females) to the control group, matched for age, sex, handedness, and education status. All individuals underwent voxel-based morphometry scans. GMV and WMV were compared between the two groups. RESULTS GMV in bilateral superior temporal gyrus, sixth area of left cerebellum, left middle temporal gyrus, left orbital inferior frontal gyrus and left middle cingulum gyrus and WMV in left thalamus and left precuneus were significantly lower in patients than controls (P<0.01). Conversely, WMV was significantly higher in bilateral lenticular putamen of patients than controls (P<0.01). CONCLUSION Abnormal GMV and WMV in many specific areas of the cerebrum provide new insights for exploration of the occurrence and development of DR and its pathophysiology.
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Affiliation(s)
- Ang Xiao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Hui-Feng Zhong
- Department of Intensive Care, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, People’s Republic of China
| | - Li-Juan Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Hui-Ye Shu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Rong-Bin Liang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, 330006, People’s Republic of China
- Correspondence: Yi Shao; Qiong Zhou Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, No. 17, YongWaiZheng Street, DongHu District, Nanchang, 330006, Jiangxi, People’s Republic of China Tel/Fax +86 791-88692520; +86 791-88694639 Email ;
| | - Qiong Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, 330006, People’s Republic of China
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21
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Manukjan N, Ahmed Z, Fulton D, Blankesteijn WM, Foulquier S. A Systematic Review of WNT Signaling in Endothelial Cell Oligodendrocyte Interactions: Potential Relevance to Cerebral Small Vessel Disease. Cells 2020; 9:cells9061545. [PMID: 32630426 PMCID: PMC7349551 DOI: 10.3390/cells9061545] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 12/21/2022] Open
Abstract
Key pathological features of cerebral small vessel disease (cSVD) include impairment of the blood brain barrier (BBB) and the progression of white matter lesions (WMLs) amongst other structural lesions, leading to the clinical manifestations of cSVD. The function of endothelial cells (ECs) is of major importance to maintain a proper BBB. ECs interact with several cell types to provide structural and functional support to the brain. Oligodendrocytes (OLs) myelinate axons in the central nervous system and are crucial in sustaining the integrity of white matter. The interplay between ECs and OLs and their precursor cells (OPCs) has received limited attention yet seems of relevance for the study of BBB dysfunction and white matter injury in cSVD. Emerging evidence shows a crosstalk between ECs and OPCs/OLs, mediated by signaling through the Wingless and Int-1 (WNT)/β-catenin pathway. As the latter is involved in EC function (e.g., angiogenesis) and oligodendrogenesis, we reviewed the role of WNT/β-catenin signaling for both cell types and performed a systematic search to identify studies describing a WNT-mediated interplay between ECs and OPCs/OLs. Dysregulation of this interaction may limit remyelination of WMLs and render the BBB leaky, thereby initiating a vicious neuroinflammatory cycle. A better understanding of the role of this signaling pathway in EC-OL crosstalk is essential in understanding cSVD development.
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Affiliation(s)
- Narek Manukjan
- Department of Pharmacology and Toxicology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; or (W.M.B.)
- CARIM—School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 616, 6200 MD Maastricht, The Netherlands
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; (Z.A.); (D.F.)
| | - Zubair Ahmed
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; (Z.A.); (D.F.)
| | - Daniel Fulton
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; (Z.A.); (D.F.)
| | - W. Matthijs Blankesteijn
- Department of Pharmacology and Toxicology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; or (W.M.B.)
- CARIM—School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Sébastien Foulquier
- Department of Pharmacology and Toxicology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; or (W.M.B.)
- CARIM—School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 616, 6200 MD Maastricht, The Netherlands
- Department of Neurology, MHeNs—School for Mental Health and Neuroscience, Maastricht University Medical Center+, PO Box 616, 6200 MD Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-43-3881409
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22
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Khan W, Egorova N, Khlif MS, Mito R, Dhollander T, Brodtmann A. Three-tissue compositional analysis reveals in-vivo microstructural heterogeneity of white matter hyperintensities following stroke. Neuroimage 2020; 218:116869. [PMID: 32334092 DOI: 10.1016/j.neuroimage.2020.116869] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022] Open
Abstract
White matter hyperintensities (WMHs) are frequently observed on brain scans of older individuals and are associated with cognitive impairment and vascular brain burden. Recent studies have shown that WMHs may only represent an extreme end of a diffuse pathological spectrum of white matter (WM) degeneration. The present study investigated the microstructural characteristics of WMHs using an advanced diffusion MRI modelling approach known as Single-Shell 3-Tissue Constrained Spherical Deconvolution (SS3T-CSD), which provides information on different tissue compartments within each voxel. The SS3T-CSD method may provide complementary information in the interpretation of pathological tissue through the tissue-specific microstructural compositions of WMHs. Data were obtained from stroke patients enrolled in the Cognition and Neocortical Volume After Stroke (CANVAS) study, a study examining brain volume and cognition after stroke. WMHs were segmented using an automated method, based on fluid attenuated inversion recovery (FLAIR) images. Automated tissue segmentation was used to identify normal-appearing white matter (NAWM). WMHs were classified into juxtaventricular, periventricular and deep lesions, based on their distance from the ventricles (3-10 mm). We aimed to compare in stroke participants the microstructural composition of the different lesion classes of WMHs and compositions of NAWM to assess the in-vivo heterogeneity of these lesions. Results showed that the 3-tissue composition significantly differed between WMHs classes and NAWM. Specifically, the 3-tissue compositions for juxtaventricular and periventricular WMHs both exhibited a relatively greater fluid-like (free water) content, which is compatible with a presence of interstitial fluid accumulation, when compared to deep WMHs. These findings provide evidence of microstructural heterogeneity of WMHs in-vivo and may support new insights for understanding the role of WMH development in vascular neurodegeneration.
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Affiliation(s)
- Wasim Khan
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, UK.
| | - Natalia Egorova
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Mohamed Salah Khlif
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Remika Mito
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Thijs Dhollander
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Melbourne Dementia Research Centre, University of Melbourne, Victoria, Australia
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23
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Brain Microcirculation and Silent Cerebral Damage. Microcirculation 2020. [DOI: 10.1007/978-3-030-28199-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Iboaya A, Harris JL, Arickx AN, Nudo RJ. Models of Traumatic Brain Injury in Aged Animals: A Clinical Perspective. Neurorehabil Neural Repair 2019; 33:975-988. [PMID: 31722616 PMCID: PMC6920554 DOI: 10.1177/1545968319883879] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in the United States, with advanced age being one of the major predictors of poor prognosis. To replicate the mechanisms and multifaceted complexities of human TBI and develop prospective therapeutic treatments, various TBI animal models have been developed. These models have been essential in furthering our understanding of the pathophysiology and biochemical effects on brain mechanisms following TBI. Despite these advances, translating preclinical results to clinical application, particularly in elderly individuals, continues to be challenging. This review aims to provide a clinical perspective, identifying relevant variables currently not replicated in TBI animal models, to potentially improve translation to clinical practice, especially as it applies to elderly populations. As background for this clinical perspective, we reviewed articles indexed on PubMed from 1970 to 2019 that used aged animal models for studying TBI. These studies examined end points relevant for clinical translation, such as neurocognitive effects, sensorimotor behavior, physiological mechanisms, and efficacy of neuroprotective therapies. However, compared with the higher incidence of TBI in older individuals, animal studies on the basic science of aging and TBI remain remarkably scarce. Moreover, a fundamental disconnect remains between experiments in animal models of TBI and successful translation of findings for treating the older TBI population. In this article, we aim to provide a clinical perspective on the unique attributes of TBI in older individuals and a critical appraisal of the research to date on TBI in aged animal models as well as recommendations for future studies.
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Affiliation(s)
- Aiwane Iboaya
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Janna L Harris
- University of Kansas Medical Center, Kansas City, KS, USA
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25
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Kelly DM, Rothwell PM. Blood pressure and the brain: the neurology of hypertension. Pract Neurol 2019; 20:100-108. [DOI: 10.1136/practneurol-2019-002269] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 12/11/2022]
Abstract
Hypertension affects more than one in four adults. The brain is an early target of hypertension-induced organ damage, and may manifest as stroke, subclinical cerebrovascular abnormalities and dementia. Hypertension-related small vessel disease can cause vascular dementia and can potentiate Alzheimer’s pathology, lowering the threshold at which signs and symptoms manifest. Many hypertensive emergencies may also have a neurological presentation, such as hypertensive encephalopathy, haemorrhagic stroke or pre-eclampsia. Here we highlight the importance of blood pressure in maintaining brain health and the brain’s role in controlling blood pressure.
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26
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Chen X, Zhu Y, Geng S, Li Q, Jiang H. Association of Blood Pressure Variability and Intima-Media Thickness With White Matter Hyperintensities in Hypertensive Patients. Front Aging Neurosci 2019; 11:192. [PMID: 31447663 PMCID: PMC6691147 DOI: 10.3389/fnagi.2019.00192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Ambulatory blood pressure variability (ABPV), ABP, and carotid intima-media thickness (IMT) are closely associated with white matter hyperintensities (WMH), and few studies focused on establishing effective models based on ABP, ABPV, and IMT to predict the WMH burden. We aimed to evaluate the value of a predictive model based on the metrics of ABP, ABPV, and IMT, which were independently associated with the WMH burden. Methods: We retrospectively enrolled 140 hypertensive inpatients for physical examinations in Shanghai East Hospital, Tongji University School of Medicine between February 2018 and January 2019. The basic clinical information of all subjects was recorded, and we also collected the metrics of ABP, ABPV, and IMT. Patients with Fazekas scale grade ≥2 were classified into heavy burden of WMH group. Then, we analyzed the association between all characteristics and the WMH burden. Multivariate analysis was performed to assess whether the metrics of ABP, ABPV, and IMT were independently associated with WMH, and we used receiver operating characteristic (ROC) to evaluate the value of predictive model based on the metrics of ABP, ABPV, and IMT. Results: Higher WMH grade was associated with increasing age, diabetes mellitus, higher total cholesterol (TC), higher low-density lipoprotein (LDL), higher IMT, higher 24-h systolic blood pressure (SBP), higher daytime SBP, higher nocturnal SBP, 24-h and daytime standard deviation (SD) of SBP, and 24-h SBP weight SD; 24-h SBP, 24-h SBP-SD, and IMT were independently related to the burden of WMH even after adjusting for the clinical variables. In addition, we also established a model that has a higher predictive capacity using 24-h SBP, 24-h SBP-SD, and IMT in the ROC analysis to assess the WMH burden in hypertensive patients. Conclusions: Higher 24-h SBP, higher 24-h SBP-SD, and larger IMT were independently associated with a greater burden of WMH among elderly primary hypertension Asian patients. Establishing a model based on these factors might provide a new approach for enhancing the accuracy of diagnosis of WMH using metrics in 24-h ABPM and carotid ultrasound.
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Affiliation(s)
- Xin Chen
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingqian Zhu
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shasha Geng
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingqing Li
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Jiang
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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27
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White Matter Hyperintensity Regression: Comparison of Brain Atrophy and Cognitive Profiles with Progression and Stable Groups. Brain Sci 2019; 9:brainsci9070170. [PMID: 31330933 PMCID: PMC6680735 DOI: 10.3390/brainsci9070170] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/07/2019] [Accepted: 07/16/2019] [Indexed: 01/01/2023] Open
Abstract
Subcortical white matter hyperintensities (WMHs) in the aging population frequently represent vascular injury that may lead to cognitive impairment. WMH progression is well described, but the factors underlying WMH regression remain poorly understood. A sample of 351 participants from the Alzheimer’s Disease Neuroimaging Initiative 2 (ADNI2) was explored who had WMH volumetric quantification, structural brain measures, and cognitive measures (memory and executive function) at baseline and after approximately 2 years. Selected participants were categorized into three groups based on WMH change over time, including those that demonstrated regression (n = 96; 25.5%), stability (n = 72; 19.1%), and progression (n = 209; 55.4%). There were no significant differences in age, education, sex, or cognitive status between groups. Analysis of variance demonstrated significant differences in atrophy between the progression and both regression (p = 0.004) and stable groups (p = 0.012). Memory assessments improved over time in the regression and stable groups but declined in the progression group (p = 0.003; p = 0.018). WMH regression is associated with decreased brain atrophy and improvement in memory performance over two years compared to those with WMH progression, in whom memory and brain atrophy worsened. These data suggest that WMHs are dynamic and associated with changes in atrophy and cognition.
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28
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Ciorba A, Bianchini C, Crema L, Ceruti S, Ermili F, Aimoni C, Pelucchi S. White matter lesions and sudden sensorineural hearing loss. J Clin Neurosci 2019; 65:6-10. [PMID: 31072738 DOI: 10.1016/j.jocn.2019.04.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 01/22/2019] [Accepted: 04/28/2019] [Indexed: 11/24/2022]
Abstract
Aim of this paper is to investigate the presence of White Matter Lesions (WMLs) in subjects affected by Sudden Sensorineural Hearing Loss (SSNHL) and possibly to evaluate the significance of WMLs in SSNHL patients. A total of 64 patients (cases) affected by SSNHL were included in this case-control study. Hearing tests were performed at SSNHL onset, after 7 days and after 30 days. Cerebral MRI sequences were performed to rule out retrocochlear pathology, and WMLs were evaluated if present. MRI control group included 32 subjects, without hearing loss, affected by pituitary adenoma, who underwent cerebral MRI of follow-up. WML presence in those affected by SSNHL resulted having a similar distribution to that of the control group; however, we observed complete hearing recovery in 42,9% of patients without WML and in 11,6% of patients with WML >1 (p = 0,017*). The incidence of WML in patients with SSNHL was not different compared to that of the control group; however, MRI could have a prognostic role for SSNHL patients, as the presence of WMLs can been linked to a poorer hearing recovery rate.
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Affiliation(s)
- Andrea Ciorba
- ENT and Audiology Department, University Hospital of Ferrara, Italy.
| | - Chiara Bianchini
- ENT and Audiology Department, University Hospital of Ferrara, Italy
| | - Laura Crema
- ENT and Audiology Department, University Hospital of Ferrara, Italy
| | - Stefano Ceruti
- Neuroradiology Department, University Hospital of Ferrara, Italy
| | - Francesca Ermili
- Neuroradiology Department, University Hospital of Ferrara, Italy
| | - Claudia Aimoni
- ENT and Audiology Department, University Hospital of Ferrara, Italy
| | - Stefano Pelucchi
- ENT and Audiology Department, University Hospital of Ferrara, Italy
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29
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Gasparini S, Ferlazzo E, Sueri C, Cianci V, Ascoli M, Cavalli SM, Beghi E, Belcastro V, Bianchi A, Benna P, Cantello R, Consoli D, De Falco FA, Di Gennaro G, Gambardella A, Gigli GL, Iudice A, Labate A, Michelucci R, Paciaroni M, Palumbo P, Primavera A, Sartucci F, Striano P, Villani F, Russo E, De Sarro G, Aguglia U. Hypertension, seizures, and epilepsy: a review on pathophysiology and management. Neurol Sci 2019; 40:1775-1783. [PMID: 31055731 DOI: 10.1007/s10072-019-03913-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Epilepsy and hypertension are common chronic conditions, both showing high prevalence in older age groups. This review outlines current experimental and clinical evidence on both direct and indirect role of hypertension in epileptogenesis and discusses the principles of drug treatment in patients with hypertension and epilepsy. METHODS We selected English-written articles on epilepsy, hypertension, stroke, and cerebrovascular disease until December, 2018. RESULTS Renin-angiotensin system might play a central role in the direct interaction between hypertension and epilepsy, but other mechanisms may be contemplated. Large-artery stroke, small vessel disease and posterior reversible leukoencephalopathy syndrome are hypertension-related brain lesions able to determine epilepsy by indirect mechanisms. The role of hypertension as an independent risk factor for post-stroke epilepsy has not been demonstrated. The role of hypertension-related small vessel disease in adult-onset epilepsy has been demonstrated. Posterior reversible encephalopathy syndrome is an acute condition, often caused by a hypertensive crisis, associated with the occurrence of acute symptomatic seizures. Chronic antiepileptic treatment should consider the risk of drug-drug interactions with antihypertensives. CONCLUSIONS Current evidence from preclinical and clinical studies supports the vision that hypertension may be a cause of seizures and epilepsy through direct or indirect mechanisms. In both post-stroke epilepsy and small vessel disease-associated epilepsy, chronic antiepileptic treatment is recommended. In posterior reversible encephalopathy syndrome blood pressure must be rapidly lowered and prompt antiepileptic treatment should be initiated.
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Affiliation(s)
- Sara Gasparini
- Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio Calabria, Italy
| | - Edoardo Ferlazzo
- Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio Calabria, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy
| | - Chiara Sueri
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio Calabria, Italy
| | - Michele Ascoli
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio Calabria, Italy
| | - Salvatore M Cavalli
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio Calabria, Italy
| | - Ettore Beghi
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Amedeo Bianchi
- Department of Neurology and Epilepsy Centre, San Donato Hospital, Arezzo, Italy
| | - Paolo Benna
- Department of Neurosciences and Mental Health, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Roberto Cantello
- Neurology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | | | | | - Antonio Gambardella
- Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy
| | - Gian Luigi Gigli
- Neurology Unit, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Alfonso Iudice
- Department of Clinical and Experimental Medicine, Section of Neurology, University of Pisa, Pisa, Italy
| | - Angelo Labate
- Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy
| | - Roberto Michelucci
- IRCCS Institute of Neurological Sciences, Neurology Unit, Bellaria Hospital, Bologna, Italy
| | - Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | - Alberto Primavera
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Ferdinando Sartucci
- Department of Clinical and Experimental Medicine, Section of Neurology, University of Pisa, Pisa, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genoa, Italy
| | - Flavio Villani
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Giovambattista De Sarro
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Umberto Aguglia
- Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy. .,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio Calabria, Italy. .,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy. .,Regional Epilepsy Centre, Magna Graecia University of Catanzaro, Riuniti Hospital, Via Melacrino, Reggio Calabria, Italy.
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30
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Das AS, Regenhardt RW, Vernooij MW, Blacker D, Charidimou A, Viswanathan A. Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies. J Stroke 2019; 21:121-138. [PMID: 30991799 PMCID: PMC6549070 DOI: 10.5853/jos.2018.03608] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 02/28/2019] [Indexed: 12/28/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. In most cases, CSVD is only recognized in its advanced stages once its symptomatic sequelae develop. However, its significance in asymptomatic healthy populations remains poorly defined. In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. While the presence of these imaging markers may reflect unique mechanisms at play, there are likely shared pathways underlying CSVD. Herein, we aim to assess the etiology and significance of these individual biomarkers by focusing in asymptomatic populations at an epidemiological level. By primarily examining population-based studies, we explore the risk factors that are involved in the formation and progression of these biomarkers. Through a critical semi-systematic review, we aim to characterize “asymptomatic” CSVD, review screening modalities, and draw associations from observational studies in clinical populations. Lastly, we highlight areas of research (including therapeutic approaches) in which further investigation is needed to better understand asymptomatic CSVD.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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31
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Prevalence of fascicular hyperintensities in peripheral nerves of healthy individuals with regard to cerebral white matter lesions. Eur Radiol 2019; 29:3480-3487. [DOI: 10.1007/s00330-019-06145-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 12/12/2022]
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32
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McKetton L, Venkatraghavan L, Rosen C, Mandell DM, Sam K, Sobczyk O, Poublanc J, Gray E, Crawley A, Duffin J, Fisher JA, Mikulis DJ. Improved White Matter Cerebrovascular Reactivity after Revascularization in Patients with Steno-Occlusive Disease. AJNR Am J Neuroradiol 2018; 40:45-50. [PMID: 30573457 DOI: 10.3174/ajnr.a5912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE One feature that patients with steno-occlusive cerebrovascular disease have in common is the presence of white matter (WM) lesions on MRI. The purpose of this study was to evaluate the effect of direct surgical revascularization on impaired WM cerebrovascular reactivity in patients with steno-occlusive disease. MATERIALS AND METHODS We recruited 35 patients with steno-occlusive disease, Moyamoya disease (n = 24), Moyamoya syndrome (n = 3), atherosclerosis (n = 6), vasculitis (n = 1), and idiopathic stenosis (n = 1), who underwent unilateral brain revascularization using a direct superficial temporal artery-to-MCA bypass (19 women; mean age, 45.8 ± 16.5 years). WM cerebrovascular reactivity was measured preoperatively and postoperatively using blood oxygen level-dependent (BOLD) MR imaging during iso-oxic hypercapnic changes in end-tidal carbon dioxide and was expressed as %Δ BOLD MR signal intensity per millimeter end-tidal partial pressure of CO2. RESULTS WM cerebrovascular reactivity significantly improved after direct unilateral superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass in the revascularized hemisphere in the MCA territory (mean ± SD, -0.0005 ± 0.053 to 0.053 ± 0.046 %BOLD/mm Hg; P < .0001) and in the anterior cerebral artery territory (mean, 0.0015 ± 0.059 to 0.021 ± 0.052 %BOLD/mm Hg; P = .005). There was no difference in WM cerebrovascular reactivity in the ipsilateral posterior cerebral artery territory nor in the vascular territories of the nonrevascularized hemisphere (P < .05). CONCLUSIONS Cerebral revascularization surgery is an effective treatment for reversing preoperative cerebrovascular reactivity deficits in WM. In addition, direct-STA-MCA bypass may prevent recurrence of preoperative symptoms.
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Affiliation(s)
- L McKetton
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - L Venkatraghavan
- Department of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada
| | - C Rosen
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - D M Mandell
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - K Sam
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.).,Russell H. Morgan Department of Radiology and Radiological Science (K.S.), John Hopkins School of Medicine, Baltimore, Maryland
| | - O Sobczyk
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - J Poublanc
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - E Gray
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - A Crawley
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - J Duffin
- Department of Physiology (J.D., J.A.F.).,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - J A Fisher
- Department of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada.,Department of Physiology (J.D., J.A.F.).,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - D J Mikulis
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.) .,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
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Diniz PHB, Valente TLA, Diniz JOB, Silva AC, Gattass M, Ventura N, Muniz BC, Gasparetto EL. Detection of white matter lesion regions in MRI using SLIC0 and convolutional neural network. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 167:49-63. [PMID: 29706405 DOI: 10.1016/j.cmpb.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 02/12/2018] [Accepted: 04/17/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVE White matter lesions are non-static brain lesions that have a prevalence rate up to 98% in the elderly population. Because they may be associated with several brain diseases, it is important that they are detected as soon as possible. Magnetic Resonance Imaging (MRI) provides three-dimensional data with the possibility to detect and emphasize contrast differences in soft tissues, providing rich information about the human soft tissue anatomy. However, the amount of data provided for these images is far too much for manual analysis/interpretation, representing a difficult and time-consuming task for specialists. This work presents a computational methodology capable of detecting regions of white matter lesions of the brain in MRI of FLAIR modality. The techniques highlighted in this methodology are SLIC0 clustering for candidate segmentation and convolutional neural networks for candidate classification. METHODS The methodology proposed here consists of four steps: (1) images acquisition, (2) images preprocessing, (3) candidates segmentation and (4) candidates classification. RESULTS The methodology was applied on 91 magnetic resonance images provided by DASA, and achieved an accuracy of 98.73%, specificity of 98.77% and sensitivity of 78.79% with 0.005 of false positives, without any false positives reduction technique, in detection of white matter lesion regions. CONCLUSIONS It is demonstrated the feasibility of the analysis of brain MRI using SLIC0 and convolutional neural network techniques to achieve success in detection of white matter lesions regions.
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Affiliation(s)
- Pedro Henrique Bandeira Diniz
- Pontifical Catholic University of Rio de Janeiro - PUC - RioR. São Vicente, 225, Gávea, RJ, Rio de Janeiro, 22453-900, Brazil.
| | - Thales Levi Azevedo Valente
- Pontifical Catholic University of Rio de Janeiro - PUC - RioR. São Vicente, 225, Gávea, RJ, Rio de Janeiro, 22453-900, Brazil.
| | - João Otávio Bandeira Diniz
- Federal University of Maranhão - UFMA Applied Computing Group - NCA Av. dos Portugueses, SN, Bacanga, MA, São Luís, 65085-580, Brazil.
| | - Aristófanes Corrêa Silva
- Federal University of Maranhão - UFMA Applied Computing Group - NCA Av. dos Portugueses, SN, Bacanga, MA, São Luís, 65085-580, Brazil.
| | - Marcelo Gattass
- Pontifical Catholic University of Rio de Janeiro - PUC - RioR. São Vicente, 225, Gávea, RJ, Rio de Janeiro, 22453-900, Brazil.
| | - Nina Ventura
- Paulo Niemeyer State Brain Institute - IECR. Lobo Júnior, 2293, Penha -RJ, 21070-060, Brazil.
| | - Bernardo Carvalho Muniz
- Paulo Niemeyer State Brain Institute - IECR. Lobo Júnior, 2293, Penha -RJ, 21070-060, Brazil.
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34
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Wan L, Huang H, Schwab N, Tanner J, Rajan A, Lam NB, Zaborszky L, Li CSR, Price CC, Ding M. From eyes-closed to eyes-open: Role of cholinergic projections in EC-to-EO alpha reactivity revealed by combining EEG and MRI. Hum Brain Mapp 2018; 40:566-577. [PMID: 30251753 DOI: 10.1002/hbm.24395] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/11/2018] [Accepted: 08/31/2018] [Indexed: 12/13/2022] Open
Abstract
Alpha rhythm (8 to 12 Hz) observed in EEG over human posterior cortex is prominent during eyes-closed (EC) resting and attenuates during eyes-open (EO) resting. Research shows that the degree of EC-to-EO alpha blocking or alpha desynchronization, termed alpha reactivity here, is a neural marker of cognitive health. We tested the role of acetylcholine in EC-to-EO alpha reactivity by applying a multimodal neuroimaging approach to a cohort of young adults and a cohort of older adults. In the young cohort, simultaneous EEG-fMRI was recorded from twenty-one young adults during both EO and EC resting. In the older cohort, functional MRI was recorded from forty older adults during EO and EC resting, along with FLAIR and diffusion MRI. For a subset of twenty older adults, EEG was recorded during EO and EC resting in a separate session. In both young and older adults, functional connectivity between the basal nucleus of Meynert (BNM), the major source of cortical acetylcholine, and the visual cortex increased from EC to EO, and this connectivity increase was positively associated with alpha reactivity; namely, the stronger the BNM-visual cortex functional connectivity increase from EC to EO, the larger the EC-to-EO alpha desynchronization. In older adults, lesions of the fiber tracts linking BNM and visual cortex quantified by leukoaraiosis volume, associated with reduced alpha reactivity. These findings support a role of acetylcholine and particularly cholinergic pathways in mediating EC-to-EO alpha reactivity and suggest that impaired alpha reactivity could serve as a marker of the integrity of the cholinergic system.
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Affiliation(s)
- Lu Wan
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Haiqing Huang
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nadine Schwab
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| | - Jared Tanner
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| | - Abhijit Rajan
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Ngoc B Lam
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Laszlo Zaborszky
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, New Jersey
| | - Chiang-Shan R Li
- Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven, Connecticut
| | - Catherine C Price
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| | - Mingzhou Ding
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
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35
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Fladt J, Kronlage C, De Marchis GM. Cerebral White Matter Hyperintensities and Microbleeds in Acute Ischemic Stroke: Impact on Recanalization Therapies. A Review of the Literature. Neurosci Lett 2018; 687:55-64. [PMID: 30194982 DOI: 10.1016/j.neulet.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 12/30/2022]
Abstract
Cerebral white matter hyperintensities (WMH) and cerebral microbleeds (CMBs) are frequently seen on brain imaging acquired for acute ischemic stroke. Given the raising use of recanalization therapies - both intravenous and endovascular - the interest on the impact of WMH and CMBs on the risk of intracerebral hemorrhage and on functional outcome is growing. In this review, we will discuss the relevance of WMH and CMBs among patients with an acute ischemic stroke, focusing on the implications for recanalization therapies.
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Affiliation(s)
- J Fladt
- Department of Neurology, University Hospital Basel, Switzerland
| | - C Kronlage
- Department of Neurology, University Hospital Basel, Switzerland
| | - G M De Marchis
- Department of Neurology, University Hospital Basel, Switzerland.
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36
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Liu Y, Dong YH, Lyu PY, Chen WH, Li R. Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment. Chin Med J (Engl) 2018; 131:615-619. [PMID: 29483399 PMCID: PMC5850681 DOI: 10.4103/0366-6999.226069] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Alzheimer's disease and vascular dementia are responsible for more than 80% of dementia cases. These two conditions share common risk factors including hypertension. Cerebral small vessel disease (CSVD) is strongly associated with both hypertension and cognitive impairment. In this review, we identify the pathophysiological changes in CSVD that are caused by hypertension and further explore the relationship between CSVD and cognitive impairment. Data Sources: We searched and scanned the PubMed database for recently published literatures up to December 2017. We used the keywords of “hypertension”, “cerebral small vessel disease”, “white matter lesions”, “enlarged perivascular spaces”, “lacunar infarcts”, “cerebral microbleeds”, and “cognitive impairment” in the database of PubMed. Study Selection: Articles were obtained and reviewed to analyze the hypertension-induced pathophysiological changes that occur in CSVD and the correlation between CSVD and cognitive impairment. Results: In recent years, studies have demonstrated that hypertension-related changes (e.g., small vascular lesions, inflammatory reactions, hypoperfusion, oxidative stress, damage to autoregulatory processes and the blood-brain barrier, and cerebral amyloid angiopathy) can occur over time in cerebral small vessels, potentially leading to lower cognitive function when blood pressure (BP) control is poor or lacking. Both isolated and co-occurrent CSVD can lead to cognitive deterioration, and this effect may be attributable to a dysfunction in either the cholinergic system or the functionality of cortical and subcortical tracts. Conclusions: We explore the currently available evidence about the hypertensive vasculopathy and inflammatory changes that occur in CSVD. Both are vital prognostic indicators of the development of cognitive impairment. Future studies should be performed to validate the relationship between BP levels and CSVD progression and between the numbers, volumes, and anatomical locations of CSVD and cognitive impairment.
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Affiliation(s)
- Yang Liu
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050017; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Yan-Hong Dong
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Pei-Yuan Lyu
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050017; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Wei-Hong Chen
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050017; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Rui Li
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050017; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
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37
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Obusez EC, Svensson L, Bullen J, Obuchowski N, Jones SE. Deep chronic microvascular white matter ischemic change as an independent predictor of acute brain infarction after thoracic aortic replacement. J Card Surg 2018; 33:552-560. [PMID: 30175455 DOI: 10.1111/jocs.13786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative brain injury is a cause of mortality and morbidity in patients who undergo thoracic aortic replacement. Chronic microvascular white matter ischemic change (WMIC) has been shown to be associated with acute brain infarction in the general population. WMIC has also been shown to be an independent predictor of non-focal neurocognitive changes, generalized seizures, and temporary neurologic dysfunction in patients who undergo thoracic aortic replacement. The aim of this study is to determine if WMIC is a risk factor for acute brain infarction in patients who undergo thoracic aortic replacement. METHODS A case-control study of patients who underwent thoracic aortic replacement between 2001 and 2014 were reviewed for neurological changes after surgery and acute brain infarction on postoperative diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI). Patients with neurological changes were matched with control patients who underwent thoracic aortic replacement and had postoperative neurological symptoms without acute brain infarctions. Acute infarction was re-assessed by reviewing DWI sequences on postoperative MRI. WMIC was assessed on FLAIR and T2WI sequences on both preoperative and postoperative MRI. Logistic regression was performed assessing the relationship of WMIC and acute ischemic infarction. RESULTS 5171 patients underwent thoracic aortic replacement; 179 had postoperative neurological changes, and of those 53 patients had acute brain infarction on postoperative DWI. Patients with deep WMIC were more likely to have acute DWI infarctions after thoracic aortic replacement (P = 0.023). CONCLUSION Our matched retrospective case-controlled study shows deep WMIC to be a predictor of acute brain infarction on DWI after thoracic aortic replacement.
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Affiliation(s)
- Emmanuel C Obusez
- Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Thoracic and Cardiovascular Surgery, Center for Aortic Surgery, Marfans Syndrome and Connective Tissue Disorder Clinic, Heart and Vascular Institute; Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Bullen
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Nancy Obuchowski
- Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Stephen E Jones
- Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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Giralt-Steinhauer E, Medrano S, Soriano-Tárraga C, Mola-Caminal M, Rasal R, Cuadrado-Godia E, Rodríguez-Campello A, Ois A, Capellades J, Jimenez-Conde J, Roquer J. Brainstem leukoaraiosis independently predicts poor outcome after ischemic stroke. Eur J Neurol 2018; 25:1086-1092. [PMID: 29660221 DOI: 10.1111/ene.13659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/02/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Increased supratentorial white matter hyperintensities volume (S-WMHV) has been reported to be a predictor of worse outcome in patients with acute ischemic stroke (AIS). However, few studies have focused on less common locations, such as brainstem white matter hyperintensities (B-WMH), and their relationship to S-WMHV. This study aimed to examine whether B-WMH affect clinical outcome after AIS or transient ischemic attack (TIA). METHODS Based on magnetic resonance imaging evidence, B-WMH were evaluated in 313 prospectively identified patients with AIS/TIA and registered as absent or present. Standardized S-WMHV was quantified using a validated volumetric image analysis and natural log-transformed (Log_S-WMHV). Poor outcome was defined as a modified Rankin Scale score of 3-6 at 3 months after the index event. RESULTS Brainstem white matter hyperintensities were detected in 57 (18.2%) patients. In unadjusted analyses for outcome, the presence of B-WMH was associated with worse outcome, compared with patients without B-WMH (P = 0.034). In multivariate analysis controlling for age, atrial fibrillation, stroke severity, reperfusion therapies and Log_S-WMHV, only B-WMH [odds ratio (OR), 2.46; P = 0.021] and stroke severity (OR, 1.23; P < 0.001) remained independently associated with unfavourable 90-day modified Rankin Scale score. Patients with B-WMH were older (OR, 1.06; P < 0.001) and tended to have more hyperlipidaemia (OR, 2.21; P = 0.023) and peripheral arterial disease (OR, 2.57; P = 0.031). CONCLUSIONS Brainstem white matter hyperintensities are an independent predictor of poor outcome after AIS/TIA and this relationship persists after adjustment for important prognostic factors. Our results also show that leukoaraiosis in this location identifies patients with a specific risk factor profile, suggesting differences in the underlying pathogenesis.
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Affiliation(s)
- E Giralt-Steinhauer
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - S Medrano
- Neuroradiology Department, Hospital del Mar, Universistat Autònoma de Barcelona, Barcelona
| | - C Soriano-Tárraga
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - M Mola-Caminal
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - R Rasal
- Neurology Service, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - E Cuadrado-Godia
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - A Rodríguez-Campello
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - A Ois
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - J Capellades
- Neuroradiology Department, Hospital del Mar, Universistat Autònoma de Barcelona, Barcelona
| | - J Jimenez-Conde
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - J Roquer
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
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Yang WI, Kim IJ, Kim MS, Kim SH, Moon JY, Sung JH, Lim SW, Cha DH, Cho SY. Association of elevated blood pressure during exercise with cerebral white matter lesions. Blood Press 2018; 27:166-172. [PMID: 29308930 DOI: 10.1080/08037051.2018.1423544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Cerebral white matter lesions (WMLs) are regarded to be subclinical ischemic changes of the cerebral parenchyma. Many previous studies have shown that baseline blood pressure (BP) is one of the most important factors for WMLs, but the relation between exercise BP and WMLs has not been fully evaluated. So, we sought to investigate the relationships between cerebral WMLs and peak exercise BP. METHODS Brain magnetic resonance imaging scan and treadmill testing were performed simultaneously in 130 consecutive subjects without history of stroke or transient ischemic stroke. RESULTS Among 130 subjects, 42 individuals (32%) presented WMLs. Individuals with WMLs were older than those without WMLs, and baseline systolic BP and pulse pressure were higher in subjects with WMLs. During treadmill test, peak exercise systolic BP was more significantly elevated in subjects with WMLs. In multivariable logistic regression analysis, elevated baseline systolic BP, not peak exercise systolic BP, was associated with the presence of WMLs, independently of age. However, in multivariable logistic regression analysis of 88 normotensive subjects, elevated peak systolic BP during exercise was the only determinant for the presence of WMLs. CONCLUSIONS Elevated peak systolic BP during exercise is significantly related with WMLs, subclinical small vessel disease of brain, especially in normotensive subjects.
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Affiliation(s)
- Woo-In Yang
- a Department of Cardiology , CHA Bundang Medical Center, CHA University , Sungnam , Republic of Korea
| | - In-Jai Kim
- a Department of Cardiology , CHA Bundang Medical Center, CHA University , Sungnam , Republic of Korea
| | - Mi-Sun Kim
- b Department of Radiology , Chaum Medical Center, CHA University , Seoul , Republic of Korea
| | - Sang-Hoon Kim
- a Department of Cardiology , CHA Bundang Medical Center, CHA University , Sungnam , Republic of Korea
| | - Jae-Youn Moon
- a Department of Cardiology , CHA Bundang Medical Center, CHA University , Sungnam , Republic of Korea
| | - Jung-Hoon Sung
- a Department of Cardiology , CHA Bundang Medical Center, CHA University , Sungnam , Republic of Korea
| | - Sang-Wook Lim
- a Department of Cardiology , CHA Bundang Medical Center, CHA University , Sungnam , Republic of Korea
| | - Dong-Hoon Cha
- a Department of Cardiology , CHA Bundang Medical Center, CHA University , Sungnam , Republic of Korea
| | - Seung-Yun Cho
- c Department of Cardiology , Chaum Medical Center, CHA University , Seoul , Republic of Korea
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Della-Morte D, Dong C, Markert MS, Elkind MSV, Sacco RL, Wright CB, Rundek T. Carotid Intima-Media Thickness Is Associated With White Matter Hyperintensities: The Northern Manhattan Study. Stroke 2017; 49:304-311. [PMID: 29284725 DOI: 10.1161/strokeaha.117.018943] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/20/2017] [Accepted: 11/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Brain white matter hyperintensities (WMH) have been associated with increased risk of stroke, cognitive decline, and dementia. WMH can be a manifestation of small vessel disease, although the total microvascular contribution to multifactorial WMH pathophysiology remains unknown. We hypothesized a possible relationship between carotid intima-media thickness (cIMT), an ultrasound imaging marker of subclinical vascular disease, and brain WMH in a multiethnic, elderly stroke-free community-based cohort. METHODS We evaluated the relationship between cIMT and WMH in the population-based Northern Manhattan Study, among individuals free of stroke. We used linear regression to examine the association of continuous measures of cIMT with quantitatively derived WMH volume, as a proportion of cranial volume, measured from fluid-attenuaded inversion recovery magnetic resonance imaging while adjusting for sociodemographics, lifestyle, and vascular risk factors. RESULTS In a cohort of 1229 participants (mean age, 71±9 years; 60% women, 15% White; 18% Black; 65% Hispanics), the mean cIMT was 0.71±0.08 mm and the median log-transformed WMH volume was 0.36 (interquartile range, 0.21-0.76). In a multivariable model, larger cIMT was significantly associated with greater WMH volume (β=0.046 per SD cIMT; P=0.04). Age and race/ethnicity were significant modifiers (P for age, 0.02; and P for race/ethnicity, 0.04). cIMT was associated with WMH volume in participants 70 years or older (β=0.088 per SD cIMT; P=0.01) and among Hispanics (β=0.084 per SD cIMT; P=0.003). CONCLUSIONS Larger cIMT was associated with greater burden of cerebral WM lesions independently of demographics and traditional vascular risk factors, particularly among elderly and Hispanic participants, who are at high risk for stroke and cognitive decline.
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Affiliation(s)
- David Della-Morte
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Chuanhui Dong
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Matthew S Markert
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Mitchell S V Elkind
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Ralph L Sacco
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Clinton B Wright
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Tatjana Rundek
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.).
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Kimura S, Ogata T, Watanabe J, Inoue T, Tsuboi Y. Does cerebral large-artery disease contribute to cognitive impairment? eNeurologicalSci 2017; 8:5-8. [PMID: 29260027 PMCID: PMC5730908 DOI: 10.1016/j.ensci.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/12/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose Although many patients with cerebral large-artery disease (CLAD) show impaired cognitive performance, the risk factors remain unclear in this population. The objective of this study was to evaluate cognitive impairment and its risk factors in patients with CLAD. Methods We recruited non-demented patients with CLAD from our hospital. CLAD was defined as occlusion or stenosis of over 50% in the carotid artery or middle cerebral artery. We collected patients' biographical data and vascular lesion and imaging data, including periventricular hyperintensity (PVH) and cerebral perfusion. The patients were divided into two groups: cognitive impairment-plus (CoI +) and normal (CoI −) groups, according to their Montreal Cognitive Assessment (MoCA) scores, with a cut-off value of 26. The factors associated with cognitive impairment were examined. Result Of the 176 patients with CLAD (mean age 70.2 ± 8.3, 40 female), 136 (77.2%) were classified as cognitively impaired. Multivariate analysis indicated that the CoI + group was associated with older age (odds ratio (OR): 1.09, P = 0.011), drinking habit (OR: 7.15, P = 0.003), increased PVH (OR: 3.46, P = 0.003), and decreased cerebral perfusion (OR: 0.897, P = 0.007). Analyses of the MoCA subscores indicated that attention, memory, and orientation were impaired in the CoI + group. Conclusion Impaired cognition was observed in some of the non-demented patients with CLAD. Older age, drinking habit, severe PVH and decreased cerebral perfusion contributed to their poor cognitive performance. Strict treatment of atherosclerosis and intervention for CLAD might be necessary to prevent cognitive decline in these patients.
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Park JH. Vascular Contributions to Late Life Depression. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fierini F, Poggesi A, Pantoni L. Leukoaraiosis as an outcome predictor in the acute and subacute phases of stroke. Expert Rev Neurother 2017; 17:963-975. [PMID: 28829216 DOI: 10.1080/14737175.2017.1371013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Leukoaraiosis (LA) is one of the neuroimaging features of cerebral small vessel disease and is associated with poor long-term prognosis. Areas covered: This narrative review focuses on the predictive role of LA on the evolution of the ischemic brain damage and on the clinical outcome in the subacute phase of stroke and in the short-term period afterwards. Expert commentary: LA predicts poorer tissue outcome and clinical prognosis also in acute and subacute stroke. In acute stroke, LA is associated with a less favorable fate of brain infarct and is a marker of increased risk of thrombolysis-related hemorrhagic transformation. The impaired cerebral microcirculation in LA patients may sustain the progression of ischemic lesion and enhance the bleeding risk. The short-term worse clinical outcome in ischemic stroke and intracranial hemorrhage patients with LA might be attributable to a state of altered brain connectivity. Endothelial failure, reduced micro-vessels density, and deficient collateral flow together with reduced functional reserve are some of the involved mechanisms. Future studies should aim at bridging the gap between the knowledge about LA pathophysiology and the therapeutic improvement of brain tissue perfusion and at producing data on early rehabilitation of stroke patients with LA at high disability risk.
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Affiliation(s)
- Fabio Fierini
- a Neurofarba Department, Neuroscience Section , University of Florence , Florence , Italy
| | - Anna Poggesi
- a Neurofarba Department, Neuroscience Section , University of Florence , Florence , Italy
| | - Leonardo Pantoni
- a Neurofarba Department, Neuroscience Section , University of Florence , Florence , Italy
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Raman MR, Kantarci K, Murray ME, Jack CR, Vemuri P. Imaging markers of cerebrovascular pathologies: Pathophysiology, clinical presentation, and risk factors. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 5:5-14. [PMID: 28054023 PMCID: PMC5198884 DOI: 10.1016/j.dadm.2016.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebrovascular pathologies (CVPs) are common pathologies associated with age-related cognitive decline along with Alzheimer disease pathologies. The impact of CVP on the prevalence of dementia is increasingly being recognized. The goal of this review is to improve our understanding of the pathophysiological underpinnings and the multimodal magnetic resonance imaging and positron emission tomography imaging changes that are associated with the hallmarks of CVP. This knowledge will facilitate the development of early detection, intervention, and prevention strategies that may contribute to lowering the risk of dementia. In this review, we will first discuss currently known risk factors of CVPs including cardiovascular, lifestyle, genetic, sex differences, and head injury. Next, we will focus on the pathophysiology of CVPs and their impact on neurodegeneration and downstream cognitive impairment. Specifically, we will discuss three of the most common cerebrovascular lesions seen on MRI: white-matter hyperintensity, microbleeds, and infarcts. Finally, we will discuss the unanswered open questions in this field.
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Affiliation(s)
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Dichgans M, Wardlaw J, Smith E, Zietemann V, Seshadri S, Sachdev P, Biessels GJ, Fazekas F, Benavente O, Pantoni L, De Leeuw F, Norrving B, Matthews P, Chen C, Mok V, Düring M, Whiteley W, Shuler K, Alonso A, Black SE, Brayne C, Chabriat H, Cordonnier C, Doubal F, Duzel E, Ewers M, Frayne R, Hachinski V, Ikram MA, Jessen F, Jouvent E, Linn J, O'Brien J, van Oostenbrugge R, Malik R, Mazoyer B, Schmidt R, Sposato LA, Stephan B, Swartz RH, Vernooij M, Viswanathan A, Werring D, Abe K, Allan L, Arba F, Diener H, Davis S, Hankey G, Lees K, Ovbiagele B, Weir C, Bae H, Bath PMW, Bordet R, Breteler M, Choi S, Deary I, DeCarli C, Ebmeier K, Feng L, Greenberg SM, Ihara M, Kalaria R, Kim S, Lim J, Lindley RI, Mead G, Murray A, Quinn T, Ritchie C, Sacco R, Al‐Shahi Salman R, Sprigg N, Sudlow C, Thomas A, van Boxtel M, van der Grond J, van der Lugt A, Yang Y. METACOHORTS for the study of vascular disease and its contribution to cognitive decline and neurodegeneration: An initiative of the Joint Programme for Neurodegenerative Disease Research. Alzheimers Dement 2016; 12:1235-1249. [PMID: 27490018 PMCID: PMC5399602 DOI: 10.1016/j.jalz.2016.06.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 06/09/2016] [Indexed: 12/18/2022]
Abstract
Dementia is a global problem and major target for health care providers. Although up to 45% of cases are primarily or partly due to cerebrovascular disease, little is known of these mechanisms or treatments because most dementia research still focuses on pure Alzheimer's disease. An improved understanding of the vascular contributions to neurodegeneration and dementia, particularly by small vessel disease, is hampered by imprecise data, including the incidence and prevalence of symptomatic and clinically "silent" cerebrovascular disease, long-term outcomes (cognitive, stroke, or functional), and risk factors. New large collaborative studies with long follow-up are expensive and time consuming, yet substantial data to advance the field are available. In an initiative funded by the Joint Programme for Neurodegenerative Disease Research, 55 international experts surveyed and assessed available data, starting with European cohorts, to promote data sharing to advance understanding of how vascular disease affects brain structure and function, optimize methods for cerebrovascular disease in neurodegeneration research, and focus future research on gaps in knowledge. Here, we summarize the results and recommendations from this initiative. We identified data from over 90 studies, including over 660,000 participants, many being additional to neurodegeneration data initiatives. The enthusiastic response means that cohorts from North America, Australasia, and the Asia Pacific Region are included, creating a truly global, collaborative, data sharing platform, linked to major national dementia initiatives. Furthermore, the revised World Health Organization International Classification of Diseases version 11 should facilitate recognition of vascular-related brain damage by creating one category for all cerebrovascular disease presentations and thus accelerate identification of targets for dementia prevention.
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Mortilla M, Federico A, De Stefano N. Uso della risonanza magnetica spettroscopica del protone nello studio delle malattie della sostanza bianca cerebrale. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140090001300113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La risonanza magnetica spettroscopica (MRS) è una tecnica non invasiva per la misura della concentrazione relativa di alcuni composti cerebrali. L'uso di questa tecnica nello studio delle malattie della materia bianca cerebrale ha apportato miglioramenti nella classificazione diagnostica e nelle misure relative all'andamento delle malattie. Un uso più estensivo delle tecniche di risonanza multimodale, comprendenti tomografia RM, spettroscopia ed altre modalità non convenzionali, dovrebbe quindi essere incoraggiato. Ciò permetterà una miglior comprensione della complessa dinamica dei cambiamenti patologici nelle malattie della sostanza bianca ed una più accurata valutazione della progressione e della risposta alla terapia della malattia stessa.
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Affiliation(s)
- M. Mortilla
- Istituto di Scienze Neurologiche e Centro NMR, Università degli Studi; Siena
| | - A. Federico
- Istituto di Scienze Neurologiche e Centro NMR, Università degli Studi; Siena
| | - N. De Stefano
- Istituto di Scienze Neurologiche e Centro NMR, Università degli Studi; Siena
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Differential associations between systemic markers of disease and cortical thickness in healthy middle-aged and older adults. Neuroimage 2016; 146:19-27. [PMID: 27847345 DOI: 10.1016/j.neuroimage.2016.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 11/20/2022] Open
Abstract
Aside from cortical damage associated with age, cerebrovascular and neurodegenerative diseases, it's an outstanding question if factors of global health, including normal variation in blood markers of metabolic and systemic function, may also be associated with individual variation in brain structure. This cross-sectional study included 138 individuals between 40 to 86 years old who were physically healthy and cognitively intact. Eleven markers (total cholesterol, HDL, LDL, triglycerides, insulin, fasting glucose, glycated hemoglobin, creatinine, blood urea nitrogen, albumin, total protein) and five derived indicators (estimated glomerular filtration rate, creatinine clearance rate, insulin-resistance, average glucose, and cholesterol/HDL ratio) were obtained from blood sampling of all participants. T1-weighted 3T MRI scans were used to evaluate gray matter cortical thickness. The markers were clustered into five factors, and factor scores were related to cortical thickness by general linear model. Two factors, one linked to insulin/metabolic health and the other to kidney function (KFF) showed regionally selective associations with cortical thickness including lateral and medial temporal, temporoparietal, and superior parietal regions for both factors and frontoparietal regions for KFF. An association between the increasing cholesterol and greater thickness in frontoparietal and occipital areas was also noted. Associations persisted independently of age, presence of cardiovascular risk factors and ApoE gene status. These findings may provide information on distinct mechanisms of inter-individual cortical variation as well as factors contributing to trajectories of cortical thinning with advancing age.
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Charidimou A, Pantoni L, Love S. The concept of sporadic cerebral small vessel disease: A road map on key definitions and current concepts. Int J Stroke 2016; 11:6-18. [PMID: 26763016 DOI: 10.1177/1747493015607485] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sporadic cerebral small vessel disease is considered to be among the most common known neuropathological processes and has an important role in stroke, cognitive impairment, and functional loss in elderly persons. The term is now commonly used to describe a range of neuroimaging, neuropathological, and associated clinical features, the pathogenesis of which is largely unclear but that are thought to arise from disease affecting the perforating cerebral arterioles, capillaries, and venules. Modern neuroimaging has revolutionized our understanding of the consequences of small vessels disease on the brain parenchyma, even though small arteries, arterioles, capillaries, and venules are difficult to be directly visualized with current techniques used in clinical practice. In this short review, we focus on histopathological and neuroimaging perspectives, basic definitions, and recent advances in the field.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, USA UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Leonardo Pantoni
- NEUROFARBA Department, University of Florence and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Seth Love
- Dementia Research Group, Institute of Clinical Neurosciences, University of Bristol, Learning & Research Level 2, Southmead Hospital, Bristol, UK
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Yu C, Han X, Zhang XL, Yu B, Dong Q. Long-term effects of white matter changes on the risk of stroke recurrence after carotid artery stenting in patients with symptomatic carotid artery stenosis. J Neurol Sci 2016; 369:11-14. [PMID: 27653857 DOI: 10.1016/j.jns.2016.07.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/11/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cerebral white matter changes (WMC) are associated with increased 30-day perioperative risk of stroke in patients undergoing carotid artery stenting (CAS). However, there is no data showing their impact on postoperative long-term stroke recurrence or survival. It remains unknown whether this effect is independent of classic cardiovascular risk factors or not. We tried to assess the effects of WMC on long-term stroke recurrence after CAS in patients with symptomatic carotid stenosis. METHODS A database of patients with symptomatic carotid stenosis who had undergone CAS was sampled in a single Chinese medical center from 2007 to 2014. Copies of baseline brain imaging were analyzed by two investigators to evaluate the severity of WMC. We analyzed the association between WMC and stroke recurrence after CAS by reviewing case histories and conducting telephone interviews, with a mean follow-up time of 28months. RESULTS 107 patients with an average age of 66years fulfilled the inclusion criteria, of which 70 were examined with CT and the remainder by MRI. In our cohort, 91.6% of the participants were male. There were 29 patients with diffuse WMC. In univariate analysis, patients with diffuse WMC had more contralateral occlusion than those with non-diffuse WMC. In patients with diffuse WMC, more stroke recurrences were observed compared with those with non-diffuse WMC (hazard ratio [HR] 3.516; 95% CI 1.176, 10.510, P=0.024). CONCLUSIONS In patients with symptomatic carotid artery stenosis, diffuse WMC were a risk factor for stroke recurrences after CAS. Larger studies are warranted to confirm this finding and explore the potential clinical impact of WMC so as to better determine treatment strategies for patients with symptomatic carotid artery stenosis.
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Affiliation(s)
- Chun Yu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Han
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
| | - Xiao Long Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Yu
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
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Issac TG, Chandra SR, Rajeswaran J, Christopher R, Philip M. Demographic Features and Neuropsychological Correlates in a Cohort of 200 Patients with Vascular Cognitive Decline Due to Cerebral Small Vessel Disease. Indian J Psychol Med 2016; 38:127-32. [PMID: 27114624 PMCID: PMC4820551 DOI: 10.4103/0253-7176.178778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Vascular dementia is the second most common form of dementia and is potentially reversible. Small vessel disease (SVD) closely mimics degenerative dementia in view of its sub-acute onset and progressive course. Therefore, unlike large vessel disease, Hachinski Ischemic scale score may not always reflect vascular cognitive decline resulting in diagnostic and therapeutic confusions. Therefore, there is a need for detailed neuropsychological assessment for various cognitive domains for early identification of vascular cognitive decline as it carries a very good long term prognosis for cognitive morbidity, unlike degenerative dementias. PATIENTS AND METHODS This prospective study involves thorough domain based neuropsychological assessment of patients with a radiological diagnosis of SVD involving the following parameters-digit forward and backward, category fluency, color trails, stick test, logical memory test, and bender gestalt test. Magnetic resonance imaging scans done using 3-tesla machines and SVD graded using Fazekas visual scale. RESULTS The mean Hachinskis score was less sensitive for differentiating vascular dementia from degenerative dementia. However, the domain based neuropsychological scores were highly sensitive showing statistically significant impairment in all 6 domains tested and compared with Fazekas 1-3 grades in imaging. DISCUSSION AND CONCLUSION This study aimed at establishing an early diagnosis of vascular mild cognitive impairment using domain wise neuropsychological testing and correlating it with radiological scores. Hachinskis score is more sensitive for large vessel disease in view of acute onset and step-like progression as against steady progression in SVD. However, domain-wise testing was highly sensitive in identifying early cognitive impairment in patients with SVD, and early therapeutic interventions are highly rewarding.
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Affiliation(s)
- Thomas Gregor Issac
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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