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Zou J, Hao S. A potential research target for cardiac rehabilitation: brain-derived neurotrophic factor. Front Cardiovasc Med 2024; 11:1348645. [PMID: 38707889 PMCID: PMC11069312 DOI: 10.3389/fcvm.2024.1348645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/19/2024] [Indexed: 05/07/2024] Open
Abstract
Cardiovascular diseases pose a major threat to human life, functional activity, and quality of life. Once the disease is present, patients can experience varying degrees of problems or limitations on three levels: physical, psychological, and social. Patients with cardiovascular disease are always at risk for adverse cardiac events, decreased physical activity, psychoemotional disturbances, and limited social participation due to their varying pathologies. Therefore, personalized cardiac rehabilitation is of great significance in improving patients' physical and mental functions, controlling disease progression, and preventing deterioration. There is a consensus on the benefits of cardiac rehabilitation in improving patients' quality of life, enhancing functional activity, and reducing mortality. As an important part of cardiac rehabilitation, Exercise plays an irreplaceable role. Aerobic exercise, resistance training, flexibility training, and other forms of exercise are recommended by many experts. Improvements in exercise tolerance, lipid metabolism, cardiac function, and psychological aspects of the patients were evident with appropriate exercise interventions based on a comprehensive assessment. Further studies have found that brain-derived neurotrophic factor may be an important mediator of exercise's ability to improve cardiovascular health. Brain-derived neurotrophic factor exerts multiple biological effects on the cardiovascular system. This article provides another perspective on the cardiac effects of exercise and further looks at the prospects for the use of brain-derived neurotrophic factor in cardiac rehabilitation. Meanwhile, the new idea that brain-derived neurotrophic factor is a key mediator connecting the brain-cardiac axis is proposed in light of the current research progress, to provide new ideas for clinical rehabilitation and scientific research.
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Affiliation(s)
- Jianpeng Zou
- Department of Rehabilitation and Physiotherapy, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shijie Hao
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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Zhang X, Lu H, Fan M, Tian W, Cui M, Jiang Y, Suo C, Zhang T, Xu K, Wang Y, Chen X. Mobility-related brain regions linking carotid intima-media thickness to specific gait performances in old age. BMC Geriatr 2024; 24:303. [PMID: 38561655 PMCID: PMC10983675 DOI: 10.1186/s12877-024-04918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Gait disturbance is common in older adults with vascular diseases. However, how carotid atherosclerosis affects gait remains poorly understood. The objectives were to investigate the associations between carotid intima-media thickness and specific gait performances and explore the potential role of brain structure in mediating these associations. METHODS A cross-sectional analysis of data from the Taizhou Imaging Study was conducted, including 707 individuals who underwent both gait and carotid ultrasound examinations. Gait assessments include the Timed-Up-and-Go test, the Tinetti test, and quantitative gait assessment using a wearable device. Quantitative parameters were summarized into independent gait domains with factor analysis. Magnetic resonance images were obtained on a 3.0-Tesla scanner, and the volumes of fifteen brain regions related to motor function (primary motor, sensorimotor), visuospatial attention (inferior posterior parietal lobules, superior posterior parietal lobules), executive control function (dorsolateral prefrontal cortex, anterior cingulate), memory (hippocampus, entorhinal cortex), motor imagery (precuneus, parahippocampus, posterior cingulated cortex), and balance (basal ganglia: pallidum, putamen, caudate, thalamus) were computed using FreeSurfer and the Desikan-Killiany atlas. Mediation analysis was conducted with carotid intima-media thickness as the predictor and mobility-related brain regions as mediators. RESULTS Carotid intima-media thickness was found to be associated with the Timed-Up-and-Go performance (β = 0.129, p = 0.010) as well as gait performances related to pace (β=-0.213, p < 0.001) and symmetry (β = 0.096, p = 0.045). Besides, gait performances were correlated with mobility-related brain regions responsible for motor, visuospatial attention, executive control, memory, and balance (all FDR < 0.05). Notably, significant regions differed depending on the gait outcomes measured. The primary motor (41.9%), sensorimotor (29.3%), visuospatial attention (inferior posterior parietal lobules, superior posterior parietal lobules) (13.8%), entorhinal cortex (36.4%), and motor imagery (precuneus, parahippocampus, posterior cingulated cortex) (27.3%) mediated the association between increased carotid intima-media thickness and poorer Timed-Up-and-Go performance. For the pace domain, the primary motor (37.5%), sensorimotor (25.8%), visuospatial attention (12.3%), entorhinal cortex (20.7%), motor imagery (24.9%), and balance (basal ganglia: pallidum, putamen, caudate, thalamus) (11.6%) acted as mediators. CONCLUSIONS Carotid intima-media thickness is associated with gait performances, and mobility-related brain volume mediates these associations. Moreover, the distribution of brain regions regulating mobility varies in the different gait domains. Our study adds value in exploring the underlying mechanisms of gait disturbance in the aging population.
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Grants
- 2022ZD0211600 the Science and Technology Innovation 2030 Major Projects
- 2022ZD0211600 the Science and Technology Innovation 2030 Major Projects
- 2022ZD0211600 the Science and Technology Innovation 2030 Major Projects
- 2022ZD0211600 the Science and Technology Innovation 2030 Major Projects
- 2022ZD0211600 the Science and Technology Innovation 2030 Major Projects
- 2021YFC2500100 National Key Research and Development Program of China
- 2021YFC2500100 National Key Research and Development Program of China
- 2021YFC2500100 National Key Research and Development Program of China
- 2021YFC2500100 National Key Research and Development Program of China
- 2021YFC2500100 National Key Research and Development Program of China
- 2021YFC2500100 National Key Research and Development Program of China
- 2021YFC2500100 National Key Research and Development Program of China
- 23ZR1414000, 22ZR1405300 the Natural Science Foundation of Shanghai, China
- 23ZR1414000, 22ZR1405300 the Natural Science Foundation of Shanghai, China
- 23ZR1414000, 22ZR1405300 the Natural Science Foundation of Shanghai, China
- 23ZR1414000, 22ZR1405300 the Natural Science Foundation of Shanghai, China
- 23ZR1414000, 22ZR1405300 the Natural Science Foundation of Shanghai, China
- 23ZR1414000, 22ZR1405300 the Natural Science Foundation of Shanghai, China
- 22QA1404000 the Shanghai Rising-Star Program
- 22QA1404000 the Shanghai Rising-Star Program
- 22QA1404000 the Shanghai Rising-Star Program
- 22QA1404000 the Shanghai Rising-Star Program
- 22QA1404000 the Shanghai Rising-Star Program
- GWGZLXK-2023-02 Fudan School of Public Health-Jiading CDC key disciplines for the high-quality development of public health
- GWGZLXK-2023-02 Fudan School of Public Health-Jiading CDC key disciplines for the high-quality development of public health
- GWGZLXK-2023-02 Fudan School of Public Health-Jiading CDC key disciplines for the high-quality development of public health
- GWGZLXK-2023-02 Fudan School of Public Health-Jiading CDC key disciplines for the high-quality development of public health
- GWGZLXK-2023-02 Fudan School of Public Health-Jiading CDC key disciplines for the high-quality development of public health
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Affiliation(s)
- Xin Zhang
- School of Public Health, the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Heyang Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Fan
- Taixing Disease Control and Prevention Center, Taizhou, Jiangsu, China
| | - Weizhong Tian
- Taizhou People's Hospital Affiliated to Nantong University, Taizhou, Jiangsu, China
| | - Mei Cui
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanfeng Jiang
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
- State Key Laboratory of Genetic Engineering, Zhangjiang Fudan International Innovation Center, School of Life Sciences, Human Phenome Institute, Fudan University, Shanghai, China
| | - Chen Suo
- School of Public Health, the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Tiejun Zhang
- School of Public Health, the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Kelin Xu
- School of Public Health, the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China.
| | - Yingzhe Wang
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China.
- State Key Laboratory of Genetic Engineering, Zhangjiang Fudan International Innovation Center, School of Life Sciences, Human Phenome Institute, Fudan University, Shanghai, China.
| | - Xingdong Chen
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China.
- State Key Laboratory of Genetic Engineering, Zhangjiang Fudan International Innovation Center, School of Life Sciences, Human Phenome Institute, Fudan University, Shanghai, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
- Yiwu Research Institute of Fudan University, Yiwu, Zhejiang, China.
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Janoutová J, Machaczka O, Kovalová M, Zatloukalová A, Ambroz P, Koutná V, Mrázková E, Bar M, Roubec M, Bártová P, Novobilský R, Sabela M, Kušnierová P, Stejskal D, Faldynová L, Walczysková S, Vališ M, Školoudík L, Šolínová P, Školoudík D, Janout V. The relationship between atherosclerosis and dementia. Cent Eur J Public Health 2024; 32:9-15. [PMID: 38669152 DOI: 10.21101/cejph.a7848] [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: 04/22/2023] [Accepted: 02/15/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE The main objective is to confirm a hypothesis that atherosclerosis, through various mechanisms, considerably influences cognitive impairment and significantly increases the risk for developing dementia. Complete sample should be 920 individuals. The present study aimed to analyse epidemiological data from a questionnaire survey. METHODS The work was carried out in the form of an epidemiological case control study. Subjects are enrolled in the study based on results of the following examinations carried out in neurology departments and outpatient centres during the project NU20-09-00119 from 2020 to 2023. Respondents were divided into four research groups according to the results of clinical examination for the presence of atherosclerosis and dementia. The survey was mainly concerned with risk factors for both atherosclerosis and dementia. It contained questions on lifestyle factors, cardiovascular risk factors, leisure activities, and hobbies. RESULTS Analysis of the as yet incomplete sample of 877 subjects has yielded the following selected results: on average, 16% of subjects without dementia had primary education while the proportion was 45.2% in the group with both dementia and atherosclerosis. Subjects with dementia did mainly physical work. Low physical activity was more frequently noted in dementia groups (Group 2 - 54.4% and Group 3 - 47.2%) than in subjects without dementia (Group 1 - 19.6% and Group 4 - 25.8%). Coronary heart disease was more frequently reported by dementia patients (33.95%) than those without dementia (16.05%). CONCLUSION Cognitively impaired individuals, in particular those with vascular cognitive impairment, have poorer quality of life and shorter survival. Risk factors contributing to such impairment are similar to those for ischaemic or haemorrhagic stroke. It may be concluded that most of the analysed risk factors play a role in the development of both atherosclerosis and dementia.
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Affiliation(s)
- Jana Janoutová
- Department of Public Health, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Ondřej Machaczka
- Science and Research Centre, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Health Management and Public Health, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
| | - Martina Kovalová
- Science and Research Centre, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Health Management and Public Health, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Anna Zatloukalová
- Science and Research Centre, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Health Management and Public Health, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
| | - Petr Ambroz
- Science and Research Centre, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Health Management and Public Health, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
| | - Veronika Koutná
- Department of Public Health, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Eva Mrázková
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Michal Bar
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Roubec
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Petra Bártová
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Richard Novobilský
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Martin Sabela
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavlína Kušnierová
- Department of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic
- Institute of Laboratory Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - David Stejskal
- Department of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic
- Institute of Laboratory Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lucie Faldynová
- Department of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava, Ostrava, Czech Republic
| | - Sylwia Walczysková
- Department of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Vališ
- Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Lukáš Školoudík
- Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petra Šolínová
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - David Školoudík
- Centre for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Vladimír Janout
- Department of Public Health, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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Liu J, Xiao G, Liang Y, He S, Lyu M, Zhu Y. Heart-brain interaction in cardiogenic dementia: pathophysiology and therapeutic potential. Front Cardiovasc Med 2024; 11:1304864. [PMID: 38327496 PMCID: PMC10847563 DOI: 10.3389/fcvm.2024.1304864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Diagnosis and treatment of patients with cardiovascular and neurologic diseases primarily focus on the heart and brain, respectively. An increasing number of preclinical and clinical studies have confirmed a causal relationship between heart and brain diseases. Cardiogenic dementia is a cognitive impairment caused by heart dysfunction and has received increasing research attention. The prevention and treatment of cardiogenic dementia are essential to improve the quality of life, particularly in the elderly and aging population. This study describes the changes in cognitive function associated with coronary artery disease, myocardial infarction, heart failure, atrial fibrillation and heart valve disease. An updated understanding of the two known pathogenic mechanisms of cardiogenic dementia is presented and discussed. One is a cascade of events caused by cerebral hypoperfusion due to long-term reduction of cardiac output after heart disease, and the other is cognitive impairment regardless of the changes in cerebral blood flow after cardiac injury. Furthermore, potential medications for the prevention and treatment of cardiogenic dementia are reviewed, with particular attention to multicomponent herbal medicines.
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Affiliation(s)
- Jiaxu Liu
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guangxu Xiao
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yujuan Liang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shuang He
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ming Lyu
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yan Zhu
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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5
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Sabayan B, Goudarzi R, Ji Y, Borhani‐Haghighi A, Olson‐Bullis BA, Murray AM, Sedaghat S. Intracranial Atherosclerosis Disease Associated With Cognitive Impairment and Dementia: Systematic Review and Meta-Analysis. J Am Heart Assoc 2023; 12:e032506. [PMID: 37955546 PMCID: PMC10727275 DOI: 10.1161/jaha.123.032506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Intracranial atherosclerosis disease (ICAD) alters cerebrovascular hemodynamics and brain structural integrity. Multiple studies have evaluated the link between ICAD and cognitive impairment, with mixed results. This study aims to systematically review and summarize the current evidence on this link. METHODS AND RESULTS PubMed, EMBASE, PsycInfo, and Web of Science were searched from 2000 to 2023 without language restriction. Cross-sectional and prospective cohort studies as well as postmortem studies were included. Studies containing data on the link between ICAD, defined as at least 50% stenosis in 1 intracranial vessel, and cognitive impairment and dementia were screened by 2 independent reviewers. A total of 22 (17 observational and 5 postmortem) unique studies, comprising 11 184 individuals (average age range, 59.8-87.6 years; 45.7% women; 36.5% Asian race), were included in the systematic review. Seven of 10 cross-sectional studies and 5 of 7 prospective studies showed a significant association between ICAD and cognitive impairment. In the pooled analysis, ICAD was associated with greater cognitive impairment (measure of association, 1.87 [95% CI, 1.49-2.35]). Meta-regression analyses did not show a significant impact of age, sex, and race. All postmortem studies showed that patients with Alzheimer disease and vascular dementia had a higher burden of ICAD compared with controls. CONCLUSIONS This study shows that ICAD is associated with cognitive impairment and dementia across age, sex, and race groups. Our findings may underscore the need to develop individualized dementia preventive care plans in patients with ICAD.
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Affiliation(s)
- Behnam Sabayan
- Department of Neurology, Hennepin Healthcare Research InstituteHennepin County Medical CenterMinneapolisMN
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Roham Goudarzi
- Faculty of ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
| | | | | | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research and Geriatrics Division, Department of MedicineHennepin Healthcare Research InstituteMinneapolisMN
| | - Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
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6
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Li T, Bao X, Li L, Qin R, Li C, Wang X. Heart failure and cognitive impairment: A narrative review of neuroimaging mechanism from the perspective of brain MRI. Front Neurosci 2023; 17:1148400. [PMID: 37051150 PMCID: PMC10083289 DOI: 10.3389/fnins.2023.1148400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/01/2023] [Indexed: 03/28/2023] Open
Abstract
Both heart failure (HF) and cognitive impairment (CI) have a significant negative impact on the health of the elderly individuals. Magnetic resonance imaging (MRI) can non-invasively detect functional and structural variations in the heart and brain, making it easier to explore the connection between the heart and brain. According to neuroimaging studies, HF patients have a higher chance of developing CI because they have a variety of different types of brain injuries. To examine how HF and CI are influenced by one another, English-language literature was searched in the Web of Science, PubMed EMBASE (OVID), PsycInfo, and Scopus databases. The search terms included “high-frequency,” “brain function,” “brain injury,” “cognition,” “cognitive impairment,” and “magnetic resonance imaging.” Normal brain function is typically impaired by HF in the form of decreased cerebral perfusion pressure, inflammation, oxidative stress, and damage to the BBB, resulting in CI and subsequent HF. Early pathophysiological alterations in patients’ brains have been widely detected using a range of novel MRI techniques, opening up new avenues for investigating the connection between HF and CI. This review aims to describe the pathogenesis of HF with CI and the early diagnostic role of MRI in the heart-brain domain.
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Affiliation(s)
- Tong Li
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiangyuan Bao
- School of Radiology, Shandong First Medical University, Taian, China
| | - Lin Li
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Rui Qin
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Cuicui Li
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Cuicui Li,
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Ximing Wang,
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7
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Jensen M, Zeller T, Twerenbold R, Thomalla G. Circulating cardiac biomarkers, structural brain changes, and dementia: Emerging insights and perspectives. Alzheimers Dement 2023; 19:1529-1548. [PMID: 36735636 DOI: 10.1002/alz.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 02/04/2023]
Abstract
Diseases of the heart and brain are strongly linked to each other, and cardiac dysfunction is associated with cognitive decline and dementia. This link between cardiovascular disease and dementia offers opportunities for dementia prevention through prevention and treatment of cardiovascular risk factors and heart disease. Increasing evidence suggests the clinical utility of cardiac biomarkers as risk markers for structural brain changes and cognitive impairment. We propose the hypothesis that structural brain changes are the link between impaired cardiac function, as captured by blood-based cardiac biomarkers, and cognitive impairment. This review provides an overview of the literature and illustrates emerging insights into the association of markers of hemodynamic stress (natriuretic peptides) and markers of myocardial injury (cardiac troponins) with imaging findings of brain damage and cognitive impairment or dementia. Based on these findings, we discuss potential pathophysiological mechanisms underlying the association of cardiac biomarkers with structural brain changes and dementia. We suggest testable hypotheses and a research plan to close the gaps in understanding the mechanisms linking vascular damage and neurodegeneration, and to pave the way for targeted effective interventions for dementia prevention. From a clinical perspective, cardiac biomarkers open the window for early identification of patients at risk of dementia, who represent a target population for preventive interventions targeting modifiable cardiovascular risk factors to avert cognitive decline and dementia.
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Affiliation(s)
- Märit Jensen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Tanja Zeller
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Clinic for Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Clinic for Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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8
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Wang W, Norby FL, Alonso A, Gottesman RF, Jack CR, Meyer ML, Knopman DS, Sullivan KJ, Hughes TM, Lakshminarayan K, Lutsey PL. Association of Carotid Intima-Media Thickness with Brain MRI Markers in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). J Stroke Cerebrovasc Dis 2022; 31:106388. [PMID: 35193028 PMCID: PMC9018472 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106388] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Elevated carotid intima-media thickness (cIMT) and carotid plaque are markers of arterial injury and may be linked to structural brain injury. We hypothesized cIMT or presence of carotid plaque at midlife are associated with presence of infarcts and cerebral microbleeds, greater white matter hyperintensity (WMH) volume, and smaller regional brain volumes in late-life. METHODS We included 1,795 Atherosclerosis Risk in Communities (ARIC) Study participants (aged 57±6 years, 57% female, 23% Black) with carotid ultrasounds in 1990-1992 and brain MRI scans in 2011-2013. Weighted linear regression was used for brain volume outcomes, while logistic regression was used for infarcts and cerebral microbleeds. RESULTS After multivariable adjustments, the highest cIMT quintile was associated with smaller deep gray matter (β [95% CI]: -0.11 [-0.22, -0.01]) and cortical volume in a temporal-parietal meta region of interest (ROI) (β [95% CI]: -0.10 [-0.20, -0.01]) in late-life. Similarly, those with carotid plaque had smaller regional brain volumes than those without (βs [95% CIs]: -0.05 [-0.12, 0.03] and -0.06 [-0.13, 0.01] for deep gray matter and temporal-parietal meta ROI). No significant relations were observed with WMH volume, infarcts, or cerebral microbleeds. CONCLUSION Over a median follow-up of 21 years, greater midlife cIMT and presence of carotid plaque were associated with smaller deep gray matter volume and cortical volume in a meta ROI involving temporal and parietal lobe regions typically involved in neurodegeneration, including Alzheimer's disease, in later life. Contrary to our hypothesis, associations between measures of arterial injury and markers of vascular brain injury were null.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States.
| | - Faye L Norby
- Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, United States.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States.
| | | | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States.
| | - Kevin J Sullivan
- Department of Medicine: The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi, United States.
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States.
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States.
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9
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Araújo NC, Suassuna JHR, Fernandes RDCL. Transcranial sonography depicts a larger substantia nigra echogenic area in renal transplant patients on calcineurin inhibitors than on rapamycin. BMC Nephrol 2022; 23:108. [PMID: 35300603 PMCID: PMC8931960 DOI: 10.1186/s12882-022-02741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After kidney transplantation neurologic manifestations may develop, including Parkinson's disease (PD). An enlarged substantia nigra (SN) by transcranial sonography has been recognized as a marker of PD. METHODS In renal transplant recipients (RTRs = 95) and controls (n = 20), measurement of mesencephalon, SN, third ventricle, spleen and carotid intima-media thickness (cIMT) and middle cerebral artery (MCA), kidney and spleen arteries Doppler resistive index (RI) were performed. RESULTS RTRs had larger SN, third ventricle and cIMT and higher renal RI than controls. The SN was larger in the CNIs group than in controls and rapamycin group, while the third ventricle was similar between patients but larger than in controls. In RTRs, SN showed a direct linear correlation with spleen and the third ventricle with age, cIMT and RI of the MCA, kidney and spleen. In CNIs group the SN correlated positively with age and cIMT, while the third ventricle reproduced RTRs correlations. Rapamycin group showed a direct linear relationship between the third ventricle and age and RI of the MCA, kidney and spleen; SN showed no correlations. CONCLUSION RTRs on CNIs present a larger SN area than on rapamycin, probably due to the antiproliferative effect of rapamycin. This finding might be relevant when interpreting TCS in RTRs.
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Affiliation(s)
- Nordeval Cavalcante Araújo
- Division of Nephrology, University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro-RJ, 20551-030, Brazil.
| | - José Hermógenes Rocco Suassuna
- Division of Nephrology, University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro-RJ, 20551-030, Brazil
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10
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Perrone L, Valente M. The Emerging Role of Metabolism in Brain-Heart Axis: New Challenge for the Therapy and Prevention of Alzheimer Disease. May Thioredoxin Interacting Protein (TXNIP) Play a Role? Biomolecules 2021; 11:1652. [PMID: 34827650 PMCID: PMC8616009 DOI: 10.3390/biom11111652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 12/15/2022] Open
Abstract
Alzheimer disease (AD) is the most frequent cause of dementia and up to now there is not an effective therapy to cure AD. In addition, AD onset occurs decades before the diagnosis, affecting the possibility to set up appropriate therapeutic strategies. For this reason, it is necessary to investigate the effects of risk factors, such as cardiovascular diseases, in promoting AD. AD shows not only brain dysfunction, but also alterations in peripheral tissues/organs. Indeed, it exists a reciprocal connection between brain and heart, where cardiovascular alterations participate to AD as well as AD seem to promote cardiovascular dysfunction. In addition, metabolic dysfunction promotes both cardiovascular diseases and AD. In this review, we summarize the pathways involved in the regulation of the brain-heart axis and the effect of metabolism on these pathways. We also present the studies showing the role of the gut microbiota on the brain-heart axis. Herein, we propose recent evidences of the function of Thioredoxin Interacting protein (TXNIP) in mediating the role of metabolism on the brain-heart axis. TXNIP is a key regulator of metabolism at both cellular and body level and it exerts also a pathological function in several cardiovascular diseases as well as in AD.
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Affiliation(s)
- Lorena Perrone
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Mariarosaria Valente
- Department of Medicine, University of Udine, 33100 Udine, Italy;
- Clinical Neurology Unit, Department of Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, 33100 Udine, Italy
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11
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Cognitive Dysfunction after Heart Disease: A Manifestation of the Heart-Brain Axis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:4899688. [PMID: 34457113 PMCID: PMC8387198 DOI: 10.1155/2021/4899688] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/31/2021] [Indexed: 12/26/2022]
Abstract
The functions of the brain and heart, which are the two main supporting organs of human life, are closely linked. Numerous studies have expounded the mechanisms of the brain-heart axis and its related clinical applications. However, the effect of heart disease on brain function, defined as the heart-brain axis, is less studied even though cognitive dysfunction after heart disease is one of its most frequently reported manifestations. Hypoperfusion caused by heart failure appears to be an important risk factor for cognitive decline. Blood perfusion, the immune response, and oxidative stress are the possible main mechanisms of cognitive dysfunction, indicating that the blood-brain barrier, glial cells, and amyloid-β may play active roles in these mechanisms. Clinicians should pay more attention to the cognitive function of patients with heart disease, especially those with heart failure. In addition, further research elucidating the associated mechanisms would help discover new therapeutic targets to intervene in the process of cognitive dysfunction after heart disease. This review discusses cognitive dysfunction in relation to heart disease and its potential mechanisms.
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12
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Sabayan B, Westendorp RGJ. Neurovascular-glymphatic dysfunction and white matter lesions. GeroScience 2021; 43:1635-1642. [PMID: 33851307 DOI: 10.1007/s11357-021-00361-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/22/2021] [Indexed: 01/09/2023] Open
Abstract
Cerebral white matter lesions (WML) represent a spectrum of age-related structural changes that are identified as areas of white matter high signal intensity on brain magnetic resonance imaging (MRI). Preservation of white matter requires proper functioning of both the cerebrovascular and glymphatic systems. The cerebrovascular safeguards adequate cerebral blood flow to supply oxygen, energy, and nutrients through a dynamic process of cerebral autoregulation and neurovascular coupling to keep up with global and regional demands of the brain. The glymphatic system maintains white matter integrity by preserving flow of interstitial fluid, exchanging metabolic waste and eventually its clearance into the venous circulation. Here, we argue that these two systems should not be considered separate entities but as one single physiologically integrated unit to preserve brain health. Due to the process of aging, damage to the neurovascular-glymphatic system accumulates over the life course. It is an insidious process that ultimately leads to the disruption of cerebral autoregulation, to the neurovascular uncoupling, and to the accumulation of metabolic waste products. As cerebral white matter is particularly vulnerable to hypoxic, inflammatory, and metabolic insults, WML are the first recognized pathologies of neurovascular-glymphatic dysfunction. A better understanding of the underlying pathophysiology will provide starting points for developing effective strategies to prevent a wide range of clinical disorders among which there are gait disturbances, functional dependence, cognitive impairment, and dementia.
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Affiliation(s)
- Behnam Sabayan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Wang ACC 739B, Boston, MA, 02114, USA.
| | - Rudi G J Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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13
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Ammirati E, Moroni F, Magnoni M, Rocca MA, Messina R, Anzalone N, De Filippis C, Scotti I, Besana F, Spagnolo P, Rimoldi OE, Chiesa R, Falini A, Filippi M, Camici PG. Extent and characteristics of carotid plaques and brain parenchymal loss in asymptomatic patients with no indication for revascularization. IJC HEART & VASCULATURE 2020; 30:100619. [PMID: 32904369 PMCID: PMC7452655 DOI: 10.1016/j.ijcha.2020.100619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/01/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Extent of subclinical atherosclerosis has been associated with brain parenchymal loss in community-dwelling aged subjects. Identification of patient-related and plaque-related markers could identify subjects at higher risk of brain atrophy, independent of cerebrovascular accidents. Aim of the study was to investigate the relation between extent and characteristics of carotid plaques and brain atrophy in asymptomatic patients with no indication for revascularization. METHODS AND RESULTS Sixty-four patients (aged 69 ± 8 years, 45% females) with carotid stenosis <70% based on Doppler flow velocity were enrolled in the study. Potential causes of cerebral damage other than atherosclerosis, including history of atrial fibrillation, heart failure, previous cardiac or neurosurgery and neurological disorders were excluded. All subjects underwent carotid computed tomography angiography, contrast enhanced ultrasound for assessment of plaque neovascularization and brain magnetic resonance imaging for measuring brain volumes. On multivariate regression analysis, age and fibrocalcific plaques were independently associated with lower total brain volumes (β = -3.13 and β = -30.7, both p < 0.05). Fibrocalcific plaques were also independently associated with lower gray matter (GM) volumes (β = -28.6, p = 0.003). On the other hand, age and extent of carotid atherosclerosis were independent predictors of lower white matter (WM) volumes. CONCLUSIONS WM and GM have different susceptibility to processes involved in parenchymal loss. Contrary to common belief, our results show that presence of fibrocalcific plaques is associated with brain atrophy.
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Affiliation(s)
- Enrico Ammirati
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
- De Gasperis Cardio Center, Niguarda Ca’ Granda Hospital, Milan, Italy
| | | | - Marco Magnoni
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Maria A Rocca
- Vita-Salute University and Neuroimaging Research Unit, Institute of Experimental Neurology, and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Messina
- Vita-Salute University and Neuroimaging Research Unit, Institute of Experimental Neurology, and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Nicoletta Anzalone
- Vita-Salute University and Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Costantino De Filippis
- Vita-Salute University and Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Isabella Scotti
- Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - Francesca Besana
- Cardiovascular Prevention Center, San Raffaele Institute, Milan, Italy
| | - Pietro Spagnolo
- Cardiovascular Prevention Center, San Raffaele Institute, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Roberto Chiesa
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Andrea Falini
- Vita-Salute University and Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Vita-Salute University and Neuroimaging Research Unit, Institute of Experimental Neurology, and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo G Camici
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
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14
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Baradaran H, Gupta A. Brain imaging biomarkers of carotid artery disease. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1277. [PMID: 33178809 PMCID: PMC7607077 DOI: 10.21037/atm-20-1939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Extracranial carotid artery atherosclerotic disease is a major contributor to ischemic stroke. Carotid atherosclerotic disease can present with a spectrum of findings ranging from mild carotid intima-media thickness to high-risk vulnerable carotid plaque features and carotid stenosis. Before leading to clinically overt stroke or transient ischemic attack, there may be other markers of downstream ischemia secondary to carotid atherosclerotic disease. In this review article, we will review some of the imaging findings that may be seen downstream to carotid artery disease on various imaging modalities, including hemodynamic and perfusional abnormalities which may be seen on CT, MR, or using other advanced imaging techniques, white matter hyperintensities on brain imaging, silent or covert brain infarctions, cerebral microbleeds, and regional and generalized cerebral volume loss. Many of these imaging findings are seen routinely on brain magnetic resonance imaging in patients without overt clinical symptoms. Despite frequently being asymptomatic, many of these imaging findings are also strongly associated with increased risk of future stroke, cognitive impairment, and even mortality. We will review the existing evidence underpinning the associations between these frequently encountered imaging findings and carotid artery atherosclerotic disease. Future validation of these imaging findings could lead to them being powerful biomarkers of cerebrovascular health.
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Affiliation(s)
- Hediyeh Baradaran
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.,Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
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15
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McGrath ER, Himali JJ, Levy D, Conner SC, DeCarli C, Pase MP, Ninomiya T, Ohara T, Courchesne P, Satizabal CL, Vasan RS, Beiser AS, Seshadri S. Growth Differentiation Factor 15 and NT-proBNP as Blood-Based Markers of Vascular Brain Injury and Dementia. J Am Heart Assoc 2020; 9:e014659. [PMID: 32921207 PMCID: PMC7792414 DOI: 10.1161/jaha.119.014659] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background GDF15 (growth differentiation factor 15) and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) may offer promise as biomarkers for cognitive outcomes, including dementia. We determined the association of these biomarkers with cognitive outcomes in a community‐based cohort. Methods and Results Plasma GDF15 (n=1603) and NT‐proBNP levels (n=1590) (53% women; mean age, 68.7 years) were measured in dementia‐free Framingham Offspring cohort participants at examination 7 (1998–2001). Participants were followed up for incident dementia. Secondary outcomes included Alzheimer disease dementia, magnetic resonance imaging structural brain measures, and neurocognitive performance. During a median 11.8‐year follow‐up, 131 participants developed dementia. On multivariable Cox proportional‐hazards analysis, higher circulating GDF15 was associated with an increased risk of incident all‐cause and Alzheimer disease dementia (hazard ratio [HR] per SD increment in natural log‐transformed biomarker value, 1.54 [95% CI, 1.22–1.95] and 1.37 [95% CI, 1.03–1.81], respectively), whereas higher plasma NT‐proBNP was also associated with an increased risk of all‐cause dementia (HR, 1.32; 95% CI, 1.05–1.65). Elevated GDF15 was associated with lower total brain and hippocampal volumes, greater white matter hyperintensity volume, and poorer cognitive performance. Elevated NT‐proBNP was associated with greater white matter hyperintensity volume and poorer cognitive performance. Addition of both biomarkers to a conventional risk factor model improved dementia risk classification (net reclassification improvement index, 0.25; 95% CI, 0.05–0.45). Conclusions Elevated plasma GDF15 and NT‐proBNP were associated with vascular brain injury on magnetic resonance imaging, poorer neurocognitive performance, and increased risk of incident dementia in individuals aged >60 years. Both biomarkers improved dementia risk classification beyond that of traditional clinical risk factors, indicating their potential value in predicting incident dementia.
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Affiliation(s)
- Emer R McGrath
- HRB Clinical Research Facility National University of Ireland Galway Galway Ireland.,Framingham Heart Study Framingham MA
| | - Jayandra J Himali
- Framingham Heart Study Framingham MA.,Boston University School of Public Health Boston MA.,Boston University School of Medicine Boston MA.,Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases University of Texas Health Sciences Center San Antonio TX
| | - Daniel Levy
- Framingham Heart Study Framingham MA.,Population Sciences Branch National Heart, Lung, and Blood Institutes of Health Bethesda MD
| | - Sarah C Conner
- Framingham Heart Study Framingham MA.,Boston University School of Medicine Boston MA
| | | | - Matthew P Pase
- Framingham Heart Study Framingham MA.,Turner Institute Monash University Clayton Victoria Australia.,Harvard University Boston MA Australia
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Tomoyuki Ohara
- Department of Epidemiology and Public Health Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | | | - Claudia L Satizabal
- Framingham Heart Study Framingham MA.,Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases University of Texas Health Sciences Center San Antonio TX
| | - Ramachandran S Vasan
- Framingham Heart Study Framingham MA.,Boston University School of Medicine Boston MA
| | - Alexa S Beiser
- Framingham Heart Study Framingham MA.,Boston University School of Public Health Boston MA.,Boston University School of Medicine Boston MA
| | - Sudha Seshadri
- Framingham Heart Study Framingham MA.,Boston University School of Medicine Boston MA.,Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases University of Texas Health Sciences Center San Antonio TX
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16
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Marseglia A, Darin‐Mattsson A, Kalpouzos G, Grande G, Fratiglioni L, Dekhtyar S, Xu W. Can active life mitigate the impact of diabetes on dementia and brain aging? Alzheimers Dement 2020; 16:1534-1543. [DOI: 10.1002/alz.12142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/10/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Anna Marseglia
- Department of Neurobiology Aging Research Center Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Alexander Darin‐Mattsson
- Department of Neurobiology Aging Research Center Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Grégoria Kalpouzos
- Department of Neurobiology Aging Research Center Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Giulia Grande
- Department of Neurobiology Aging Research Center Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Laura Fratiglioni
- Department of Neurobiology Aging Research Center Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
- Stockholm Gerontology Research Center Stockholm Sweden
| | - Serhiy Dekhtyar
- Department of Neurobiology Aging Research Center Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Weili Xu
- Department of Neurobiology Aging Research Center Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
- Department of Epidemiology and Biostatistics School of Public Health Tianjin Medical University Tianjin China
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17
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Riching AS, Major JL, Londono P, Bagchi RA. The Brain-Heart Axis: Alzheimer's, Diabetes, and Hypertension. ACS Pharmacol Transl Sci 2019; 3:21-28. [PMID: 32259085 DOI: 10.1021/acsptsci.9b00091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 01/15/2023]
Abstract
Alzheimer's disease (AD) is a debilitating neurodegenerative disorder affecting millions worldwide. Currently, there are only four approved treatments for AD, which improve symptoms modestly. AD is believed to be caused by the formation of intercellular plaques and intracellular tangles in the brain, but thus far all new drugs which target these pathologies have failed clinical trials. New research highlights the link between AD and Type II Diabetes (T2D), and some believe that AD is actually a brain specific form of it termed Type III Diabetes (T3D). Drugs which are currently approved for the treatment of T2D, such as metformin, have shown promising results in improving cognitive function and even preventing the development of AD in diabetic patients. Recent studies shed light on the relationship between the brain and cardiovascular system in which the brain and heart communicate with one another via the vasculature to regulate fluid and nutrient homeostasis. This line of research reveals how the brain-heart axis regulates hypertension and diabetes, both of which can impact cognitive function. In this review we survey past and ongoing research and clinical trials for AD, and argue that AD is a complex and systemic disorder which requires comprehensive approaches beyond the brain for effective prevention and/or treatment.
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Affiliation(s)
- Andrew S Riching
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, United States.,Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Jennifer L Major
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, United States.,Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Pilar Londono
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Rushita A Bagchi
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, United States.,Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, United States
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18
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Veugen MGJ, Henry RMA, Brunner-La Rocca HP, Dagnelie PC, Schram MT, van Agtmaal MJM, van der Kallen CJH, Sep SJS, van Boxtel MPJ, Bekers O, Meex SJR, Jansen JFA, Kroon AA, Stehouwer CDA. Cross-Sectional Associations Between Cardiac Biomarkers, Cognitive Performance, and Structural Brain Changes Are Modified by Age. Arterioscler Thromb Vasc Biol 2019; 38:1948-1958. [PMID: 29954754 DOI: 10.1161/atvbaha.118.311082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective- NT-proBNP (N-terminal pro-B-type natriuretic peptide) and cardiac troponin T (cTNT) are associated with cognitive performance. Whether this extends to individuals <60 years of age is unclear. We investigated whether age modified the associations between NT-proBNP and cTNT and cognitive performance and structural brain changes. Approach and Results- In 3011 individuals (60±8 years; 49% women), NT-proBNP and cTNT, memory, information processing speed and executive functioning, grey matter (GM) and white matter, and white matter hyperintensity (WMH) volumes were determined. We used regression, adjusted for educational level, cardiovascular factors, and lifestyle factors, to test whether cross-sectional associations between biomarkers and cognitive performance and structural brain changes were modified by age (<60 versus ≥60 years). ≥60 years, higher NT-proBNP was associated with lower memory (β [SD] per 10-fold higher level [95% confidence interval (CI)], -0.11 [-0.22 to -0.00]), information processing speed (-0.12 [95% CI, -0.21 to -0.03]), executive functioning (-0.12 [95% CI, -0.22 to -0.03]), and smaller GM (β [mL] per 10-fold higher level, -6.89 [95% CI, -11.58 to -2.20]). Additionally, higher cTNT was associated with lower memory (-0.33 [95% CI, -0.53 to -0.12]) and information processing speed (-0.17 [95% CI, -0.3 to -0.01]); with smaller GM (-16.07 [95% CI, -24.90 to -7.24]) and greater WMH (10β WMH per 10-fold higher level, 0.31 [95% CI, 0.10-0.52]). <60 years, NT-proBNP and cTNT were not associated with cognitive performance ( Pinteraction, <0.10). In contrast, higher NT-proBNP was associated with smaller GM (-7.43 [95% CI, -11.70 to -3.16]) and greater WMH (0.13 [95% CI, 0.01-0.25]; Pinteraction,>0.10). Higher cTNT was associated with greater WMH (0.18 [95% CI, -0.01 to 0.37]; Pinteraction,>0.10) but not with GM (0.07 [95% CI, -6.87 to 7.02]; Pinteraction, <0.10). Conclusions- Biomarkers of cardiac injury are continuously associated with structural brain changes in both older and younger individuals but with poorer cognitive performance only in older individuals. These findings stress the continuous nature of the heart-brain axis in the development of cognitive impairment.
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Affiliation(s)
- Marja G J Veugen
- From the Department of Internal Medicine (M.G.J.V., R.M.A.H., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., A.A.K., C.D.A.S.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Ronald M A Henry
- From the Department of Internal Medicine (M.G.J.V., R.M.A.H., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., A.A.K., C.D.A.S.).,Heart and Vascular Centre (R.M.A.H., M.T.S.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology (H.-P.B.-L.R.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Pieter C Dagnelie
- Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.).,CAPHRI Care and Public Health Research Institute (P.C.D.).,Department of Epidemiology (P.C.D.)
| | - Miranda T Schram
- From the Department of Internal Medicine (M.G.J.V., R.M.A.H., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., A.A.K., C.D.A.S.).,Heart and Vascular Centre (R.M.A.H., M.T.S.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Marnix J M van Agtmaal
- From the Department of Internal Medicine (M.G.J.V., R.M.A.H., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., A.A.K., C.D.A.S.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Carla J H van der Kallen
- From the Department of Internal Medicine (M.G.J.V., R.M.A.H., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., A.A.K., C.D.A.S.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Simone J S Sep
- From the Department of Internal Medicine (M.G.J.V., R.M.A.H., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., A.A.K., C.D.A.S.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology (M.P.J.v.B., J.F.A.J.).,MHeNS School for Mental Health and Neuroscience (M.P.J.v.B.), Maastricht University, the Netherlands
| | - Otto Bekers
- Department of Clinical Chemistry (O.B., S.J.R.M.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Steven J R Meex
- Department of Clinical Chemistry (O.B., S.J.R.M.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Jacobus F A Jansen
- Department of Psychiatry and Neuropsychology (M.P.J.v.B., J.F.A.J.).,Department of Radiology and Nuclear Medicine (J.F.A.J.)
| | - Abraham A Kroon
- From the Department of Internal Medicine (M.G.J.V., R.M.A.H., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., A.A.K., C.D.A.S.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
| | - Coen D A Stehouwer
- From the Department of Internal Medicine (M.G.J.V., R.M.A.H., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., A.A.K., C.D.A.S.).,Maastricht University Medical Center+, the Netherlands; and CARIM School for Cardiovascular Diseases (M.G.J.V., R.M.A.H., H.-P.B.-L.R., P.C.D., M.T.S., M.J.M.v.A., C.J.H.v.d.K., S.J.S.S., O.B., S.J.R.M., A.A.K., C.D.A.S.)
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19
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Magro-Checa C, Kumar S, Ramiro S, Beaart-van de Voorde L, Eikenboom J, Ronen I, de Bresser J, van Buchem M, Huizinga T, Steup-Beekman G. Are serum autoantibodies associated with brain changes in systemic lupus erythematosus? MRI data from the Leiden NP-SLE cohort. Lupus 2019; 28:94-103. [PMID: 30526327 PMCID: PMC6304692 DOI: 10.1177/0961203318816819] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/09/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The effect of serum autoantibodies on the brain of systemic lupus erythematosus (SLE) patients remains unclear. We investigated whether serum autoantibodies, individually and assessed in groups, are associated with specific brain-MRI abnormalities or whether these structural changes are associated with other SLE-related or traditional cardiovascular disease risk factors. METHODS All patients underwent brain 3Tesla-MRI. White matter hyperintensities (WMHs), ischemic lesions, inflammatory-like lesions and cerebral atrophy were scored. Serum autoantibodies analyzed included lupus anticoagulant (LAC), anticardiolipine (aCL) IgG and IgM (first 3 also grouped into antiphospholipid autoantibodies (aPL)), anti-dsDNA, anti-SSA, anti-SSB, anti-RNP, and anti-Sm (the latter 5 grouped into SLE-related autoantibodies). Associations were assessed using logistic regression analysis adjusted for potential confounders. Furthermore, a sensitivity analysis including anti-Beta2 glycoprotein-1 antibodies (anti-β2GP1) in the aPL group was performed and the potential modification role of the neuropsychiatric clinical status in the model was assessed. RESULTS 325 patients (mean age 42 years (SD 14), 89% female) were included. The following MRI-brain abnormalities were found: WMHs (71%), lacunar infarcts (21%), gliosis (11%), micro-hemorrhages (5%), large hemorrhages (2%), inflammatory-like lesions (6%) and atrophy (14%). No associations were found between individual or total SLE-related autoantibodies and inflammatory-like lesions. A higher number of positive aPL was associated with lacunar infarcts (OR 1.37 (95%CI 1.02-1.99) and gliosis (OR 2.15 (1.37-3.37)). LAC was associated with lacunar infarcts in white matter (OR 3.38 (1.32-8.68)) and atrophy (OR 2.49 (1.01-6.15)), and aCL IgG with gliosis (OR 2.71 (1.05-7.02)). Among other variables, SLE patients with hypertension presented a higher chance for WMHs (OR 5.61 (2.52-12.48)) and lacunar infarcts in WM (OR 2.52 (1.10-5.74)) and basal ganglia (OR 8.34 (2.19-31.70)), while cumulative SLE-damage was correlated with lacunar infarcts in WM (OR 1.43 (1.07-1.90)), basal ganglia (OR 1.72 (1.18-2.51)) and cerebellum (OR 1.79 (1.33-2.41)). These associations were confirmed in the sensitivity analysis. CONCLUSIONS Brain abnormalities in SLE represent different underlying pathogenic mechanisms. aPL are associated with ischemic brain changes in SLE, while the presence of SLE-related serum autoantibodies is not related to inflammatory-like lesions. Hypertension and cumulative SLE-damage associate with ischemic MRI-brain changes in SLE, suggesting the importance of accelerated atherosclerosis in this process.
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Affiliation(s)
- C. Magro-Checa
- Department of Rheumatology, Leiden
University Medical Center, Leiden, the Netherlands
- Department of Rheumatology, Zuyderland
Medical Center, Heerlen, the Netherlands
| | - S. Kumar
- Department of Neuroradiology,
National
Neuroscience Institute, Singapore
| | - S. Ramiro
- Department of Rheumatology, Leiden
University Medical Center, Leiden, the Netherlands
- Department of Rheumatology, Zuyderland
Medical Center, Heerlen, the Netherlands
| | | | - J. Eikenboom
- Department of Thrombosis and Hemostasis,
Leiden University Medical Center, Leiden, the Netherlands
| | - I. Ronen
- CJ Gorter Center for High Field MRI,
Department of Radiology, Leiden University Medical Center, Leiden, the
Netherlands
| | - J de Bresser
- Department of Radiology, Leiden
University Medical Center, Leiden, The Netherlands
| | - M.A van Buchem
- Department of Radiology, Leiden
University Medical Center, Leiden, The Netherlands
| | - T.W. Huizinga
- Department of Rheumatology, Leiden
University Medical Center, Leiden, the Netherlands
| | - G.M. Steup-Beekman
- Department of Rheumatology, Leiden
University Medical Center, Leiden, the Netherlands
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20
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Witt LS, Rotter J, Stearns SC, Gottesman RF, Kucharska-Newton AM, Richey Sharrett A, Wruck LM, Bressler J, Sueta CA, Chang PP. Heart Failure and Cognitive Impairment in the Atherosclerosis Risk in Communities (ARIC) Study. J Gen Intern Med 2018; 33:1721-1728. [PMID: 30030736 PMCID: PMC6153245 DOI: 10.1007/s11606-018-4556-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/26/2018] [Accepted: 06/27/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies suggest that heart failure (HF) is an independent risk factor for cognitive decline. A better understanding of the relationship between HF, cognitive status, and cognitive decline in a community-based sample may help clinicians understand disease risk. OBJECTIVE To examine whether persons with HF have a higher prevalence of cognitive impairment and whether persons developing HF have more rapid cognitive decline. DESIGN This observational cohort study of American adults in the Atherosclerosis Risk in Communities (ARIC) study has two components: cross-sectional analysis examining the association between prevalent HF and cognition using multinomial logistic regression, and change over time analysis detailing the association between incident HF and change in cognition over 15 years. PARTICIPANTS Among visit 5 (2011-2013) participants (median age 75 years), 6495 had neurocognitive information available for cross-sectional analysis. Change over time analysis examined the 5414 participants who had cognitive scores and no prevalent HF at visit 4 (1996-1998). MEASUREMENTS The primary outcome was cognitive status, classified as normal, mild cognitive impairment [MCI], and dementia on the basis of standardized cognitive tests (delayed word recall, word fluency, and digit symbol substitution). Cognitive change was examined over a 15-year period. Control variables included socio-demographic, vascular, and smoking/drinking measures. RESULTS At visit 5, participants with HF had a higher prevalence of dementia (adjusted relative risk ratio [RRR] = 1.60 [95% CI 1.13, 2.25]) and MCI (RRR = 1.36 [1.12, 1.64]) than those without HF. A decline in cognition between visits 4 and 5 was - 0.07 standard deviation units [- 0.13, - 0.01] greater among persons who developed HF compared to those who did not. Results did not differ by ejection fraction. CONCLUSION HF is associated with neurocognitive dysfunction and decline independent of other co-morbid conditions. Further study is needed to determine the underlying pathophysiology.
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Affiliation(s)
- Lucy S Witt
- Department of Hospital Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA.
| | - Jason Rotter
- Department of Health Policy & Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sally C Stearns
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa M Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Jan Bressler
- Human Genetics, and Environmental Sciences, University of Texas Health School of Public Health Department of Epidemiology, Austin, TX, USA
| | - Carla A Sueta
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patricia P Chang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Lin YF, Smith AV, Aspelund T, Betensky RA, Smoller JW, Gudnason V, Launer LJ, Blacker D. Genetic overlap between vascular pathologies and Alzheimer's dementia and potential causal mechanisms. Alzheimers Dement 2018; 15:65-75. [PMID: 30240575 DOI: 10.1016/j.jalz.2018.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/12/2018] [Accepted: 08/11/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION We sought to examine the genetic overlap between vascular pathologies and Alzheimer's disease (AD) dementia, and the potential mediating role of vascular pathologies between AD-related genetic variants and late-life cognition. METHODS For 2907 stroke-free older individuals, we examined the association of polygenic risk scores for AD dementia (ADPRSs) with vascular pathologies and with cognition. Mediation analyses addressed whether association between ADPRSs and cognition was mediated by a vascular pathology. RESULTS ADPRSs were associated with lobar cerebral microbleeds, white matter lesion load, and coronary artery calcification, mostly explained by single nucleotide polymorphisms in the 19q13 region. The effect of ADPRSs on cognition was partially but significantly mediated by cerebral microbleeds, white matter lesions, and coronary artery calcification. DISCUSSION Our findings provide evidence for genetic overlap, mostly due to apolipoprotein E (APOE) gene, between vascular pathologies and AD dementia. The association between AD polygenic risk and late-life cognition is mediated in part via effects on vascular pathologies.
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Affiliation(s)
- Yen-Feng Lin
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Albert Vernon Smith
- Icelandic Heart Association, Kopavogur, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thor Aspelund
- Icelandic Heart Association, Kopavogur, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Rebecca A Betensky
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jordan W Smoller
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute of Ageing, National Institutes of Health, Bethesda, MD, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Gerontology Research Unit, Massachusetts General Hospital, Boston, MA, USA.
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22
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Zhang C, She Y, Lan T, Hu B, Zhang G, He J, Wang Z, Jiang M, Hu R. Study on epidemiology of cognitive dysfunction after stroke in the population over the age of 45 in Inner Mongolia. Int J Neurosci 2018; 128:654-662. [PMID: 29172850 DOI: 10.1080/00207454.2017.1408615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To analyze the prevalence of different degrees vascular cognitive impairment (VCI) in stroke and the characteristics of demography distribution in Inner Mongolia. In order to provide reference data and theoretical guidance for the prevention and treatment of VCI after stroke in the area. METHODS Stratified multi-stage random sampling was used to extract six regions of Inner Mongolia as the first sampling cluster; and then the corresponding banners (counties) were selected randomly as the secondary sampling cluster; according to the number of patient required to investigation, the corresponding number of communities was randomly selected from the secondary sampling cluster. According to the diagnostic criteria of 'Guidelines for the diagnosis and treatment of vascular cognitive impairment' and National Institute of Neurological Disorders and Stroke convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), we screened all stroke patients aged 45 or older from each community, a total of 444 patients participated in the questionnaire and various scale assessments. RESULTS The prevalence of VCI, vascular cognitive impairment no dementia and vascular dementia was 80.41%, 34.46% and 45.95% respectively. The prevalence of VCI in stroke was significantly different in different nationality, age and education level (P < 0.05), and there was no significant difference in gender, occupation, marital status and family structure (P > 0.05). CONCLUSION The prevalence of VCI after stroke was higher in Inner Mongolia, and VCI had a relatively high morbidity in old age people and person with less education in Chinese Han population.
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Affiliation(s)
- Chunyu Zhang
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Yan She
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Tian Lan
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Baolige Hu
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Guohua Zhang
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Juan He
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Zhiguang Wang
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Mingfang Jiang
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Riletemuer Hu
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
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23
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Cardiovascular disease and brain health: Focus on white matter hyperintensities. IJC HEART & VASCULATURE 2018; 19:63-69. [PMID: 29946567 PMCID: PMC6016077 DOI: 10.1016/j.ijcha.2018.04.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 12/28/2022]
Abstract
Diseases affecting the brain contribute to a substantial proportion of morbidity and mortality in the general population. Conditions such as stroke, dementia and cognitive impairment have a prominent impact on global public health. Despite the heterogeneous clinical manifestations of these conditions and their diverse prognostic implications, current evidence supports a role for cardiovascular disease as a common pathophysiological ground. Brain white matter hyperintensities (WMH) are patchy white matter signal hyperintensity on T2-weighted magnetic resonance imaging sequences commonly found in elderly individuals. WMH appear to have a vascular pathogenesis and have been shown to confer an increased risk of stroke and cognitive decline. Indeed, they were proposed as a marker for central nervous system frailty. Cardiovascular diseases seem to play a key role in the etiology of WMH. Carotid atherosclerosis and atrial fibrillation were shown to be associated with higher WMH burden, while adequate blood pressure control has been reported reducing WMH progression. Aim of the present work is to review the available evidence linking WMH to cardiovascular disease, highlighting the complex interplay between cerebral and cardiovascular health.
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24
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Ferguson IT, Elbejjani M, Sabayan B, Jacobs DR, Meirelles O, Sanchez OA, Tracy R, Bryan N, Launer LJ. N-Terminal pro-Brain Natriuretic Peptide and Associations With Brain Magnetic Resonance Imaging (MRI) Features in Middle Age: The CARDIA Brain MRI Study. Front Neurol 2018; 9:307. [PMID: 29867721 PMCID: PMC5949318 DOI: 10.3389/fneur.2018.00307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/18/2018] [Indexed: 11/23/2022] Open
Abstract
Objective As part of research on the heart–brain axis, we investigated the association of N-terminal pro-brain natriuretic peptide (NT-proBNP) with brain structure and function in a community-based cohort of middle-aged adults from the Brain Magnetic Resonance Imaging sub-study of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Approach and results In a cohort of 634 community-dwelling adults with a mean (range) age of 50.4 (46–52) years, we examined the cross-sectional association of NT-proBNP to total, gray (GM) and white matter (WM) volumes, abnormal WM load and WM integrity, and to cognitive function tests [the Digit Symbol Substitution Test (DSST), the Stroop test, and the Rey Auditory–Verbal Learning Test]. These associations were examined using linear regression models adjusted for demographic and cardiovascular risk factors and cardiac output. Higher NT-proBNP concentration was significantly associated with smaller GM volume (β = −3.44; 95% CI = −5.32, −0.53; p = 0.003), even after additionally adjusting for cardiac output (β = −2.93; 95% CI = −5.32, −0.53; p = 0.017). Higher NT-proBNP levels were also associated with lower DSST scores. NT-proBNP was not related to WM volume, WM integrity, or abnormal WM load. Conclusion In this middle-aged cohort, subclinical levels of NT-proBNP were related to brain function and specifically to GM and not WM measures, extending similar findings in older cohorts. Further research is warranted into biomarkers of cardiac dysfunction as a target for early markers of a brain at risk.
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Affiliation(s)
- Ian T Ferguson
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
| | - Martine Elbejjani
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
| | - Behnam Sabayan
- Department of Neurology, Northwestern University, Chicago, IL, United States
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Osorio Meirelles
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
| | - Otto A Sanchez
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Russell Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, United States.,Department of Biochemistry, University of Vermont College of Medicine, Burlington, VT, United States
| | - Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
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25
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Kuller LH, Lopez OL, Gottdiener JS, Kitzman DW, Becker JT, Chang Y, Newman AB. Subclinical Atherosclerosis, Cardiac and Kidney Function, Heart Failure, and Dementia in the Very Elderly. J Am Heart Assoc 2017; 6:e005353. [PMID: 28735291 PMCID: PMC5586275 DOI: 10.1161/jaha.116.005353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Heart failure (HF) and dementia are major causes of disability and death among older individuals. Risk factors and biomarkers of HF may be determinants of dementia in the elderly. We evaluated the relationship between biomarkers of cardiovascular disease and HF and risk of dementia and death. Three hypotheses were tested: (1) higher levels of high-sensitivity cardiac troponin T, N-terminal of prohormone brain natriuretic peptide, and cystatin C predict risk of death, cardiovascular disease, HF, and dementia; (2) higher levels of cardiovascular disease biomarkers are associated with increased risk of HF and then secondary increased risk of dementia; and (3) risk of dementia is lower among participants with a combination of lower coronary artery calcium, atherosclerosis, and lower high-sensitivity cardiac troponin T (myocardial injury). METHODS AND RESULTS The Cardiovascular Health Study Cognition Study was a continuation of the Cardiovascular Health Study limited to the Pittsburgh, PA, center from 1998-1999 to 2014. In 1992-1994, 924 participants underwent magnetic resonance imaging of the brain. There were 199 deaths and 116 developed dementia before 1998-1999. Of the 609 participants eligible for the Pittsburgh Cardiovascular Health Study Cognition Study, 87.5% (n=532) were included in the study. There were 120 incident HF cases and 72% had dementia. In 80 of 87, dementia preceded HF. A combination of low coronary artery calcium score and low high-sensitivity cardiac troponin T was significantly associated with reduced risk of dementia and HF. CONCLUSIONS Most participants with HF had dementia but with onset before HF. Lower high-sensitivity cardiac troponin T and coronary artery calcium was associated with low risk of dementia based on a small number of events. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.
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Affiliation(s)
- Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Oscar L Lopez
- Department of Neurology, School of Medicine, University of Pittsburgh, PA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, PA
| | - John S Gottdiener
- Division of Cardiovascular Medicine, School of Medicine, University of Maryland, Baltimore, MD
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - James T Becker
- Department of Neurology, School of Medicine, University of Pittsburgh, PA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, PA
| | - Yuefang Chang
- Department of Neurological Surgery, University of Pittsburgh, PA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
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26
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Pendlebury ST, Rothwell PM. Brain Atrophy, N-Terminal Brain Natriuretic Peptide, and Carotid Disease: Interconnecting Relationships Between Cerebral Perfusion, Cardiovascular Disease, Inflammation, and Cognitive Decline. Arterioscler Thromb Vasc Biol 2016; 36:2141-2142. [PMID: 27784701 DOI: 10.1161/atvbaha.116.308362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah T Pendlebury
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (S.T.P., P.M.R.) and NIHR Oxford Biomedical Research Centre (S.T.P., P.M.R.), John Radcliffe Hospital, University of Oxford, United Kingdom.
| | - Peter M Rothwell
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (S.T.P., P.M.R.) and NIHR Oxford Biomedical Research Centre (S.T.P., P.M.R.), John Radcliffe Hospital, University of Oxford, United Kingdom
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