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Kapoor A, Dutt S, Alitin JPM, Sible IJ, Marshall A, Shenasa F, Engstrom AC, Gaubert A, Shao X, Bradford DR, Rodgers K, Mather M, Wang DJJ, Nation DA. Older adults with reduced cerebrovascular reactivity exhibit high white matter hyperintensity burden. Neurobiol Aging 2024; 139:5-10. [PMID: 38579393 DOI: 10.1016/j.neurobiolaging.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
Cerebrovascular reactivity (CVR) deficits may contribute to small vessel disease, such as white matter hyperintensities (WMH). Moreover, apolipoprotein-e4 (APOE4) carriers at genetic risk for Alzheimer's disease exhibit cerebrovascular dysfunction relative to non-carriers. We examined whether older adults, and APOE4 carriers specifically, with diminished CVR would exhibit higher WMH burden. Independently living older adults (N = 125, mean age = 69.2 years; SD = 7.6; 31.2% male) free of dementia or clinical stroke underwent brain MRI to quantify cerebral perfusion during CVR to hypercapnia and hypocapnia and determine WMH volume. Adjusting for age, sex and intracranial volume, hierarchical regression analysis revealed a significant association between whole brain CVR to hypercapnia and WMH overall [B = -.02, 95% CI (-.04, -.008), p =.003] and in APOE4 carriers [B = -.03, 95% CI (-.06, -.009), p =.009]. Findings suggest deficits in cerebral vasodilatory capacity are associated with WMH burden in older adults and future studies are warranted to further delineate the effect of APOE4 on precipitating WMH.
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Affiliation(s)
- Arunima Kapoor
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Shubir Dutt
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - John Paul M Alitin
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Isabel J Sible
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Anisa Marshall
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Fatemah Shenasa
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Allison C Engstrom
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Aimée Gaubert
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Xingfeng Shao
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - David Robert Bradford
- Center for Innovations in Brain Science, Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Kathleen Rodgers
- Center for Innovations in Brain Science, Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Mara Mather
- University of Southern California Leonard Davis School of Gerontology, USA
| | - Danny J J Wang
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Daniel A Nation
- University of Southern California Leonard Davis School of Gerontology, USA; Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, University of Southern California Keck School of Medicine, USA.
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Altunkalem Seydi K, Kaya D, Yavuz I, Ontan MS, Dost FS, Isik AT. Primitive reflexes and dementia in older adults: a meta-analysis of observational and cohort studies. Psychogeriatrics 2024; 24:688-700. [PMID: 38400649 DOI: 10.1111/psyg.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
Primitive reflexes (PRs) are clinical signs that indicate diffuse cerebral dysfunction and frontal lesions. We aimed to present a comprehensive analysis of the prevalence and risk of PRs in patients with dementia. English-language articles published from January 1990 to April 2021 were searched in PubMed, ScienceDirect, Cochrane, and Web of Science with keywords. The titles and abstracts of the identified articles were screened to identify potentially relevant papers. Odds ratios and risk ratios were extracted with 95% confidence intervals and combined using the random-effects model after logarithmic transformation. The prevalence in dementia patients was also combined using the random-effects model. This meta-analysis involved 29 studies. The snout reflex (48% of cases) was the most prevalent. It was found that the risk of PRs in individuals with dementia was significantly elevated, ranging from 13.94 to 16.38 times higher than in healthy controls. The grasp reflex exhibited the highest risk for dementia. This meta-analysis showed that the prevalence and the risk of PRs is high in older patients with dementia. Therefore, PRs, especially the grasp reflex, should be carefully assessed as a part of routine physical examination in the diagnostic process for dementia.
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Affiliation(s)
- Kübra Altunkalem Seydi
- Unit for Ageing Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Derya Kaya
- Unit for Ageing Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Idil Yavuz
- Department of Statistics, Dokuz Eylul University, Faculty of Science, Izmir, Turkey
| | - Mehmet Selman Ontan
- Unit for Ageing Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Fatma Sena Dost
- Department of Geriatric Medicine, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Ahmet Turan Isik
- Unit for Ageing Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Ahmed M, Chen J, Arani A, Senjem ML, Cogswell PM, Jack CR, Liu C. The diamagnetic component map from quantitative susceptibility mapping (QSM) source separation reveals pathological alteration in Alzheimer's disease-driven neurodegeneration. Neuroimage 2023; 280:120357. [PMID: 37661080 DOI: 10.1016/j.neuroimage.2023.120357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/13/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
A sensitive and accurate imaging technique capable of tracking the disease progression of Alzheimer's Disease (AD) driven amnestic dementia would be beneficial. A currently available method for pathology detection in AD with high accuracy is Positron Emission Tomography (PET) imaging, despite certain limitations such as low spatial resolution, off-targeting error, and radiation exposure. Non-invasive MRI scanning with quantitative magnetic susceptibility measurements can be used as a complementary tool. To date, quantitative susceptibility mapping (QSM) has widely been used in tracking deep gray matter iron accumulation in AD. The present work proposes that by compartmentalizing quantitative susceptibility into paramagnetic and diamagnetic components, more holistic information about AD pathogenesis can be acquired. Particularly, diamagnetic component susceptibility (DCS) can be a powerful indicator for tracking protein accumulation in the gray matter (GM), demyelination in the white matter (WM), and relevant changes in the cerebrospinal fluid (CSF). In the current work, voxel-wise group analysis of the WM and the CSF regions show significantly lower |DCS| (the absolute value of DCS) value for amnestic dementia patients compared to healthy controls. Additionally, |DCS| and τ PET standardized uptake value ratio (SUVr) were found to be associated in several GM regions typically affected by τ deposition in AD. Therefore, we propose that the separated diamagnetic susceptibility can be used to track pathological neurodegeneration in different tissue types and regions of the brain. With the initial evidence, we believe the usage of compartmentalized susceptibility demonstrates substantive potential as an MRI-based technique for tracking AD-driven neurodegeneration.
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Affiliation(s)
- Maruf Ahmed
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, USA
| | - Jingjia Chen
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Information Technology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Chunlei Liu
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, USA; Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94720, USA.
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Wang Y, Liu Z. Research progress on the correlation between MRI and impairment caused by cerebral small vessel disease: A review. Medicine (Baltimore) 2023; 102:e35389. [PMID: 37800770 PMCID: PMC10553107 DOI: 10.1097/md.0000000000035389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is a chronic global brain disease mainly involving small blood vessels in the brain. The disease can be gradually aggravated with the increase of age, so it is the primary cause of brain dysfunction in the elderly. With the increasing aging of the world population and the high incidence of cerebrovascular risk factors, the incidence of CSVD is increasing day by day. CSVD is characterized by insidious onset, slow progression, diverse clinical manifestations, and difficult early diagnosis. CSVD can lead to cognitive impairment, gait impairment, affective impairment, and so on. however, it has not received enough attention from researchers in the past. In recent years, some studies have shown that CSVD patients have a high proportion of related impairment, which seriously affect patients daily life and social functions. Currently, no clear preventive measures or treatments exist to improve the condition. With the development of magnetic resonance imaging, CSVD has become more and more recognized and the detection rate has gradually improved. This paper reviews the research progress of magnetic resonance imaging and cognitive impairment, gait impairment, affective impairment, urination disorder, swallowing disorder, and other disorders to provide a useful reference for the early diagnosis and treatment of CSVD and expand new ideas.
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Affiliation(s)
- Yang Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- Department of Neurology, 980th Hospital of PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Zhirong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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Alban SL, Lynch KM, Ringman JM, Toga AW, Chui HC, Sepehrband F, Choupan J. The association between white matter hyperintensities and amyloid and tau deposition. Neuroimage Clin 2023; 38:103383. [PMID: 36965457 PMCID: PMC10060905 DOI: 10.1016/j.nicl.2023.103383] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/09/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023]
Abstract
White matter hyperintensities (WMHs) frequently occur in Alzheimer's Disease (AD) and have a contribution from ischemia, though their relationship with β-amyloid and cardiovascular risk factors (CVRFs) is not completely understood. We used AT classification to categorize individuals based on their β-amyloid and tau pathologies, then assessed the effects of β-amyloid and tau on WMH volume and number. We then determined regions in which β-amyloid and WMH accumulation were related. Last, we analyzed the effects of various CVRFs on WMHs. As secondary analyses, we observed effects of age and sex differences, atrophy, cognitive scores, and APOE genotype. PET, MRI, FLAIR, demographic, and cardiovascular health data was collected from the Alzheimer's Disease Neuroimaging Initiative (ADNI-3) (N = 287, 48 % male). Participants were categorized as A + and T + if their Florbetapir SUVR and Flortaucipir SUVR were above 0.79 and 1.25, respectively. WMHs were mapped on MRI using a deep convolutional neural network (Sepehrband et al., 2020). CVRF scores were based on history of hypertension, systolic and diastolic blood pressure, pulse rate, respiration rate, BMI, and a cumulative score with 6 being the maximum score. Regression models and Pearson correlations were used to test associations and correlations between variables, respectively, with age, sex, years of education, and scanner manufacturer as covariates of no interest. WMH volume percent was significantly associated with global β-amyloid (r = 0.28, p < 0.001), but not tau (r = 0.05, p = 0.25). WMH volume percent was higher in individuals with either A + or T + pathology compared to controls, particularly within in the A+/T + group (p = 0.007, Cohen's d = 0.4, t = -2.5). Individual CVRFs nor cumulative CVRF scores were associated with increased WMH volume. Finally, the regions where β-amyloid and WMH count were most positively associated were the middle temporal region in the right hemisphere (r = 0.18, p = 0.002) and the fusiform region in the left hemisphere (r = 0.017, p = 0.005). β-amyloid and WMH have a clear association, though the mechanism facilitating this association is still not fully understood. The associations found between β-amyloid and WMH burden emphasizes the relationship between β-amyloid and vascular lesion formation while factors like CVRFs, age, and sex affect AD development through various mechanisms. These findings highlight potential causes and mechanisms of AD as targets for future preventions and treatments. Going forward, a larger emphasis may be placed on β-amyloid's vascular effects and the implications of impaired brain clearance in AD.
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Affiliation(s)
- Sierra L Alban
- Laboratory of NeuroImaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kirsten M Lynch
- Laboratory of NeuroImaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John M Ringman
- Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Arthur W Toga
- Laboratory of NeuroImaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Helena C Chui
- Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Farshid Sepehrband
- Laboratory of NeuroImaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeiran Choupan
- Laboratory of NeuroImaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; NeuroScope Inc., Scarsdale, NY, USA
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Wouts L, Marijnissen RM, Oude Voshaar RC, Beekman ATF. Strengths and Weaknesses of the Vascular Apathy Hypothesis: A Narrative Review. Am J Geriatr Psychiatry 2023; 31:183-194. [PMID: 36283953 DOI: 10.1016/j.jagp.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 10/07/2022]
Abstract
The vascular apathy hypothesis states that cerebral small vessel disease (CSVD) can cause apathy, even when no other symptoms of CSVD are present. In order to examine this hypothesis, the objectives of this narrative review are to evaluate the evidence for a pathophysiological mechanism linking CSVD to apathy and to examine whether CSVD can be a sole cause of apathy. The nature of the CSVD-apathy relationship was evaluated using the Bradford Hill criteria as a method for research on the distinction between association and causation. Pathological, neuroimaging, and behavioral studies show that CSVD can cause lesions in the reward network, which causes an apathy syndrome. Studies in healthy older individuals, stroke patients and cognitively impaired persons consistently show an association between CSVD markers and apathy, although studies in older persons suffering from depression are inconclusive. A biological gradient is confirmed, as well as a temporal relationship, although the evidence for the latter is still weak. The specificity of this causal relationship is low given there often are other contributing factors in CSVD patients with apathy, particularly depression and cognitive deterioration. Differentiating between vascular apathy and other apathy syndromes on the basis of clinical features is not yet possible, while in-depth knowledge about differences in the prognosis and efficacy of treatment options for apathy caused by CSVD and other apathy syndromes is lacking. Since we cannot differentiate between etiologically different apathy syndromes as yet, it is premature to use the term vascular apathy which would suggest a distinct clinical apathy syndrome.
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Affiliation(s)
- Lonneke Wouts
- Department of Old Age Psychiatry (L.W.), Pro Persona Mental Health Institute, Nijmegen, the Netherlands; Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands.
| | - Radboud M Marijnissen
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry (A.T.F.B.), Amsterdam UMC, Vrije Universiteit, and GGZinGeest, Amsterdam, the Netherlands
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White matter microglia heterogeneity in the CNS. Acta Neuropathol 2022; 143:125-141. [PMID: 34878590 DOI: 10.1007/s00401-021-02389-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/17/2021] [Accepted: 11/28/2021] [Indexed: 02/07/2023]
Abstract
Microglia, the resident myeloid cells in the central nervous system (CNS) play critical roles in shaping the brain during development, responding to invading pathogens, and clearing tissue debris or aberrant protein aggregations during ageing and neurodegeneration. The original concept that like macrophages, microglia are either damaging (pro-inflammatory) or regenerative (anti-inflammatory) has been updated to a kaleidoscope view of microglia phenotypes reflecting their wide-ranging roles in maintaining homeostasis in the CNS and, their contribution to CNS diseases, as well as aiding repair. The use of new technologies including single cell/nucleus RNA sequencing has led to the identification of many novel microglia states, allowing for a better understanding of their complexity and distinguishing regional variations in the CNS. This has also revealed differences between species and diseases, and between microglia and other myeloid cells in the CNS. However, most of the data on microglia heterogeneity have been generated on cells isolated from the cortex or whole brain, whereas white matter changes and differences between white and grey matter have been relatively understudied. Considering the importance of microglia in regulating white matter health, we provide a brief update on the current knowledge of microglia heterogeneity in the white matter, how microglia are important for the development of the CNS, and how microglial ageing affects CNS white matter homeostasis. We discuss how microglia are intricately linked to the classical white matter diseases such as multiple sclerosis and genetic white matter diseases, and their putative roles in neurodegenerative diseases in which white matter is also affected. Understanding the wide variety of microglial functions in the white matter may provide the basis for microglial targeted therapies for CNS diseases.
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Chan CK, Pettigrew C, Soldan A, Zhu Y, Wang MC, Albert M, Rosenberg PB. Association Between Late-Life Neuropsychiatric Symptoms and Cognitive Decline in Relation to White Matter Hyperintensities and Amyloid Burden. J Alzheimers Dis 2022; 86:1415-1426. [PMID: 35213370 PMCID: PMC9969328 DOI: 10.3233/jad-215267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) among cognitively normal older adults are increasingly recognized as risk factors for cognitive decline and impairment. However, the underlying mechanisms remain unclear. OBJECTIVE To examine whether biomarkers of Alzheimer's disease (amyloid burden) and cerebrovascular disease (white matter hyperintensity (WMH) volume) modify the association between NPS and cognitive decline among cognitively unimpaired older adults. METHODS Analyses included 193 cognitively unimpaired participants (M age = 70 years) from the BIOCARD study, including 148 with PET amyloid and WMH biomarker data. NPS were measured with Neuropsychiatric Inventory and Geriatric Depression Scale scores. Linear mixed effects models were used to examine the association between baseline NPS and longitudinal cognitive trajectories (M follow-up = 3.05 years), using separate models for global, episodic memory, and executive function cognitive composite scores. In a subset of individuals with biomarker data, we evaluated whether WMH or cortical amyloid burden modified the relationship between NPS and cognitive change (as indicated by the NPS×biomarker×time interactions). RESULTS Higher baseline NPS were associated with lower executive function scores, but not a faster rate of decline in executive function. NPS symptoms were unrelated to the global or episodic memory composite scores, and there was little evidence of a relationship between NPS symptoms and cognitive change over time. The associations between NPS and cognitive decline did not differ by amyloid or WMH burden, and NPS were unrelated to amyloid and WMH burden. CONCLUSION These results suggest that the effect of neuropsychiatric symptoms on executive dysfunction may occur through mechanisms outside of amyloid and cerebrovascular disease.
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Affiliation(s)
- Carol K. Chan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Corinne Pettigrew
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Yuxin Zhu
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mei-Cheng Wang
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
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Garnier-Crussard A, Bougacha S, Wirth M, Dautricourt S, Sherif S, Landeau B, Gonneaud J, De Flores R, de la Sayette V, Vivien D, Krolak-Salmon P, Chételat G. White matter hyperintensity topography in Alzheimer's disease and links to cognition. Alzheimers Dement 2021; 18:422-433. [PMID: 34322985 PMCID: PMC9292254 DOI: 10.1002/alz.12410] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 01/18/2023]
Abstract
Introduction White matter hyperintensities (WMH) are often described in Alzheimer's disease (AD), but their topography and specific relationships with cognition remain unclear. Methods Regional WMH were estimated in 54 cognitively impaired amyloid beta–positive AD (Aβpos‐AD), compared to 40 cognitively unimpaired amyloid beta–negative older controls (Aβneg‐controls) matched for vascular risk factors. The cross‐sectional association between regional WMH volume and cognition was assessed within each group, controlling for cerebral amyloid burden, global cortical atrophy, and hippocampal atrophy. Results WMH volume was larger in Aβpos‐AD compared to Aβneg‐controls in all regions, with the greatest changes in the splenium of the corpus callosum (S‐CC). In Aβpos‐AD patients, larger total and regional WMH volume, especially in the S‐CC, was strongly associated with decreased cognition. Discussion WMH specifically contribute to lower cognition in AD, independently from amyloid deposition and atrophy. This study emphasizes the clinical relevance of WMH in AD, especially posterior WMH, and most notably S‐CC WMH.
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Affiliation(s)
- Antoine Garnier-Crussard
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France.,Clinical and Research Memory Center of Lyon, Lyon Institute For Elderly, Hospices Civils de Lyon, Lyon, France.,University of Lyon, Lyon, France
| | - Salma Bougacha
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Miranka Wirth
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Sophie Dautricourt
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France.,Department of Neurology, CHU de Caen, Caen, France
| | - Siya Sherif
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Brigitte Landeau
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Julie Gonneaud
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Robin De Flores
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Vincent de la Sayette
- Department of Neurology, CHU de Caen, Caen, France.,Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
| | - Denis Vivien
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France.,Department of Clinical Research, CHU de Caen, Caen, France
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Center of Lyon, Lyon Institute For Elderly, Hospices Civils de Lyon, Lyon, France.,University of Lyon, Lyon, France.,Neuroscience Research Centre of Lyon, INSERM 1048, CNRS 5292, Lyon, France
| | - Gaël Chételat
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
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Chen HM, Chen CCC, Wang HC, Chang YC, Pan KJ, Chen WH, Chen HC, Wu YY, Chai JW, Ouyang YC, Lee SK. Novel Automated Method for the Detection of White Matter Hyperintensities in Brain Multispectral MR Images. Curr Med Imaging 2021; 16:469-478. [PMID: 32484081 DOI: 10.2174/1573405614666180801112844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 01/28/2018] [Accepted: 07/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND According to the Standards for Reporting Vascular Changes on Neuroimaging, White Matter Hyperintensities (WMHs) are cerebral white matter lesions that are characterized by abnormal tissues of variable sizes and appear hyperintense in T2-weighted Magnetic Resonance (MR) measurements without cavitation (i.e., their tissue signals differ from those of Cerebrospinal Fluid or CSF). Such abnormal tissue regions are typically observed in the MR images of brains of healthy older adults and are associated with a number of geriatric neurodegenerative diseases. Explanations of the exact causes and mechanisms of these diseases remain inconclusive. Moreover, WMHs are typically identified by visual assessment and manual examination, both of which require considerable time. This brings up a need of developing a method for detecting WMHs more objectively and enabling patients to be treated early. As a consequence, damages on nerve cells can be limited and the severity of patients' conditions can be contained. AIMS This paper presents a computer-aided technique for automatically detecting and segmenting anomalies in MR images. METHODS The method has two steps: (1) a Band Expansion Process (BEP) to expand the dimensions of brain MR images nonlinearly and (2) anomaly detection algorithms to detect WMHs. Synthesized MR images provided by BrainWeb were used as benchmarks against which the detection performance of the algorithms was determined. RESULTS The most notable findings are as follows: Firstly, compared with the other anomaly detection algorithms and the Lesion Segmentation Tool (LST), BEP-anomaly detection is shown to be the most effective in detecting WMHs. Secondly, across all levels of background noise and inhomogeneity, the mean Similarity Index (SI) produced by our proposed algorithm is higher than that produced by LST, indicating that the algorithm is more effective than LST in segmenting WMHs from brain MR images. CONCLUSION Experimental results demonstrated a significantly high accuracy of the BEP-K/R-RX method in detection of synthetic brain MS lesion data. In the meantime, it also effectively enhances the detection of brain lesions.
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Affiliation(s)
- Hsian-Min Chen
- Department of Medical Research, Center for Quantitative Imaging in Medicine (CQUIM), Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
| | - Clayton Chi-Chang Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Hsin Che Wang
- Department of Medical Research, Center for Quantitative Imaging in Medicine (CQUIM), Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yung-Chieh Chang
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Electrical Engineering, National Chung Hsing University, Taichung, Taiwan
| | - Kuan-Jung Pan
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Hsien Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ying Wu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,Section of Radiology, College of Medicine, China Medical University, Taichung, Taiwan
| | - Yen-Chieh Ouyang
- Department of Electrical Engineering, National Chung Hsing University, Taichung, Taiwan
| | - San-Kan Lee
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan
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Feng T, Yamashita T, Sasaki R, Tadokoro K, Matsumoto N, Hishikawa N, Abe K. Protective effects of edaravone on white matter pathology in a novel mouse model of Alzheimer's disease with chronic cerebral hypoperfusion. J Cereb Blood Flow Metab 2021; 41:1437-1448. [PMID: 33106078 PMCID: PMC8142121 DOI: 10.1177/0271678x20968927] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
White matter lesions (WMLs) caused by cerebral chronic hypoperfusion (CCH) may contribute to the pathophysiology of Alzheimer's disease (AD). However, the underlying mechanisms and therapeutic approaches have yet to be totally identified. In the present study, we investigated a potential therapeutic effect of the free radical scavenger edaravone (EDA) on WMLs in our previously reported novel mouse model of AD (APP23) plus CCH with motor and cognitive deficits. Relative to AD with CCH mice at 12 months (M) of age, EDA strongly improved CCH-induced WMLs in the corpus callosum of APP23 mice at 12 M by improving the disruption of white matter integrity, enhancing the proliferation of oligodendrocyte progenitor cells, attenuating endothelium/astrocyte unit dysfunction, and reducing neuroinflammation and oxidative stress. The present study demonstrates that the long-term administration of EDA may provide a promising therapeutic approach for WMLs in AD plus CCH disease with cognitive deficits.
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Affiliation(s)
- Tian Feng
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toru Yamashita
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Koh Tadokoro
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Namiko Matsumoto
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Nozomi Hishikawa
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Koji Abe
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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12
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Clancy U, Gilmartin D, Jochems ACC, Knox L, Doubal FN, Wardlaw JM. Neuropsychiatric symptoms associated with cerebral small vessel disease: a systematic review and meta-analysis. Lancet Psychiatry 2021; 8:225-236. [PMID: 33539776 DOI: 10.1016/s2215-0366(20)30431-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cerebral small vessel disease, a common cause of vascular dementia, is often considered clinically silent before dementia or stroke become apparent. However, some individuals have subtle symptoms associated with acute MRI lesions. We aimed to determine whether neuropsychiatric and cognitive symptoms vary according to small vessel disease burden. METHODS In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, and PsycINFO for articles published in any language from database inception to Jan 24, 2020. We searched for studies assessing anxiety, apathy, delirium, emotional lability, fatigue, personality change, psychosis, dementia-related behavioural symptoms or cognitive symptoms (including subjective memory complaints), and radiological features of cerebral small vessel disease. We extracted reported odds ratios (OR), standardised mean differences (SMD), and correlations, stratified outcomes by disease severity or symptom presence or absence, and pooled data using random-effects meta-analyses, reporting adjusted findings when possible. We assessed the bias on included studies using the Risk of Bias for Non-randomized Studies tool. This study is registered with PROSPERO, CRD42018096673. FINDINGS Of 7119 papers identified, 81 studies including 79 cohorts in total were eligible for inclusion (n=21 730 participants, mean age 69·2 years). Of these 81 studies, 45 (8120 participants) reported effect estimates. We found associations between worse white matter hyperintensity (WMH) severity and apathy (OR 1·41, 95% CI 1·05-1·89) and the adjusted SMD in apathy score between WMH severities was 0·38 (95% CI 0·15-0·61). Worse WMH severity was also associated with delirium (adjusted OR 2·9, 95% CI 1·12-7·55) and fatigue (unadjusted OR 1·63, 95% CI 1·20-2·22). WMHs were not consistently associated with subjective memory complaints (OR 1·34, 95% CI 0·61-2·94) and unadjusted SMD for WMH severity between these groups was 0·08 (95% CI -0·31 to 0·47). Anxiety, dementia-related behaviours, emotional lability, and psychosis were too varied or sparse for meta-analysis; these factors were reviewed narratively. Overall heterogeneity varied from 0% to 79%. Only five studies had a low risk of bias across all domains. INTERPRETATION Apathy, fatigue, and delirium associated independently with worse WMH, whereas subjective cognitive complaints did not. The association of anxiety, dementia-related behaviours, emotional lability, and psychosis with cerebral small vessel disease require further investigation. These symptoms should be assessed longitudinally to improve early clinical detection of small vessel disease and enable prevention trials to happen early in the disease course, long before cognition declines. FUNDING Chief Scientist Office of the Scottish Government, UK Dementia Research Institute, Fondation Leducq, Stroke Association Garfield-Weston Foundation, Alzheimer's Society, and National Health Service Research Scotland.
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Affiliation(s)
- Una Clancy
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Daniel Gilmartin
- Department of Geriatric Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Angela C C Jochems
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Lucy Knox
- Department of Medicine, Borders General Hospital, NHS Borders, Melrose, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
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13
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Anor CJ, Dadar M, Collins DL, Tartaglia MC. The Longitudinal Assessment of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Alzheimer's Disease and Their Association With White Matter Hyperintensities in the National Alzheimer's Coordinating Center's Uniform Data Set. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:70-78. [PMID: 32389747 PMCID: PMC7529680 DOI: 10.1016/j.bpsc.2020.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPSs) are common in Alzheimer's disease (AD). NPSs contribute to patients' distress, caregiver burden, and institutionalization. White matter hyperintensities (WMHs) appear on magnetic resonance imaging, usually indicative of cerebrovascular disease. WMHs have been associated with certain NPSs. We aimed to assess the relationship between WMH and NPS severity in mild cognitive impairment (MCI) due to AD (MCI-AD) and in AD and to assess the ability of WMHs to predict NPS progression. Data were obtained from the National Alzheimer's Coordinating Center. METHODS A total of 252 participants (114 with MCI-AD and 138 with AD) were used in this study. Baseline WMHs were quantified using an automated segmentation technique. NPSs were measured using the Neuropsychiatric Inventory. Mixed-effect models and correlations were used to determine the relationship between WMHs and NPSs. RESULTS Longitudinal mixed-effect models revealed a significant relationship between increase in Neuropsychiatric Inventory total scores and baseline WMHs (p = .014). There was a significant relationship between baseline WMHs and an increase in delusions (p = .023), hallucinations (p = .040), agitation (p = .093), depression (p = .017), and irritability (p = .002). Correlation plot analysis showed that baseline whole-brain WMHs predicted change in future Neuropsychiatric Inventory total scores (r = .169, p = .008) and predicted change in future agitation severity scores (r = .165, p = .009). WMHs in the temporal lobes (r = .169, p = .008) and frontal lobes (r = .153, p = .016) contributed most to this change. CONCLUSIONS Depression, irritability, and agitation are common NPSs and very distressful to patients and caregivers. Our findings of increased NPS severity over time in MCI-AD and AD with increased WMHs have important implications for treatment, arguing for aggressive treatment of vascular risk factors in patients with MCI-AD or AD.
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Affiliation(s)
- Cassandra J Anor
- University Health Network Memory Clinic, Department of Neurology, Toronto, Ontario, Canada; Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Mahsa Dadar
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - D Louis Collins
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - M Carmela Tartaglia
- University Health Network Memory Clinic, Department of Neurology, Toronto, Ontario, Canada; Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.
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14
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Caillaud M, Hudon C, Boller B, Brambati S, Duchesne S, Lorrain D, Gagnon JF, Maltezos S, Mellah S, Phillips N, Belleville S. Evidence of a Relation Between Hippocampal Volume, White Matter Hyperintensities, and Cognition in Subjective Cognitive Decline and Mild Cognitive Impairment. J Gerontol B Psychol Sci Soc Sci 2020; 75:1382-1392. [PMID: 31758692 PMCID: PMC7424270 DOI: 10.1093/geronb/gbz120] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The concepts of mild cognitive impairment (MCI) and subjective cognitive decline (SCD) have been proposed to identify individuals in the early stages of Alzheimer's disease (AD), or other neurodegenerative diseases. One approach to validate these concepts is to investigate the relationship between pathological brain markers and cognition in those individuals. METHOD We included 126 participants from the Consortium for the Early Identification of Alzheimer's disease-Quebec (CIMA-Q) cohort (67 SCD, 29 MCI, and 30 cognitively healthy controls [CH]). All participants underwent a complete cognitive assessment and structural magnetic resonance imaging. Group comparisons were done using cognitive data, and then correlated with hippocampal volumes and white matter hyperintensities (WMHs). RESULTS Significant differences were found between participants with MCI and CH on episodic and executive tasks, but no differences were found when comparing SCD and CH. Scores on episodic memory tests correlated with hippocampal volumes in both MCI and SCD, whereas performance on executive tests correlated with WMH in all of our groups. DISCUSSION As expected, the SCD group was shown to be cognitively healthy on tasks where MCI participants showed impairment. However, SCD's hippocampal volume related to episodic memory performances, and WMH to executive functions. Thus, SCD represents a valid research concept and should be used, alongside MCI, to better understand the preclinical/prodromal phase of AD.
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Affiliation(s)
- Marie Caillaud
- Research Centre, Institut universitaire de gériatrie de Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Québec, Canada
| | - Carol Hudon
- CERVO Brain Research Centre, Institut universitaire en santé mentale de Québec, Canada
- Department of Psychology, Université de Laval, Québec, Canada
| | - Benjamin Boller
- Research Centre, Institut universitaire de gériatrie de Montréal, Québec, Canada
- Departement of Psychology, Université du Québec à Trois-Rivières, Québec, Canada
| | - Simona Brambati
- Research Centre, Institut universitaire de gériatrie de Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Québec, Canada
| | - Simon Duchesne
- CERVO Brain Research Centre, Institut universitaire en santé mentale de Québec, Canada
- Department of Radiology, Université de Laval, Québec, Canada
| | - Dominique Lorrain
- Research Centre, Centre de recherche sur le vieillissement de Sherbrooke, Québec, Canada
- Department of Psychology, Université de Sherbrooke, Québec, Canada
| | - Jean-François Gagnon
- Research Centre, Institut universitaire de gériatrie de Montréal, Québec, Canada
- Departement of Psychology, Université du Québec à Trois-Rivières, Québec, Canada
- Department of Psychology, Université du Québec à Montréal, Québec, Canada
| | - Samantha Maltezos
- Research Centre, Institut universitaire de gériatrie de Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Québec, Canada
| | - Samira Mellah
- Research Centre, Institut universitaire de gériatrie de Montréal, Québec, Canada
| | - Natalie Phillips
- Department of Psychology, Centre for Research in Human Development (CRDH), Concordia University, Montreal, Québec, Canada
| | | | - Sylvie Belleville
- Research Centre, Institut universitaire de gériatrie de Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Québec, Canada
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15
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White matter hyperintensities are associated with falls in older people with dementia. Brain Imaging Behav 2020; 13:1265-1272. [PMID: 30145714 DOI: 10.1007/s11682-018-9943-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
White Matter Hyperintensities (WMHs) are associated with impaired gait, balance and cognition and increased fall risk in cognitively healthy older people. However, few studies have examined such relationships in older people with dementia. Understanding the role of WMHs in falls may assist in developing effective fall prevention strategies. We investigated the relationship between baseline WMHs, cognitive and sensorimotor function and prospective falls in older people with dementia. Twenty-eight community-dwelling older people with mild-moderate dementia (MMSE 11-23; ACE-R < 83) underwent magnetic resonance imaging and assessment of sensorimotor and cognitive (global and processing speed) function at baseline. WMHs, were quantified using a fully automated segmentation toolbox, UBO Detector ( https://cheba.unsw.edu.au/group/neuroimaging-pipeline ). Falls were ascertained prospectively for 12-months using monthly calendars with the assistance of carers. The median age of the participants was 83 years (IQR 77-86); 36% were female; 21 (75%) fell during follow-up. Using Generalized Linear Models, larger volumes of total WMHs were found to be significantly associated with poorer global cognitive and sensorimotor function. Using modified Poisson regression, total, periventricular and deep WMHs were each associated with future falls while controlling for age, sex, intracranial volume and vascular risk. Each standard deviation increase in total and periventricular WMH volume resulted in a 33% (RR 1.33 95%CI 1.07-1.66) and 30% (RR 1.30 95%CI 1.06-1.60) increased risk of falling, respectively. When the deep WMH volume z-scores were dichotomized at the median, individuals with greater deep WMH volumes had an 81% (RR 1.81 95% CI 1.02-3.21) increased risk of falling. WMHs were associated with poorer sensorimotor and cognitive function in people with dementia and total, periventricular and deep WMHs were associated with falls. Further research is needed to confirm these preliminary findings and explore the impact of vascular risk reduction strategies on WMHs, functional performance and falls.
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16
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White matter changes in primary central nervous system lymphoma patients treated with high-dose methotrexate with or without rituximab. J Neurooncol 2019; 145:461-466. [PMID: 31621040 DOI: 10.1007/s11060-019-03279-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE White matter changes (WMCs) can develop following systemic chemotherapy in patients with primary central nervous system lymphomas (PCNSLs), but the frequency and extent of these changes is not well characterized. This single center retrospective semi-quantitative study was performed to determine the rate, timing and grade of WMC on MRI in adult patients with newly-diagnosed radiotherapy-naïve PCNSL undergoing treatment with high-dose methotrexate (HD-MTX) with or without the addition of rituximab (-R). METHODS Serial MRI scans of consecutive adult PCNSL patients treated with HD-MTX ± R were assessed for WMC comparing the pre-treatment to post-treatment scans utilizing a 0-to-8-point severity scoring system. RESULTS Forty-seven PCNSL patients treated with either HD-MTX-R (n = 34; median age 66, 50% male) or HD-MTX (n = 13; median age 53, 54% male) were included in the analysis. WMC were detected in 62% (95% CI 46-76%) overall, in 68% of the HD-MTX-R, and in 46% of the HD-MTX group. Among patients with WMC (n = 29), WMC were first detected at an average of 2.8 months from beginning of therapy in the HD-MTX-R versus at 10.7 months in the HD-MTX group. Average WMC non-zero scores when first detected following the start of treatment were 2.5 (± 1.1) in HD-MTX-R and 1.5 (± 0.6) in HD-MTX. CONCLUSIONS Development of WMC in PCNSL patients treated with MTX and MTX-R is common. WMC changes appear to be more frequent, occur earlier and are more extensive in patients treated with HD-MTX-R compared to HD-MTX. Prospective studies are required to determine whether WMC correlate with survival or neurocognitive outcomes.
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Bhattarai JJ, Oehlert ME, Multon KD, Sumerall SW. Dementia and Cognitive Impairment Among U.S. Veterans With a History of MDD or PTSD: A Retrospective Cohort Study Based on Sex and Race. J Aging Health 2019; 31:1398-1422. [PMID: 29900802 DOI: 10.1177/0898264318781131] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The aim of this study was to examine major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) diagnosed at age < 55 as predictors, and sex and race as potential moderators, of dementia and other forms of cognitive impairment. Method: Veterans (N = 4,800) aged ⩾ 56 years were grouped by psychiatric history, sex, and race. Hierarchical and stepwise regression were employed to determine significant predictors. Results: MDD and PTSD were associated with almost double the risk for developing dementia or cognitive impairment at age ⩾ 56. Sex, as a moderator, had small effects whereas race increased the risk almost twofold for Black veterans, given the presence of MDD history. Discussion: MDD and PTSD act as significant risk factors for dementia and other forms of cognitive impairment, and Black veterans, given a history of MDD, may be at an increased risk. An important endeavor for future research is to examine how this risk may vary across dementia subtypes and related conditions.
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Affiliation(s)
| | - Mary E Oehlert
- 2 VA Eastern Kansas Health Care System, Leavenworth, KS, USA
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18
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Liu PP, Xie Y, Meng XY, Kang JS. History and progress of hypotheses and clinical trials for Alzheimer's disease. Signal Transduct Target Ther 2019; 4:29. [PMID: 31637009 PMCID: PMC6799833 DOI: 10.1038/s41392-019-0063-8] [Citation(s) in RCA: 332] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/07/2019] [Accepted: 07/17/2019] [Indexed: 12/20/2022] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive memory loss along with neuropsychiatric symptoms and a decline in activities of daily life. Its main pathological features are cerebral atrophy, amyloid plaques, and neurofibrillary tangles in the brains of patients. There are various descriptive hypotheses regarding the causes of AD, including the cholinergic hypothesis, amyloid hypothesis, tau propagation hypothesis, mitochondrial cascade hypothesis, calcium homeostasis hypothesis, neurovascular hypothesis, inflammatory hypothesis, metal ion hypothesis, and lymphatic system hypothesis. However, the ultimate etiology of AD remains obscure. In this review, we discuss the main hypotheses of AD and related clinical trials. Wealthy puzzles and lessons have made it possible to develop explanatory theories and identify potential strategies for therapeutic interventions for AD. The combination of hypometabolism and autophagy deficiency is likely to be a causative factor for AD. We further propose that fluoxetine, a selective serotonin reuptake inhibitor, has the potential to treat AD.
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Affiliation(s)
- Pei-Pei Liu
- Clinical Systems Biology Laboratories, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Yi Xie
- Clinical Systems Biology Laboratories, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Xiao-Yan Meng
- Clinical Systems Biology Laboratories, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Jian-Sheng Kang
- Clinical Systems Biology Laboratories, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
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19
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Guo C, Niu K, Luo Y, Shi L, Wang Z, Zhao M, Wang D, Zhu W, Zhang H, Sun L. Intra-Scanner and Inter-Scanner Reproducibility of Automatic White Matter Hyperintensities Quantification. Front Neurosci 2019; 13:679. [PMID: 31354406 PMCID: PMC6635556 DOI: 10.3389/fnins.2019.00679] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate white matter hyperintensities (WMH) quantification reproducibility from multiple aspects of view and examine the effects of scan-rescan procedure, types of scanner, imaging protocols, scanner software upgrade, and automatic segmentation tools on WMH quantification results using magnetic resonance imaging (MRI). Methods: Six post-stroke subjects (4 males; mean age = 62.8, range = 58-72 years) were scanned and rescanned with both 3D T1-weighted, 2D and 3D T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) MRI across four different MRI scanners within 12 h. Two automated WMH segmentation and quantification tools were used to measure WMH volume based on each MR scan. Robustness was assessed using the coefficient of variation (CV), Dice similarity coefficient (DSC), and intra-class correlation (ICC). Results: Experimental results show that the best reproducibility was achieved by using 3D T2-FLAIR MRI under intra-scanner setting with CV ranging from 2.69 to 2.97%, while the largest variability resulted from comparing WMH volumes measured based on 2D T2-FLAIR MRI with those of 3D T2-FLAIR MRI, with CV values in the range of 15.62%-29.33%. The WMH quantification variability based on 2D MRIs is larger than 3D MRIs due to their large slice thickness. The DSC of WMH segmentation labels between intra-scanner MRIs ranges from 0.63 to 0.77, while that for inter-scanner MRIs is in the range of 0.63-0.65. In addition to image acquisition, the choice of automatic WMH segmentation tool also has a large impact on WMH quantification. Conclusion: WMH reproducibility is one of the primary issues to be considered in multicenter and longitudinal studies. The study provides solid guidance in assisting multicenter and longitudinal study design to achieve meaningful results with enough power.
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Affiliation(s)
- Chunjie Guo
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Kai Niu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yishan Luo
- BrainNow Medical Technology Limited, Sha Tin, Hong Kong
| | - Lin Shi
- BrainNow Medical Technology Limited, Sha Tin, Hong Kong.,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Zhuo Wang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Meng Zhao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Defeng Wang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China.,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Wan'an Zhu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Li Sun
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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van den Berg E, Geerlings MI, Biessels GJ, Nederkoorn PJ, Kloppenborg RP. White Matter Hyperintensities and Cognition in Mild Cognitive Impairment and Alzheimer's Disease: A Domain-Specific Meta-Analysis. J Alzheimers Dis 2019; 63:515-527. [PMID: 29630548 DOI: 10.3233/jad-170573] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND White matter hyperintensities (WMHs) are related to cognitive dysfunction in the general population. The clinical relevance of WMHs in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) is, however, unclear. OBJECTIVE This meta-analysis aimed to quantify the association of WMHs and specific cognitive domains in patients with MCI or AD. METHODS PubMed (January 1990-January 2017) was searched for studies that used MRI to quantify WMHs, and measured cognitive functioning (≥1 predefined cognitive domain with ≥1 test) in a well-defined population of persons diagnosed with MCI or AD. Fischer's Z was used as the common metric for effect size. Modifying effects of demographics, MMSE, and WMH location were examined. RESULTS Twelve cross-sectional studies on AD (total n = 1,370, median age 75 years) and 10 studies on MCI (9 cross-sectional, 1 longitudinal; total n = 2,286, median age 73 years) were included. The association between WMHs and overall cognition was significantly stronger for MCI (-0.25, -0.36 to -0.14) than for AD (-0.11, -0.14 to -0.08; QM = 10.7, p < 0.05). For both groups, largest effect sizes were found in attention and executive functions (-0.26, -0.36 to -0.15) and processing speed (-0.21, -0.35 to -0.12). No significant modifying effects of age and gender were found. CONCLUSION WMHs have a medium-sized association with different cognitive functions in patients with MCI and a small, but statistically significant, association with cognition in AD. These result underscore the role of co-occurring vascular brain damage in MCI and AD.
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Affiliation(s)
- Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
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21
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Kaskikallio A, Karrasch M, Rinne JO, Tuokkola T, Parkkola R, Grönholm-Nyman P. Domain-specific cognitive effects of white matter pathology in old age, mild cognitive impairment and Alzheimer's disease. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:453-470. [PMID: 31198088 DOI: 10.1080/13825585.2019.1628916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Concomitant white matter (WM) brain pathology is often present in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Cognitive effects of WM pathology on cognition in normal and pathological aging have been studied, but very little is known about possible group-specific effects in old age, MCI and AD. The purpose of the current study was to examine the relationship between WM pathology and cognitive functioning in four cognitive domains in old age, MCI and AD. The study utilized multi-domain neuropsychological data and visually rated MRI imaging data from a sample of 56 healthy older adults, 40 patients with MCI and 52 patients with AD (n = 148). After controlling for age and education, main effects of frontal WM pathology (especially in the left hemisphere) were found for cognitive performances in two domains, whereas a main effect of parieto-occipital WM pathology was only found for processing speed. In addition, with regard to processing speed, an interaction between group and WM changes was found: Patients with AD that had moderate or severe left frontal WM pathology were considerably slower than patients with AD that had milder cerebrovascular pathology. Frontal WM pathology, especially in the left hemisphere, seems to affect cognitive functions in many domains in all three groups. The results of the study increase our knowledge of cognitive repercussions stemming from frontal and/or parieto-occipital WM pathology in AD. Clinicians should be aware that patients with AD with prominent frontal cerebrovascular pathology can have considerably slowed cognitive processing.
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Affiliation(s)
- Alar Kaskikallio
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Juha O Rinne
- Turku PET-Centre, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | | | - Riitta Parkkola
- Department of Radiology, University and University Hospital of Turku, Turku, Finland
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22
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Keřkovský M, Stulík J, Dostál M, Kuhn M, Lošák J, Praksová P, Hulová M, Bednařík J, Šprláková-Puková A, Mechl M. Structural and functional MRI correlates of T2 hyperintensities of brain white matter in young neurologically asymptomatic adults. Eur Radiol 2019; 29:7027-7036. [PMID: 31144071 DOI: 10.1007/s00330-019-06268-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/25/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Although white matter hyperintensities (WMHs) are quite commonly found incidentally, their aetiology, structural characteristics, and functional consequences are not entirely known. The purpose of this study was to quantify WMHs in a sample of young, neurologically asymptomatic adults and evaluate the structural and functional correlations of lesion load with changes in brain volume, diffusivity, and functional connectivity. METHODS MRI brain scan using multimodal protocol was performed in 60 neurologically asymptomatic volunteers (21 men, 39 women, mean age 34.5 years). WMHs were manually segmented in 3D FLAIR images and counted automatically. The number and volume of WMHs were correlated with brain volume, resting-state functional MRI (rs-fMRI), and diffusion tensor imaging (DTI) data. Diffusion parameters measured within WMHs and normally appearing white matter (NAWM) were compared. RESULTS At least 1 lesion was found in 40 (67%) subjects, median incidence was 1 lesion (interquartile range [IQR] = 4.5), and median volume was 86.82 (IQR = 227.23) mm3. Neither number nor volume of WMHs correlated significantly with total brain volume or volumes of white and grey matter. Mean diffusivity values within WMHs were significantly higher compared with those for NAWM, but none of the diffusion parameters of NAWM were significantly correlated with WMH load. Both the number and volume of WMHs were correlated with the changes of functional connectivity between several regions of the brain, mostly decreased connectivity of the cerebellum. CONCLUSIONS WMHs are commonly found even in young, neurologically asymptomatic adults. Their presence is not associated with brain atrophy or global changes of diffusivity, but the increasing number and volume of these lesions correlate with changes of brain connectivity, and especially that of the cerebellum. KEY POINTS • White matter hyperintensities (WMHs) are commonly found in young, neurologically asymptomatic adults. • The presence of WMHs is not associated with brain atrophy or global changes of white matter diffusivity. • The increasing number and volume of WMHs correlate with changes of brain connectivity, and especially with that of the cerebellum.
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Affiliation(s)
- Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, The University Hospital Brno and Masaryk University, Brno, Czech Republic.
| | - Jakub Stulík
- Department of Radiology and Nuclear Medicine, The University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, The University Hospital Brno and Masaryk University, Brno, Czech Republic.,Department of Biophysics, Masaryk University, Brno, Czech Republic
| | - Matyáš Kuhn
- Department of Psychiatry, The University Hospital Brno and Masaryk University, Brno, Czech Republic.,Behavioural and Social Neuroscience, CEITEC MU, Brno, Czech Republic
| | - Jan Lošák
- Department of Psychiatry, The University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Petra Praksová
- Department of Neurology, The University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Monika Hulová
- Department of Neurology, The University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Josef Bednařík
- Department of Neurology, The University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Andrea Šprláková-Puková
- Department of Radiology and Nuclear Medicine, The University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Marek Mechl
- Department of Radiology and Nuclear Medicine, The University Hospital Brno and Masaryk University, Brno, Czech Republic
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23
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Abstract
PURPOSE OF REVIEW This review presents the latest developments covered in the literature regarding psychosis in neurodegenerative disorders and discusses possible future research directions. RECENT FINDINGS Recent findings in the field of psychosis and neurodegenerative disorders revolve around four main themes. The first theme is the impact of sex on the expression of psychosis in neurodegenerative disorders. The second theme focuses on the relationship between psychosis and neurodegenerative disease biomarkers. The third concerns how psychotic symptoms in neurodegenerative disorders may share common mechanisms with other primary psychotic disorders such as schizophrenia. Finally, there have been some promising developments in the area of therapeutics to treat dementia-related psychosis involving both established and novel treatments. SUMMARY New findings in the field of neurodegeneration and psychosis parallel new directions in the field of neurodegeneration in general. More specifically, we have seen a shift in focus to issues highlighting the role of sex, biomarkers, translation to other disorders, and therapeutics.
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24
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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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25
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Ogama N, Sakurai T, Saji N, Nakai T, Niida S, Toba K, Umegaki H, Kuzuya M. Frontal White Matter Hyperintensity Is Associated with Verbal Aggressiveness in Elderly Women with Alzheimer Disease and Amnestic Mild Cognitive Impairment. Dement Geriatr Cogn Dis Extra 2018; 8:138-150. [PMID: 29805380 PMCID: PMC5968270 DOI: 10.1159/000486826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/12/2018] [Indexed: 12/30/2022] Open
Abstract
Background/Aims Behavioral and psychological symptoms of dementia (BPSD) are exhibited in most patients with Alzheimer disease (AD). Although white matter hyperintensity (WMH) is often observed with AD, the precise role of WMH in BPSD remains unclear. The current study aimed to identify the impact of regional WMH on specific features of BPSD in persons with mild to moderate AD and amnestic mild cognitive impairment (aMCI). Methods A sample of 256 female outpatients with AD (n = 217) and aMCI (n = 39) were recruited. We assessed BPSD using the Dementia Behavior Disturbance Scale. WMH and brain atrophy were evaluated using an automatic segmentation program. Regional WMH was evaluated as periventricular hyperintensity (PVH) and deep WMH in frontal, temporal, occipital, and parietal lobes. Results Whole-brain WMH was associated with verbal aggressiveness. In multivariate analysis, PVH in the frontal lobe was independently associated with verbal aggressiveness after adjustment for brain atrophy and clinical confounders. Conclusion The current results indicated that PVH in the frontal lobe was independently associated with verbal aggressiveness.
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Affiliation(s)
- Noriko Ogama
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Toshiharu Nakai
- NeuroImaging and Informatics, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Institutes of Innovation for Future Society, Nagoya University, Nagoya, Japan
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26
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Al-Janabi OM, Panuganti P, Abner EL, Bahrani AA, Murphy R, Bardach SH, Caban-Holt A, Nelson PT, Gold BT, Smith CD, Wilcock DM, Jicha GA. Global Cerebral Atrophy Detected by Routine Imaging: Relationship with Age, Hippocampal Atrophy, and White Matter Hyperintensities. J Neuroimaging 2018; 28:301-306. [PMID: 29314393 DOI: 10.1111/jon.12494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/29/2017] [Accepted: 12/10/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Interpreting the clinical significance of moderate-to-severe global cerebral atrophy (GCA) is a conundrum for many clinicians, who visually interpret brain imaging studies in routine clinical practice. GCA may be attributed to normal aging, Alzheimer's disease (AD), or cerebrovascular disease (CVD). Understanding the relationships of GCA with aging, AD, and CVD is important for accurate diagnosis and treatment decisions for cognitive complaints. METHODS To elucidate the relative associations of age, moderate-to-severe white matter hyperintensities (WMHs), and moderate-to-severe medial temporal lobe atrophy (MTA), with moderate-to-severe GCA, we visually rated clinical brain imaging studies of 325 participants from a community based sample. Logistic regression analysis was conducted to assess the relations of GCA with age, WMH, and MTA. RESULTS The mean age was 76.2 (±9.6) years, 40.6% were male, and the mean educational attainment was 15.1 (±3.7) years. Logistic regression results demonstrated that while a 1-year increase in age was associated with GCA (OR = 1.04; P = .04), MTA (OR = 3.7; P < .001), and WMH (OR = 8.80; P < .001) were strongly associated with GCA in our study population. Partial correlation analysis showed that the variance of GCA explained by age is less than the variance attributed to MTA and WMH (r = .13, .21, and .43, respectively). CONCLUSIONS Moderate-to-severe GCA is most likely to occur in the presence of AD or CVD and should not be solely attributed to age when evaluating clinical imaging findings in the workup of cognitive complaints. Developing optimal diagnostic and treatment strategies for cognitive decline in the setting of GCA requires an understanding of its risk factors in the aging population.
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Affiliation(s)
- Omar M Al-Janabi
- Sanders-Brown Center on Aging, Lexington, KY.,Departments of Behavioral Science, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Pradeep Panuganti
- Neurology, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Erin L Abner
- Sanders-Brown Center on Aging, Lexington, KY.,Epidemiology and Biostatistics, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Ahmed A Bahrani
- Sanders-Brown Center on Aging, Lexington, KY.,Biomedical Engineering, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Ronan Murphy
- Sanders-Brown Center on Aging, Lexington, KY.,Neurology, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Shoshana H Bardach
- Sanders-Brown Center on Aging, Lexington, KY.,Gerontology, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Allison Caban-Holt
- Sanders-Brown Center on Aging, Lexington, KY.,Departments of Behavioral Science, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Peter T Nelson
- Sanders-Brown Center on Aging, Lexington, KY.,Pathology, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Brian T Gold
- Sanders-Brown Center on Aging, Lexington, KY.,Neuroscience, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Charles D Smith
- Sanders-Brown Center on Aging, Lexington, KY.,Neurology, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Donna M Wilcock
- Sanders-Brown Center on Aging, Lexington, KY.,Physiology, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
| | - Gregory A Jicha
- Sanders-Brown Center on Aging, Lexington, KY.,Departments of Behavioral Science, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY.,Neurology, University of Kentucky Colleges of Medicine, Public Health and Engineering, Lexington, KY
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27
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Ghafoorian M, Karssemeijer N, Heskes T, van Uden IWM, Sanchez CI, Litjens G, de Leeuw FE, van Ginneken B, Marchiori E, Platel B. Location Sensitive Deep Convolutional Neural Networks for Segmentation of White Matter Hyperintensities. Sci Rep 2017; 7:5110. [PMID: 28698556 PMCID: PMC5505987 DOI: 10.1038/s41598-017-05300-5] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/26/2017] [Indexed: 02/06/2023] Open
Abstract
The anatomical location of imaging features is of crucial importance for accurate diagnosis in many medical tasks. Convolutional neural networks (CNN) have had huge successes in computer vision, but they lack the natural ability to incorporate the anatomical location in their decision making process, hindering success in some medical image analysis tasks. In this paper, to integrate the anatomical location information into the network, we propose several deep CNN architectures that consider multi-scale patches or take explicit location features while training. We apply and compare the proposed architectures for segmentation of white matter hyperintensities in brain MR images on a large dataset. As a result, we observe that the CNNs that incorporate location information substantially outperform a conventional segmentation method with handcrafted features as well as CNNs that do not integrate location information. On a test set of 50 scans, the best configuration of our networks obtained a Dice score of 0.792, compared to 0.805 for an independent human observer. Performance levels of the machine and the independent human observer were not statistically significantly different (p-value = 0.06).
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Affiliation(s)
- Mohsen Ghafoorian
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands.
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Nico Karssemeijer
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Inge W M van Uden
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Clara I Sanchez
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Litjens
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elena Marchiori
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Bram Platel
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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28
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Raj D, Yin Z, Breur M, Doorduin J, Holtman IR, Olah M, Mantingh-Otter IJ, Van Dam D, De Deyn PP, den Dunnen W, Eggen BJL, Amor S, Boddeke E. Increased White Matter Inflammation in Aging- and Alzheimer's Disease Brain. Front Mol Neurosci 2017; 10:206. [PMID: 28713239 PMCID: PMC5492660 DOI: 10.3389/fnmol.2017.00206] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/12/2017] [Indexed: 11/13/2022] Open
Abstract
Chronic neuroinflammation, which is primarily mediated by microglia, plays an essential role in aging and neurodegeneration. It is still unclear whether this microglia-induced neuroinflammation occurs globally or is confined to distinct brain regions. In this study, we investigated microglia activity in various brain regions upon healthy aging and Alzheimer's disease (AD)-related pathology in both human and mouse samples. In purified microglia isolated from aging mouse brains, we found a profound gene expression pattern related to pro-inflammatory processes, phagocytosis, and lipid homeostasis. Particularly in white matter microglia of 24-month-old mice, abundant expression of phagocytic markers including Mac-2, Axl, CD16/32, Dectin1, CD11c, and CD36 was detected. Interestingly, in white matter of human brain tissue the first signs of inflammatory activity were already detected during middle age. Thus quantification of microglial proteins, such as CD68 (commonly associated with phagocytosis) and HLA-DR (associated with antigen presentation), in postmortem human white matter brain tissue showed an age-dependent increase in immunoreactivity already in middle-aged people (53.2 ± 2.0 years). This early inflammation was also detectable by non-invasive positron emission tomography imaging using [11C]-(R)-PK11195, a ligand that binds to activated microglia. Increased microglia activity was also prominently present in the white matter of human postmortem early-onset AD (EOAD) brain tissue. Interestingly, microglia activity in the white matter of late-onset AD (LOAD) CNS was similar to that of the aged clinically silent AD cases. These data indicate that microglia-induced neuroinflammation is predominant in the white matter of aging mice and humans as well as in EOAD brains. This white matter inflammation may contribute to the progression of neurodegeneration, and have prognostic value for detecting the onset and progression of aging and neurodegeneration.
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Affiliation(s)
- Divya Raj
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Zhuoran Yin
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands.,Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Marjolein Breur
- Department of Pathology, VU University Medical CenterAmsterdam, Netherlands
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Inge R Holtman
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Marta Olah
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Ietje J Mantingh-Otter
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Debby Van Dam
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of AntwerpWilrijk, Belgium.,Department of Neurology and Alzheimer Research Center, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Peter P De Deyn
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of AntwerpWilrijk, Belgium.,Department of Neurology and Alzheimer Research Center, University Medical Center Groningen, University of GroningenGroningen, Netherlands.,Biobank, Institute Born-BungeWilrijk, Belgium
| | - Wilfred den Dunnen
- Department of Pathology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Bart J L Eggen
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - Sandra Amor
- Department of Pathology, VU University Medical CenterAmsterdam, Netherlands.,Neuroimmunology Unit, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and DentistryLondon, United Kingdom
| | - Erik Boddeke
- Department of Neuroscience, Section Medical Physiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
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29
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An energy minimization method for MS lesion segmentation from T1-w and FLAIR images. Magn Reson Imaging 2017; 39:1-6. [DOI: 10.1016/j.mri.2016.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
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30
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Ghafoorian M, Karssemeijer N, van Uden IWM, de Leeuw FE, Heskes T, Marchiori E, Platel B. Automated detection of white matter hyperintensities of all sizes in cerebral small vessel disease. Med Phys 2017; 43:6246. [PMID: 27908171 DOI: 10.1118/1.4966029] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE White matter hyperintensities (WMH) are seen on FLAIR-MRI in several neurological disorders, including multiple sclerosis, dementia, Parkinsonism, stroke and cerebral small vessel disease (SVD). WMHs are often used as biomarkers for prognosis or disease progression in these diseases, and additionally longitudinal quantification of WMHs is used to evaluate therapeutic strategies. Human readers show considerable disagreement and inconsistency on detection of small lesions. A multitude of automated detection algorithms for WMHs exists, but since most of the current automated approaches are tuned to optimize segmentation performance according to Jaccard or Dice scores, smaller WMHs often go undetected in these approaches. In this paper, the authors propose a method to accurately detect all WMHs, large as well as small. METHODS A two-stage learning approach was used to discriminate WMHs from normal brain tissue. Since small and larger WMHs have quite a different appearance, the authors have trained two probabilistic classifiers: one for the small WMHs (⩽3 mm effective diameter) and one for the larger WMHs (>3 mm in-plane effective diameter). For each size-specific classifier, an Adaboost is trained for five iterations, with random forests as the basic classifier. The feature sets consist of 22 features including intensities, location information, blob detectors, and second order derivatives. The outcomes of the two first-stage classifiers were combined into a single WMH likelihood by a second-stage classifier. Their method was trained and evaluated on a dataset with MRI scans of 362 SVD patients (312 subjects for training and validation annotated by one and 50 for testing annotated by two trained raters). To analyze performance on the separate test set, the authors performed a free-response receiving operating characteristic (FROC) analysis, instead of using segmentation based methods that tend to ignore the contribution of small WMHs. RESULTS Experimental results based on FROC analysis demonstrated a close performance of the proposed computer aided detection (CAD) system to human readers. While an independent reader had 0.78 sensitivity with 28 false positives per volume on average, their proposed CAD system reaches a sensitivity of 0.73 with the same number of false positives. CONCLUSIONS The authors have developed a CAD system with all its ingredients being optimized for a better detection of WMHs of all size, which shows performance close to an independent reader.
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Affiliation(s)
- Mohsen Ghafoorian
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525, The Netherlands and Institute for Computing and Information Sciences, Radboud University, Nijmegen 6525 GA, The Netherlands
| | - Nico Karssemeijer
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| | - Inge W M van Uden
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen 6525 EN, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen 6525 EN, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen 6525 EC, The Netherlands
| | - Elena Marchiori
- Institute for Computing and Information Sciences, Radboud University, Nijmegen 6525 EC, The Netherlands
| | - Bram Platel
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525, The Netherlands
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Saji N, Ogama N, Toba K, Sakurai T. White matter hyperintensities and geriatric syndrome: An important role of arterial stiffness. Geriatr Gerontol Int 2016; 15 Suppl 1:17-25. [PMID: 26671153 DOI: 10.1111/ggi.12673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 12/16/2022]
Abstract
White matter hyperintensities (WMH) are defined as cerebral white matter changes presumed to be of vascular origin, bilateral and mostly symmetrical. They can appear as hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences, and as isointense or hypointense on T1-weighted magnetic resonance imaging of the brain. WMH have been focused on because of their clinical importance as a risk factor for cerebrovascular diseases and cognitive impairment. WMH are associated with geriatric syndrome, which is defined by clinical symptoms characteristic of older adults, including cognitive and functional impairment and falls. Cerebral small vessel diseases, such as WMH, might play an important role as risk factors for cerebrovascular diseases, cognitive impairment and geriatric syndrome through the mechanism of arterial stiffness. However, the vascular, physiological and metabolic roles of arterial stiffness remain unclear. Basically, arterial stiffness indicates microvessel arteriosclerosis presenting with vascular endothelial dysfunction. These changes might arise from hemodynamic stress as a result of a "tsunami effect" on cerebral parenchyma. In the present article, we review the clinical characteristics of WMH, focusing particularly on two associations: (i) those between cerebral small vessel diseases including WMH and arterial stiffness; and (ii) those between WMH and geriatric syndrome.
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Affiliation(s)
- Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Noriko Ogama
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Biobank, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
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32
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Klöppel S, Peter J, Ludl A, Pilatus A, Maier S, Mader I, Heimbach B, Frings L, Egger K, Dukart J, Schroeter ML, Perneczky R, Häussermann P, Vach W, Urbach H, Teipel S, Hüll M, Abdulkadir A. Applying Automated MR-Based Diagnostic Methods to the Memory Clinic: A Prospective Study. J Alzheimers Dis 2016; 47:939-54. [PMID: 26401773 PMCID: PMC4923764 DOI: 10.3233/jad-150334] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies have demonstrated that fully automated pattern recognition methods applied to structural magnetic resonance imaging (MRI) aid in the diagnosis of dementia, but these conclusions are based on highly preselected samples that significantly differ from that seen in a dementia clinic. At a single dementia clinic, we evaluated the ability of a linear support vector machine trained with completely unrelated data to differentiate between Alzheimer’s disease (AD), frontotemporal dementia (FTD), Lewy body dementia, and healthy aging based on 3D-T1 weighted MRI data sets. Furthermore, we predicted progression to AD in subjects with mild cognitive impairment (MCI) at baseline and automatically quantified white matter hyperintensities from FLAIR-images. Separating additionally recruited healthy elderly from those with dementia was accurate with an area under the curve (AUC) of 0.97 (according to Fig. 4). Multi-class separation of patients with either AD or FTD from other included groups was good on the training set (AUC > 0.9) but substantially less accurate (AUC = 0.76 for AD, AUC = 0.78 for FTD) on 134 cases from the local clinic. Longitudinal data from 28 cases with MCI at baseline and appropriate follow-up data were available. The computer tool discriminated progressive from stable MCI with AUC = 0.73, compared to AUC = 0.80 for the training set. A relatively low accuracy by clinicians (AUC = 0.81) illustrates the difficulties of predicting conversion in this heterogeneous cohort. This first application of a MRI-based pattern recognition method to a routine sample demonstrates feasibility, but also illustrates that automated multi-class differential diagnoses have to be the focus of future methodological developments and application studies
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Affiliation(s)
- Stefan Klöppel
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.,Freiburg Brain Imaging, University Medical Center Freiburg, Germany.,Departments of Psychiatry and Psychotherapy, Section of Gerontopsychiatry and Neuropsychology, University Medical Center Freiburg, Freiburg, Germany.,Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
| | - Jessica Peter
- Freiburg Brain Imaging, University Medical Center Freiburg, Germany.,Departments of Psychiatry and Psychotherapy, Section of Gerontopsychiatry and Neuropsychology, University Medical Center Freiburg, Freiburg, Germany.,Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
| | - Anna Ludl
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany
| | - Anne Pilatus
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany
| | - Sabrina Maier
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany
| | - Irina Mader
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Bernhard Heimbach
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany
| | - Lars Frings
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.,Department of Nuclear Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Karl Egger
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Juergen Dukart
- F. Hoffmann-La Roche, pRED, Pharma Research and Early Development, DTA Neuroscience, Basel, Switzerland.,Max Planck Institute for Human Cognitive and Brain Sciences & Clinic for Cognitive Neurology, University of Leipzig, and German Consortium for Frontotemporal Lobar Degeneration, Ulm, Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences & Clinic for Cognitive Neurology, University of Leipzig, and German Consortium for Frontotemporal Lobar Degeneration, Ulm, Germany
| | - Robert Perneczky
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College of Science, Technology and Medicine London, United Kingdom.,Cognitive Impairment and Dementia Services, Lakeside Mental Health Unit, West London Mental Health NHS Trust, London, UK.,Departments of Psychiatry and Psychotherapy, Technical University München, Germany
| | | | - Werner Vach
- Center for Medical Biometry and Medical Informatics, University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Stefan Teipel
- Departments of Psychosomatic Medicine, University of Rostock, and German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Michael Hüll
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.,Clinics for Geronto- and Neuropsychiatry, ZfP Emmendingen, Emmendingen, Germany
| | - Ahmed Abdulkadir
- Freiburg Brain Imaging, University Medical Center Freiburg, Germany.,Department of Computer Science and BIOSS Centre for Biological Signaling Studies, University of Freiburg, Germany
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Zhai Y, Yamashita T, Nakano Y, Sun Z, Morihara R, Fukui Y, Ohta Y, Hishikawa N, Abe K. Disruption of White Matter Integrity by Chronic Cerebral Hypoperfusion in Alzheimer’s Disease Mouse Model. J Alzheimers Dis 2016; 52:1311-9. [DOI: 10.3233/jad-160120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Coutu JP, Goldblatt A, Rosas HD, Salat DH. White Matter Changes are Associated with Ventricular Expansion in Aging, Mild Cognitive Impairment, and Alzheimer's Disease. J Alzheimers Dis 2016; 49:329-42. [PMID: 26444767 PMCID: PMC5996384 DOI: 10.3233/jad-150306] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
White matter lesions are highly prevalent in individuals with Alzheimer's disease (AD). Although these lesions are presumed to be of vascular origin and linked to small vessel disease in older adults, little information exists about their relationship to markers of classical AD neurodegeneration. Thus, we examined the link between these white matter changes (WMC) segmented on T1-weighted MRI and imaging markers presumed to be altered due to primary AD neurodegenerative processes. Tissue microstructure of WMC was quantified using diffusion tensor imaging and the relationship of WMC properties and volume to neuroimaging markers was examined in 219 cognitively healthy older adults and individuals with mild cognitive impairment and AD using data from the Alzheimer's Disease Neuroimaging Initiative. No significant group differences in WMC properties were found. However, there were strong associations between diffusivity of WMC and ventricular volume, volume of WMC and total WM volume. In comparison, group differences in parahippocampal white matter microstructure were found for all diffusion metrics and were largely explained by hippocampal volume. Factor analysis on neuroimaging markers suggested two independent sets of covarying degenerative changes, with potentially age- and vascular-mediated tissue damage contributing to one factor and classical neurodegenerative changes associated with AD contributing to a second factor. These data demonstrate two potentially distinct classes of degenerative change in AD, with one factor strongly linked to aging, ventricular expansion, and both volume and tissue properties of white matter lesions, while the other factor related to classical patterns of cortical and hippocampal neurodegeneration in AD.
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Affiliation(s)
- Jean-Philippe Coutu
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Alison Goldblatt
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - H. Diana Rosas
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David H. Salat
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, USA
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35
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Automatic white matter lesion segmentation using contrast enhanced FLAIR intensity and Markov Random Field. Comput Med Imaging Graph 2015; 45:102-11. [PMID: 26398564 DOI: 10.1016/j.compmedimag.2015.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 08/08/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022]
Abstract
White matter lesions (WMLs) are small groups of dead cells that clump together in the white matter of brain. In this paper, we propose a reliable method to automatically segment WMLs. Our method uses a novel filter to enhance the intensity of WMLs. Then a feature set containing enhanced intensity, anatomical and spatial information is used to train a random forest classifier for the initial segmentation of WMLs. Following that a reliable and robust edge potential function based Markov Random Field (MRF) is proposed to obtain the final segmentation by removing false positive WMLs. Quantitative evaluation of the proposed method is performed on 24 subjects of ENVISion study. The segmentation results are validated against the manual segmentation, performed under the supervision of an expert neuroradiologist. The results show a dice similarity index of 0.76 for severe lesion load, 0.73 for moderate lesion load and 0.61 for mild lesion load. In addition to that we have compared our method with three state of the art methods on 20 subjects of Medical Image Computing and Computer Aided Intervention Society's (MICCAI's) MS lesion challenge dataset, where our method shows better segmentation accuracy compare to the state of the art methods. These results indicate that the proposed method can assist the neuroradiologists in assessing the WMLs in clinical practice.
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36
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Dugger BN, Davis K, Malek-Ahmadi M, Hentz JG, Sandhu S, Beach TG, Adler CH, Caselli RJ, Johnson TA, Serrano GE, Shill HA, Belden C, Driver-Dunckley E, Caviness JN, Sue LI, Jacobson S, Powell J, Sabbagh MN. Neuropathological comparisons of amnestic and nonamnestic mild cognitive impairment. BMC Neurol 2015; 15:146. [PMID: 26289075 PMCID: PMC4545878 DOI: 10.1186/s12883-015-0403-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there are studies investigating the pathologic origins of mild cognitive impairment (MCI), they have revolved around comparisons to normal elderly individuals or those with Alzheimer's disease (AD) or other dementias. There are few studies directly comparing the comprehensive neuropathology of amnestic (aMCI) and nonamnestic (naMCI) MCI. METHODS The database of the Brain and Body Donation Program ( www.brainandbodydonationprogram.org ), a longitudinal clinicopathological study of normal aging and neurodegenerative disorders, was queried for subjects who were carrying a diagnosis of aMCI or naMCI at the time of autopsy. Neuropathological lesions, including neuritic plaques, neurofibrillary tangles (NFTs), Lewy bodies (LBs), infarcts, cerebral white matter rarefaction (CWMR), cerebral amyloid angiopathy (CAA), and concurrent major clinicopathological diagnoses, including Parkinson's disease (PD) were analyzed. RESULTS Thirty four subjects with aMCI and 15 naMCI met study criteria. Subjects with aMCI were older at death (88 vs. 83 years of age, p = 0.03). Individuals with naMCI had higher densities of LBs within the temporal lobe (p = 0.04) while subjects with aMCI had a propensity for increased NFTs in parietal and temporal lobes (p values = 0.07). After adjusting for age at death, the only significant difference was greater densities of temporal lobe NFTs within the aMCI group. Other regional pathology scores for plaques, NFTs, and LBs were similar between groups. Subjects met clinico-pathological criteria for co-existent PD in 24 % aMCI and 47 % naMCI while neuropathological criteria for AD were met in equal percentages of aMCI and of naMCI cases (53 %); these proportional differences were not significant (p values > 0.35). Furthermore, regardless of amnestic status, there was a greater presence of CAA (71 % of MCI with executive dysfunction vs. 39 % without p = 0.03) and a greater presence of CWMR (81 % of MCI with executive dysfunction and 54 % without p = 0.046) in MCI cases with executive dysfunction. CONCLUSIONS No single pathologic entity strongly dichotomized MCI groups, perhaps due to the pathologic heterogeneity found within both entities. However, these data suggest the possibility for naMCI to have a propensity for increased LBs and aMCI for increased NFTs in select anatomic regions.
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Affiliation(s)
- Brittany N Dugger
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, 10515 W. Santa Fe Dr., Sun City, AZ, 85351, USA.
| | - Kathryn Davis
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, AZ, USA.
| | - Michael Malek-Ahmadi
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, AZ, USA.
| | | | - Shawn Sandhu
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, AZ, USA.
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, 10515 W. Santa Fe Dr., Sun City, AZ, 85351, USA.
| | | | | | | | - Geidy E Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, 10515 W. Santa Fe Dr., Sun City, AZ, 85351, USA.
| | - Holly A Shill
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, AZ, USA.
| | - Christine Belden
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, AZ, USA.
| | | | | | - Lucia I Sue
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, 10515 W. Santa Fe Dr., Sun City, AZ, 85351, USA.
| | - Sandra Jacobson
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, AZ, USA.
| | - Jessica Powell
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, AZ, USA.
| | - Marwan N Sabbagh
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, AZ, USA.
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Wu MK, Lu YT, Huang CW, Lin PH, Chen NC, Lui CC, Chang WN, Lee CC, Chang YT, Chen SF, Chang CC. Clinical Significance of Cerebrovascular Biomarkers and White Matter Tract Integrity in Alzheimer Disease: Clinical correlations With Neurobehavioral Data in Cross-Sectional and After 18 Months Follow-ups. Medicine (Baltimore) 2015; 94:e1192. [PMID: 26181568 PMCID: PMC4617061 DOI: 10.1097/md.0000000000001192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cerebrovascular risk factors and white matter (WM) damage lead to worse cognitive performance in Alzheimer dementia (AD). This study investigated WM microstructure using diffusion tensor imaging in patients with mild to moderate AD and investigated specific fiber tract involvement with respect to predefined cerebrovascular risk factors and neurobehavioral data prediction cross-sectionally and after 18 months. To identify the primary pathoanatomic relationships of risk biomarkers to fiber tract integrity, we predefined 11 major association tracts and calculated tract specific fractional anisotropy (FA) values. Eighty-five patients with AD underwent neurobehavioral assessments including the minimental state examination (MMSE) and 12-item neuropsychiatric inventory twice with a 1.5-year interval to represent major outcome factors. In the cross-sectional data, total cholesterol, low-density lipoprotein, vitamin B12, and homocysteine levels correlated variably with WM FA values. After entering the biomarkers and WM FA into a regression model to predict neurobehavioral outcomes, only fiber tract FA or homocysteine level predicted the MMSE score, and fiber tract FA or age predicted the neuropsychiatric inventory total scores and subdomains of apathy, disinhibition, and aberrant motor behavior. In the follow-up neurobehavioral data, the mean global FA value predicted the MMSE and aberrant motor behavior subdomain, while age predicted the anxiety and elation subdomains. Cerebrovascular risk biomarkers may modify WM microstructural organization, while the association with fiber integrity showed greater clinical significance to the prediction of neurobehavioral outcomes both cross-sectionally and longitudinally.
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Affiliation(s)
- Ming-Kung Wu
- From the Department of Psychiatry (M-KW, S-FC); Department of Neurology, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine (Y-TL, C-WH, N-CC, W-NC, Y-TC, S-FC, C-CC); Department of Health and Beauty, Shu-Zen College of Medicine and Management (P-HL, Chen-Chang Lee); and Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (Chun-Chung Lui)
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Kishi T, Matsunaga S, Oya K, Ikuta T, Iwata N. Protection against Brain Atrophy by Anti-dementia Medication in Mild Cognitive Impairment and Alzheimer's Disease: Meta-Analysis of Longitudinal Randomized Placebo-Controlled Trials. Int J Neuropsychopharmacol 2015; 18:pyv070. [PMID: 26091818 PMCID: PMC4675981 DOI: 10.1093/ijnp/pyv070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/16/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There has not been conclusive evidence for prevention of brain atrophy by anti-dementia drugs in mild cognitive impairment and Alzheimer's Disease. METHODS Relevant studies were identified through searches of PubMed, databases of the Cochrane Library, and PsycINFO citations up to 16 May, 2015. Only double-blind, randomized, placebo-controlled clinical trials of anti-dementia drugs in patients with mild cognitive impairment or Alzheimer's Disease were included. Primary outcomes were annualized percent change of total brain volume (%TBV/y), annualized percent change of hippocampal volume (%HV/y), and annualized percent change of ventricular volume (%VV/y) measured by magnetic resonance imaging. Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated for relevant outcomes. RESULTS Seven randomized, placebo-controlled clinical trials (n=1708) were found to meet the inclusion criteria, including 4 mild cognitive impairment studies (n=1327) and 3 Alzheimer's Disease studies (n=381) [3 donepezil studies (2 mild cognitive impairment studies and 1 Alzheimer's Disease study), 1 galantaime study for mild cognitive impairment, 2 mementine studies for Alzheimer's Disease, and 1 rivastigmine study for mild cognitive impairment]. Pooled anti-dementia drugs showed superior protective outcomes compared with placebo regarding %TBV/y (SMD=-0.21, 95%CI=-0.37 to -0.04, P=.01, N=4, n=624) and %VV/y (SMD=-0.79, 95%CI=-1.40 to -0.19, P=.01, N=3, n=851). However, %HV/y failed to show difference between both groups. Among anti-dementia drugs, donepezil showed significantly greater protective effects than placebo regarding %TBV/y (SMD=-0.43, 95%CI=-0.74 to -0.12, P=.007, N=1, n=164) and %VV/y (SMD=-0.51, 95%CI=-0.73 to -0.29, P<.00001, N=2, n=338). Rivastigmine was also superior to placebo regarding %VV/y (SMD=-1.33, 95%CI=-1.52 to -1.14, P<.00001). CONCLUSIONS The results favored the hypothesis that anti-dementia drugs may prevent brain atrophy in patients with mild cognitive impairment and Alzheimer's Disease.
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Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Drs Kishi, Matsunaga, Oya, and Iwata); Department of Communication Sciences and Disorders, School of Applied Sciences, University of Mississippi, University, Mississippi (Dr Ikuta).
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Kotze MJ, Lückhoff HK, Brand T, Pretorius J, van Rensburg SJ. Apolipoprotein E ε-4 as a genetic determinant of Alzheimer's disease heterogeneity. Degener Neurol Neuromuscul Dis 2015; 5:9-18. [PMID: 32669910 PMCID: PMC7337157 DOI: 10.2147/dnnd.s41721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/23/2015] [Indexed: 12/30/2022] Open
Abstract
Alzheimer's disease (AD) displays a high degree of heterogeneity in terms of its etiology, presentation, prognosis, and treatment response. This can partly be explained by high-penetrance mutations in the amyloid precursor protein, presenilin 1 and presenilin 2 genes causing amyloid beta aggregation, which is a major pathogenic mechanism in the development of early-onset AD in a small subgroup of patients. Late-onset AD is considered a polygenic disorder in which cumulative risk resulting from interaction with modifiable environmental risk factors may be responsible for the majority of cases. The ε-4 allele of the apolipoprotein E (APOE) gene has emerged as the most significant genetic risk factor for late-onset AD, influencing nearly every pathogenic domain affected in AD. It is a major risk factor for cerebral amyloid angiopathy, recognized as a common pathological finding in an AD subtype associated with white matter dysfunction. The APOE ε-4 allele is also a known risk factor for ischemic stroke, which can result in vascular dementia or contribute to subcortical vascular dysfunction. In this review, we evaluate the clinical relevance of APOE genotyping in relation to cholesterol metabolism and available evidence on risk reduction strategies applicable to AD.
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Affiliation(s)
- MJ Kotze
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - HK Lückhoff
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - T Brand
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Pretorius
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - SJ van Rensburg
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and the National Health Laboratory Service, Tygerberg Hospital, Tygerberg, South Africa
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Ogama N, Yoshida M, Nakai T, Niida S, Toba K, Sakurai T. Frontal white matter hyperintensity predicts lower urinary tract dysfunction in older adults with amnestic mild cognitive impairment and Alzheimer's disease. Geriatr Gerontol Int 2015; 16:167-74. [DOI: 10.1111/ggi.12447] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Noriko Ogama
- Center for Comprehensive Care and Research on Memory Disorders; National Center for Geriatrics and Gerontology; Obu Japan
- Biobank; National Center for Geriatrics and Gerontology; Obu Japan
| | - Masaki Yoshida
- Department of Urology; National Center for Geriatrics and Gerontology; Obu Japan
| | - Toshiharu Nakai
- NeuroImaging and Informatics; National Center for Geriatrics and Gerontology; Obu Japan
| | - Shumpei Niida
- Biobank; National Center for Geriatrics and Gerontology; Obu Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders; National Center for Geriatrics and Gerontology; Obu Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders; National Center for Geriatrics and Gerontology; Obu Japan
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Shim YS, Yang DW, Roe CM, Coats MA, Benzinger TL, Xiong C, Galvin JE, Cairns NJ, Morris JC. Pathological correlates of white matter hyperintensities on magnetic resonance imaging. Dement Geriatr Cogn Disord 2015; 39:92-104. [PMID: 25401390 PMCID: PMC4312498 DOI: 10.1159/000366411] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We investigated the histopathological correlates of white matter hyperintensities (WMHs) in participants with Alzheimer's disease (AD) or cerebrovascular disease, and in aged controls. METHODS We reviewed 57 participants who had neuropathology and in whom neuroimaging was done. In addition to AD pathology, cortical microinfarcts, lacunes, and cerebral hemorrhages were assessed. Small-vessel disease included arteriolosclerosis and cerebral amyloid angiopathy. Postmortem brain tissue corresponding to regions of WMHs was investigated in 14 participants. The variables included: demyelination of the deep and periventricular white matter (WM), atrophy of the ventricular ependyma, and thickness of blood vessels. Partial Spearman's rank test and linear regression analysis, adjusted for age at the clinical evaluation and the duration to death, were performed. RESULTS The severity of arteriosclerosis was correlated with the volume of periventricular hyperintensity (PVH) estimated by magnetic resonance imaging. Deep white matter hyperintensity (DWMH) volume was correlated with the presence of cortical microinfarcts and cerebral hemorrhages. The severity of the breakdown of the ventricular lining was correlated with PVHs, and DWMHs correlated with the severity of deep WM demyelination. The diameter of small blood vessels was not associated with WMHs. CONCLUSION WMHs are consistent with small-vessel disease and increase the tissue water content. We found no association between WMHs and the thickness of small blood vessels.
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Affiliation(s)
- Yong S. Shim
- Department of Neurology, The Catholic University of Korea College of Medicine, Seoul, South Korea,Correspondence to: Yong S. Shim, The Catholic University of Korea Bucheon St. Mary's Hospital, 2 Sosa-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-717, South Korea (Tel: +82-32-340-7094, Fax: +82-32-340-2669, ) Co-Correspondence: John C. Morris, Knight ADRC, Washington University School of Medicine, 4488 Forest Park Avenue, St. Louis, MO 63108, USA (Tel: +1-314-286-2881, Fax: +1-314-286-2448, )
| | - Dong-Won Yang
- Department of Neurology, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Catherine M. Roe
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Mary A. Coats
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Tammie L. Benzinger
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Chengjie Xiong
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - James E. Galvin
- Departments of Neurology, Psychiatry and Population Health, New York University Langone Medical Center, New York, NY, USA
| | - Nigel J. Cairns
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - John C. Morris
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA,Correspondence to: Yong S. Shim, The Catholic University of Korea Bucheon St. Mary's Hospital, 2 Sosa-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-717, South Korea (Tel: +82-32-340-7094, Fax: +82-32-340-2669, ) Co-Correspondence: John C. Morris, Knight ADRC, Washington University School of Medicine, 4488 Forest Park Avenue, St. Louis, MO 63108, USA (Tel: +1-314-286-2881, Fax: +1-314-286-2448, )
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Clinical and demographic predictors of mild cognitive impairment for converting to Alzheimer's disease and reverting to normal cognition. J Neurol Sci 2014; 346:288-92. [DOI: 10.1016/j.jns.2014.09.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/07/2014] [Accepted: 09/09/2014] [Indexed: 11/17/2022]
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Ramirez J, McNeely AA, Scott CJ, Stuss DT, Black SE. Subcortical hyperintensity volumetrics in Alzheimer's disease and normal elderly in the Sunnybrook Dementia Study: correlations with atrophy, executive function, mental processing speed, and verbal memory. ALZHEIMERS RESEARCH & THERAPY 2014; 6:49. [PMID: 25478020 PMCID: PMC4255416 DOI: 10.1186/alzrt279] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 07/15/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Subcortical hyperintensities (SHs) are radiological entities commonly observed on magnetic resonance imaging (MRI) of patients with Alzheimer's disease (AD) and normal elderly controls. Although the presence of SH is believed to indicate some form of subcortical vasculopathy, pathological heterogeneity, methodological differences, and the contribution of brain atrophy associated with AD pathology have yielded inconsistent results in the literature. METHODS Using the Lesion Explorer (LE) MRI processing pipeline for SH quantification and brain atrophy, this study examined SH volumes of interest and cognitive function in a sample of patients with AD (n = 265) and normal elderly controls (n = 100) from the Sunnybrook Dementia Study. RESULTS Compared with healthy controls, patients with AD were found to have less gray matter, less white matter, and more sulcal and ventricular cerebrospinal fluid (all significant, P <0.0001). Additionally, patients with AD had greater volumes of whole-brain SH (P <0.01), periventricular SH (pvSH) (P <0.01), deep white SH (dwSH) (P <0.05), and lacunar lesions (P <0.0001). In patients with AD, regression analyses revealed a significant association between global atrophy and pvSH (P = 0.02) and ventricular atrophy with whole-brain SH (P <0.0001). Regional volumes of interest revealed significant correlations with medial middle frontal SH volume and executive function (P <0.001) in normal controls but not in patients with AD, global pvSH volume and mental processing speed (P <0.01) in patients with AD, and left temporal SH volume and memory (P <0.01) in patients with AD. CONCLUSIONS These brain-behavior relationships and correlations with brain atrophy suggest that subtle, yet measurable, signs of small vessel disease may have potential clinical relevance as targets for treatment in Alzheimer's dementia.
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Affiliation(s)
- Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada ; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada ; Sunnybrook Health Sciences Centre, Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alicia A McNeely
- LC Campbell Cognitive Neurology Research Unit, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada ; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada ; Sunnybrook Health Sciences Centre, Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Christopher Jm Scott
- LC Campbell Cognitive Neurology Research Unit, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada ; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada ; Sunnybrook Health Sciences Centre, Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Donald T Stuss
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada ; Rotman Research Institute, Baycrest, Toronto, ON, Canada ; Ontario Brain Institute, Toronto, ON, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology Research Unit, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada ; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada ; Sunnybrook Health Sciences Centre, Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada ; Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada ; Rotman Research Institute, Baycrest, Toronto, ON, Canada
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Overdorp EJ, Kessels RPC, Claassen JA, Oosterman JM. Cognitive impairments associated with medial temporal atrophy and white matter hyperintensities: an MRI study in memory clinic patients. Front Aging Neurosci 2014; 6:98. [PMID: 24904411 PMCID: PMC4034495 DOI: 10.3389/fnagi.2014.00098] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/06/2014] [Indexed: 11/13/2022] Open
Abstract
In this retrospective study, we investigated the independent effects of white matter hyperintensities (WMH) and hippocampal atrophy on cognitive functions in a broad sample of patients seen in a memory clinic. To ensure generalizability, these associations were examined irrespective of diagnosis and with minimal exclusion criteria. Next to these independent effects, interactions between WMH and hippocampal atrophy were examined. Between January 2006 and September 2011 a total of 500 patients visited the memory clinic, 397 of whom were included. Magnetic resonance images of 397 patients were visually analyzed for WMH, medial temporal atrophy (MTA), and global atrophy. We evaluated the association of WMH and MTA with the following cognitive domains: global cognition, episodic memory, working memory, executive function and psychomotor speed. Main effects and interaction effects were examined by means of correlation and regression analyses. In the regression analyses, we controlled for potential confounding effects of global atrophy. The correlational results revealed that WMH were associated with global cognition, executive function and psychomotor speed, whereas a trend was found for episodic memory. MTA was associated with all these four cognitive domains; an additional trend was observed for working memory. Hierarchical regression analyses revealed main independent effects of MTA for episodic memory, executive function, psychomotor speed and global cognition; WMH were only associated with global cognition. The interaction between MTA and WMH was significant for episodic memory only. This study demonstrates that predominantly MTA is an independent predictor not only for memory function, with which is it classically associated, but also for global cognition and executive function. Taken together, MTA may be an important correlate of cognitive deficits found in people attending the memory clinic.
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Affiliation(s)
- Eduard J Overdorp
- Department of Psychiatry, Gelre Medical Centre Zutphen, Netherlands ; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Nijmegen, Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Nijmegen, Netherlands ; Department of Medical Psychology, Radboud University Medical Center-Radboud Alzheimer Center Nijmegen, Netherlands
| | - Jurgen A Claassen
- Department of Medical Psychology, Radboud University Medical Center-Radboud Alzheimer Center Nijmegen, Netherlands ; Department of Geriatric Medicine, Radboud University Medical Center-Radboud Alzheimer Center Nijmegen, Netherlands
| | - Joukje M Oosterman
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Nijmegen, Netherlands
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Foley JM, Salat DH, Stricker NH, Zink TA, Grande LJ, McGlinchey RE, Milberg WP, Leritz EC. Interactive effects of apolipoprotein E4 and diabetes risk on later myelinating white matter regions in neurologically healthy older aged adults. Am J Alzheimers Dis Other Demen 2014; 29:222-35. [PMID: 24381137 PMCID: PMC4356251 DOI: 10.1177/1533317513517045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Possession of the apolipoprotein E4 (APOE4) allele and diabetes risk are independently related to reduced white matter (WM) integrity that may contribute to the development of Alzheimer's disease (AD). The purpose of this study is to examine the interactive effects of APOE4 and diabetes risk on later myelinating WM regions among healthy elderly individuals at risk of AD. A sample of 107 healthy elderly (80 APOE4-/27 APOE4+) individuals underwent structural magnetic resonance imaging/diffusion tensor imaging (DTI). Data were prepared using Tract-Based Spatial Statistics, and a priori regions of interest (ROIs) were extracted from T1-based WM parcellations. Regions of interest included later myelinating frontal/temporal/parietal WM regions and control regions measured by fractional anisotropy (FA). There were no APOE group differences in DTI for any ROI. Within the APOE4 group, we found negative relationships between hemoglobin A1c/fasting glucose and APOE4 on FA for all later myelinating WM regions but not for early/middle myelinating control regions. Results also showed APOE4/diabetes risk interactions for WM underlying supramarginal, superior temporal, precuneus, superior parietal, and superior frontal regions. Results suggest interactive effects of APOE4 and diabetes risk on later myelinating WM regions, which supports preclinical detection of AD among this particularly susceptible subgroup.
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Affiliation(s)
- Jessica M. Foley
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - David H. Salat
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Nikki H. Stricker
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Tyler A. Zink
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Laura J. Grande
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Regina E. McGlinchey
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - William P. Milberg
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Elizabeth C. Leritz
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- Division of Aging, Brigham & Women’s Hospital, Boston, MA, USA
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Gao J, Li C, Feng C, Xie M, Yin Y, Davatzikos C. Non-locally regularized segmentation of multiple sclerosis lesion from multi-channel MRI data. Magn Reson Imaging 2014; 32:1058-66. [PMID: 24948583 DOI: 10.1016/j.mri.2014.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 01/20/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
Abstract
Segmentation of multiple sclerosis (MS) lesion is important for many neuroimaging studies. In this paper, we propose a novel algorithm for automatic segmentation of MS lesions from multi-channel MR images (T1W, T2W and FLAIR images). The proposed method is an extension of Li et al.'s algorithm in [1], which only segments the normal tissues from T1W images. The proposed method is aimed to segment MS lesions, while normal tissues are also segmented and bias field is estimated to handle intensity inhomogeneities in the images. Another contribution of this paper is the introduction of a nonlocal means technique to achieve spatially regularized segmentation, which overcomes the influence of noise. Experimental results have demonstrated the effectiveness and advantages of the proposed algorithm.
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Affiliation(s)
- Jingjing Gao
- School of Electronic Engineering, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China; Center of Biomedical Image Computing and Analytics, University of PA, Philadelphia 19104, USA
| | - Chunming Li
- Center of Biomedical Image Computing and Analytics, University of PA, Philadelphia 19104, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Chaolu Feng
- Key Laboratory of Medical Image Computing of Ministry of Education, Northeastern University, Shenyang, Liaoning 110819, China
| | - Mei Xie
- School of Electronic Engineering, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Yilong Yin
- School of Computer Science and Technology, Shandong University, Jinan, Shandong 250100, China
| | - Christos Davatzikos
- Center of Biomedical Image Computing and Analytics, University of PA, Philadelphia 19104, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Tsuno N, Homma A. What is the association between depression and Alzheimer’s disease? Expert Rev Neurother 2014; 9:1667-76. [DOI: 10.1586/ern.09.106] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Iorio M, Spalletta G, Chiapponi C, Luccichenti G, Cacciari C, Orfei MD, Caltagirone C, Piras F. White matter hyperintensities segmentation: a new semi-automated method. Front Aging Neurosci 2013; 5:76. [PMID: 24339815 PMCID: PMC3857525 DOI: 10.3389/fnagi.2013.00076] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/30/2013] [Indexed: 11/13/2022] Open
Abstract
White matter hyperintensities (WMH) are brain areas of increased signal on T2-weighted or fluid-attenuated inverse recovery magnetic resonance imaging (MRI) scans. In this study we present a new semi-automated method to measure WMH load that is based on the segmentation of the intensity histogram of fluid-attenuated inversion recovery images. Thirty patients with mild cognitive impairment with variable WMH load were enrolled. The semi-automated WMH segmentation included removal of non-brain tissue, spatial normalization, removal of cerebellum and brain stem, spatial filtering, thresholding to segment probable WMH, manual editing for correction of false positives and negatives, generation of WMH map, and volumetric estimation of the WMH load. Accuracy was quantitatively evaluated by comparing semi-automated and manual WMH segmentations performed by two independent raters. Differences between the two procedures were assessed using Student’s t-tests and similarity was evaluated using linear regression model and Dice similarity coefficient (DSC). The volumes of the manual and semi-automated segmentations did not statistically differ (t-value = -1.79, DF = 29, p = 0.839 for rater 1; t-value = 1.113, DF = 29, p = 0.2749 for rater 2), were highly correlated [R2 = 0.921, F(1,29) = 155.54, p < 0.0001 for rater 1; R2 = 0.935, F(1,29) = 402.709, p < 0.0001 for rater 2] and showed a very strong spatial similarity (mean DSC = 0.78, for rater 1 and 0.77 for rater 2). In conclusion, our semi-automated method to measure the load of WMH is highly reliable and could represent a good tool that could be easily implemented in routinely neuroimaging analyses to map clinical consequences of WMH.
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Affiliation(s)
- Mariangela Iorio
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation Rome, Italy
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Nakaaki S, Sato J, Torii K, Oka M, Negi A, Nakamae T, Narumoto J, Miyata J, Furukawa TA, Mimura M. Decreased white matter integrity before the onset of delusions in patients with Alzheimer's disease: diffusion tensor imaging. Neuropsychiatr Dis Treat 2013; 9:25-9. [PMID: 23293524 PMCID: PMC3534309 DOI: 10.2147/ndt.s38942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The pathology of delusions in patients with Alzheimer's disease (AD) associated with white matter (WM) abnormalities is poorly understood. In addition, whether the abnormalities in WM integrity that underlie the delusions develop before the onset of the delusions remains unclear. In this study, we used a diffusion tensor imaging approach to examine the existence of baseline abnormalities in WM integrity in AD patients who developed delusions and AD patients who did not develop delusions. METHODS Using the Neuropsychiatric Inventory, we identified patients with AD who exhibit delusions during a 1-year period. All the patients underwent a magnetic resonance imaging (MRI) examination at baseline. We conducted fractional anisotropy using tract-based spatial statistics software and compared the results of AD patients who developed delusions with those who did not develop delusions. RESULTS Compared with the AD patients who did not develop delusions (n = 15), the AD patients who developed delusions (n = 10) exhibited two relatively large clusters and one minimal cluster of significantly lower fractional anisotropy results. The first cluster was located in the left parieto-occipital region and included several fibers: the left inferior longitudinal fasciculus, the inferior fronto-occipital fasciculus, the posterior corona radiate, and the forceps major of the corpus callosum. The second cluster was located on the body of the corpus callosum. A third minimal cluster was located on the superior temporal gyrus white matter. CONCLUSION Abnormalities in WM integrity involving several fibers may be crucial to the development of delusions in AD patients.
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Affiliation(s)
- Shutaro Nakaaki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Ogawa Y, Hashimoto M, Yatabe Y, Kaneda K, Honda K, Yuuki S, Hirai T, Ikeda M. Association of cerebral small vessel disease with delusions in patients with Alzheimer's disease. Int J Geriatr Psychiatry 2013; 28:18-25. [PMID: 22396307 DOI: 10.1002/gps.3781] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 01/11/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cerebral small vessel disease (SVD) is frequently observed in patients with Alzheimer's disease (AD). However, the association between SVD and clinical symptoms exhibited by patients with AD remains unclear. This study examined the association of SVD as observed on magnetic resonance imaging (MRI) with behavioural and psychological symptoms of dementia and cognitive function of patients with probable AD. METHODS A total of 163 consecutive patients (55 men, 108 women) with probable AD were included in this cross-sectional study of a prospective cohort. Patients were divided into two groups based on the presence or absence of cerebral SVD [white matter hyperintensities (WMH) grade 0/1 (Fazekas scale) and no lacunes: SVD absent, WMH grade 2/3 (Fazekas scale) or the number of lacunes ≥1: SVD present]. Cognitive functions were assessed using the Mini mental state examination, word recall and recognition subtests in the Alzheimer's Disease Assessment Scale-Cognitive Subscale, as well as the letter fluency task and the category fluency task. Psychiatric symptoms were rated according to Neuropsychiatric Inventory. RESULTS Patients with probable AD with cerebral SVD had significantly more delusions and depression than those without SVD. No significant differences were observed in other neuropsychiatric symptoms, MMSE or word recall and recognition tests between both groups. CONCLUSIONS Our results suggest that cerebral SVD observed on MRI of patients with AD is associated with delusions and depression.
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Affiliation(s)
- Yusuke Ogawa
- Department of Psychiatry and Neuropathobiology, Graduate School of Medical Science, Kumamoto University, Japan
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