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Triana AM, Saramäki J, Glerean E, Hayward NMEA. Neuroscience meets behavior: A systematic literature review on magnetic resonance imaging of the brain combined with real-world digital phenotyping. Hum Brain Mapp 2024; 45:e26620. [PMID: 38436603 PMCID: PMC10911114 DOI: 10.1002/hbm.26620] [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: 05/17/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024] Open
Abstract
A primary goal of neuroscience is to understand the relationship between the brain and behavior. While magnetic resonance imaging (MRI) examines brain structure and function under controlled conditions, digital phenotyping via portable automatic devices (PAD) quantifies behavior in real-world settings. Combining these two technologies may bridge the gap between brain imaging, physiology, and real-time behavior, enhancing the generalizability of laboratory and clinical findings. However, the use of MRI and data from PADs outside the MRI scanner remains underexplored. Herein, we present a Preferred Reporting Items for Systematic Reviews and Meta-Analysis systematic literature review that identifies and analyzes the current state of research on the integration of brain MRI and PADs. PubMed and Scopus were automatically searched using keywords covering various MRI techniques and PADs. Abstracts were screened to only include articles that collected MRI brain data and PAD data outside the laboratory environment. Full-text screening was then conducted to ensure included articles combined quantitative data from MRI with data from PADs, yielding 94 selected papers for a total of N = 14,778 subjects. Results were reported as cross-frequency tables between brain imaging and behavior sampling methods and patterns were identified through network analysis. Furthermore, brain maps reported in the studies were synthesized according to the measurement modalities that were used. Results demonstrate the feasibility of integrating MRI and PADs across various study designs, patient and control populations, and age groups. The majority of published literature combines functional, T1-weighted, and diffusion weighted MRI with physical activity sensors, ecological momentary assessment via PADs, and sleep. The literature further highlights specific brain regions frequently correlated with distinct MRI-PAD combinations. These combinations enable in-depth studies on how physiology, brain function and behavior influence each other. Our review highlights the potential for constructing brain-behavior models that extend beyond the scanner and into real-world contexts.
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Affiliation(s)
- Ana María Triana
- Department of Computer Science, School of ScienceAalto UniversityEspooFinland
| | - Jari Saramäki
- Department of Computer Science, School of ScienceAalto UniversityEspooFinland
| | - Enrico Glerean
- Department of Neuroscience and Biomedical Engineering, School of ScienceAalto UniversityEspooFinland
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2
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Wang H, Yu M, Ren J, Zhong X, Xu D, Gao L, Xu H. Neuroanatomical correlates of cognitive impairment following basal ganglia-thalamic post-hemorrhagic stroke: Uncovering network-wide alterations in hemispheric gray matter asymmetry. Brain Res 2023; 1820:148559. [PMID: 37652090 DOI: 10.1016/j.brainres.2023.148559] [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: 04/12/2023] [Revised: 08/16/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
Cognitive impairment and recovery are central issues in hemorrhagic stroke. This study aimed to investigate whether post-hemorrhagic stroke cognitive impairment (PhSCI) is associated with cortical gray matter (GM) loss and hemispheric asymmetry changes and whether these changes could predict improvements in cognitive function during the recovery. Nineteen patients with PhSCI, comprising 10 with basal ganglia hemorrhage and 9 with thalamic hemorrhage, were recruited. Among them, 9 completed a course of repetitive transcranial magnetic stimulation (rTMS). Additionally, 19 demographically and comorbidity-matched healthy controls were also included. Structural brain MRI and cognitive assessments were performed. Voxel-wise GM volume and hemispheric asymmetry were analyzed. The PhSCI patients exhibited bilateral, yet asymmetric, GM losses in the hippocampus, fusiform, lateral temporal, prefrontal, somatomotor, and inferior parietal regions. The analysis of GM asymmetry revealed that patients showed rightward GM in the lateral temporal, somatomotor, and inferior parietal regions. Among the 9 PhSCI patients who completed rTMS, there was a marginal trend of regional GM increase and leftward GM, and these changes were in parallel with the improvements in cognitive tests. Further lesion connectivity and metanalytic mapping identified two interconnected systems linked to the lesions, which were anchored in the default mode, somatomotor, and salience/cognitive control networks and in the cognitive domains of memory, language, decision-making, and executive function. In conclusion, PhSCI patients exhibited network-wide cortical GM losses, distal to subcortical hemorrhagic lesions, and hemisphere asymmetry changes. These changes appear to predict rTMS-related cognitive improvements, suggesting that even subcortical focal lesions can lead to alterations in distal cortical neuroanatomical architecture. Our preliminary findings provide new insights into the neuroanatomical basis of PhSCI.
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Affiliation(s)
- Huan Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Minhua Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Jinxia Ren
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Xiaoli Zhong
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Dan Xu
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China.
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China.
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3
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Vaisvilaite L, Andersson M, Salami A, Specht K. Time of day dependent longitudinal changes in resting-state fMRI. Front Neurol 2023; 14:1166200. [PMID: 37475742 PMCID: PMC10354550 DOI: 10.3389/fneur.2023.1166200] [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: 02/15/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Longitudinal studies have become more common in the past years due to their superiority over cross-sectional samples. In light of the ongoing replication crisis, the factors that may introduce variability in resting-state networks have been widely debated. This publication aimed to address the potential sources of variability, namely, time of day, sex, and age, in longitudinal studies within individual resting-state fMRI data. DCM was used to analyze the fMRI time series, extracting EC connectivity measures and parameters that define the BOLD signal. In addition, a two-way ANOVA was used to assess the change in EC and parameters that define the BOLD signal between data collection waves. The results indicate that time of day and gender have significant model evidence for the parameters that define the BOLD signal but not EC. From the ANOVA analysis, findings indicate that there was a significant change in the two nodes of the DMN and their connections with the fronto-parietal network. Overall, these findings suggest that in addition to age and gender, which are commonly accounted for in the fMRI data collection, studies should note the time of day, possibly treating it as a covariate in longitudinal samples.
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Affiliation(s)
- Liucija Vaisvilaite
- ReState Research Group, Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Mohn Medical and Imaging Visualization Centre, Haukel and University Hospital, Bergen, Norway
| | - Micael Andersson
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Alireza Salami
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Ageing Research Center, Karolinska Institute, Stockholm, Sweden
| | - Karsten Specht
- ReState Research Group, Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Mohn Medical and Imaging Visualization Centre, Haukel and University Hospital, Bergen, Norway
- Department of Education, UiT/The Arctic University of Norway, Tromsø, Norway
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4
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Boa Sorte Silva NC, Gill DP, Nagamatsu LS, Owen AM, Petrella RJ. Systolic blood pressure dipping may be associated with mobility impairment and brain volume in community-dwelling older adults: An exploratory study. Exp Gerontol 2020; 141:111100. [DOI: 10.1016/j.exger.2020.111100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022]
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Jennings JR, Muldoon MF, Allen B, Ginty AT, Gianaros PJ. Cerebrovascular function in hypertension: Does high blood pressure make you old? Psychophysiology 2020; 58:e13654. [PMID: 32830869 DOI: 10.1111/psyp.13654] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022]
Abstract
The majority of individuals over an age of 60 have hypertension. Elevated blood pressure and older age are associated with very similar changes in brain structure and function. We review the parallel brain changes associated with increasing age and blood pressure. This review focuses on joint associations of aging and elevated blood pressure with neuropsychological function, regional cerebral blood flow responses to cognitive and metabolic challenges, white matter disruptions, grey matter volume, cortical thinning, and neurovascular coupling. Treatment of hypertension ameliorates many of these changes but fails to reverse them. Treatment of hypertension itself appears more successful with better initial brain function. We show evidence that sympathetic and renal influences known to increase blood pressure also impact brain integrity. Possible central mechanisms contributing to the course of hypertension and aging are then suggested. An emphasis is placed on psychologically relevant factors: stress, cardiovascular reactions to stress, and diet/obesity. The contribution of some of these factors to biological aging remains unclear and may provide a starting point for defining the independent and interacting effects of aging and increasing blood pressure on the brain.
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Affiliation(s)
- J Richard Jennings
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew F Muldoon
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ben Allen
- Department of Psychology, University of Tennessee, Knoxville, TN, USA
| | - Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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Zhang J, Lyu T, Yang Y, Wang Y, Zheng Y, Qu S, Zhang Z, Cai X, Tang C, Huang Y. Acupuncture at LR3 and KI3 shows a control effect on essential hypertension and targeted action on cerebral regions related to blood pressure regulation: a resting state functional magnetic resonance imaging study. Acupunct Med 2020; 39:53-63. [PMID: 32529884 DOI: 10.1177/0964528420920282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of acupuncture at LR3 and KI3 on hypertension at different time points and on related cerebral regions using resting-state functional magnetic resonance imaging (rs-fMRI). METHODS We randomly divided 29 subjects into two groups: Group A (receiving acupuncture at LR3 + KI3; 15 subjects) and group B (receiving acupuncture at LR3 and a sham location not corresponding to any traditional acupuncture point; 14 subjects). Acupuncture was performed. Blood pressure (BP) changes were recorded and analyzed using SPSS 20.0 statistical software. We used a 3.0T MRI scanner and standard GE 8 channel head coil to collect whole brain fMRI data in both groups. Data analysis and processing was based on the R2009a MATLAB platform. REST 1.8 software was used to analyze the whole brain amplitude of low-frequency fluctuation (ALFF). RESULTS After acupuncture, a statistically significant reduction in BP at different time points was observed in group A. In group B, a statistically significant reduction was found only in diastolic blood pressure (DBP) and was not sustained. Acupuncture at LR3 + KI3 specifically affected brain areas involved in BP regulation, as well as those involved in auditory sense, speech, vision, movement and sensation. CONCLUSION Acupuncture at LR3 + KI3 showed positive immediate and long-term effects on BP, particularly systolic blood pressure (SBP). After ALFF analysis, we concluded that LR3 + KI3 activates brain areas related to BP regulation. In addition, after acupuncture at LR3 + KI3, a highly targeted effect was observed in brain areas associated with BP. In addition, extracerebral areas involving vision, motion control, cognition and hearing were activated, which could potentially contribute to the mitigation of hypertensive complications in patients in an advanced stage of the disease.
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Affiliation(s)
- Jiping Zhang
- School of the Tradition Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Taibiao Lyu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yicheng Yang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanjie Wang
- Weinan Vocational and Technical College, Weinan, China
| | - Yu Zheng
- School of the Tradition Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Shanshan Qu
- School of the Tradition Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Zhinan Zhang
- School of the Tradition Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Xiaowen Cai
- School of the Tradition Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Chunzhi Tang
- Clinical Medical College of Acupuncture and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong Huang
- School of the Tradition Chinese Medicine, Southern Medical University, Guangzhou, China
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7
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Ghazi L, Yaffe K, Tamura MK, Rahman M, Hsu CY, Anderson AH, Cohen JB, Fischer MJ, Miller ER, Navaneethan SD, He J, Weir MR, Townsend RR, Cohen DL, Feldman HI, Drawz PE. Association of 24-Hour Ambulatory Blood Pressure Patterns with Cognitive Function and Physical Functioning in CKD. Clin J Am Soc Nephrol 2020; 15:455-464. [PMID: 32217634 PMCID: PMC7133123 DOI: 10.2215/cjn.10570919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/14/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Hypertension is highly prevalent in patients with CKD as is cognitive impairment and frailty, but the link between them is understudied. Our objective was to determine the association between ambulatory BP patterns, cognitive function, physical function, and frailty among patients with nondialysis-dependent CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Ambulatory BP readings were obtained on 1502 participants of the Chronic Renal Insufficiency Cohort. We evaluated the following exposures: (1) BP patterns (white coat, masked, sustained versus controlled hypertension) and (2) dipping patterns (reverse, extreme, nondippers versus normal dippers). Outcomes included the following: (1) cognitive impairment scores from the Modified Mini Mental Status Examination of <85, <80, and <75 for participants <65, 65-79, and ≥80 years, respectively; (2) physical function, measured by the short physical performance battery (SPPB), with higher scores (0-12) indicating better functioning; and (3) frailty, measured by meeting three or more of the following criteria: slow gait speed, muscle weakness, low physical activity, exhaustion, and unintentional weight loss. Cognitive function and frailty were assessed at the time of ambulatory BP (baseline) and annually thereafter. SPPB was assessed at baseline logistic and linear regression and Cox discrete models assessed the cross-sectional and longitudinal relationship between dipping and BP patterns and outcomes. RESULTS Mean age of participants was 63±10 years, 56% were male, and 39% were black. At baseline, 129 participants had cognitive impairment, and 275 were frail. Median SPPB score was 9 (interquartile range, 7-10). At baseline, participants with masked hypertension had 0.41 (95% CI, -0.78 to -0.05) lower SPPB scores compared with those with controlled hypertension in the fully adjusted model. Over 4 years of follow-up, 529 participants had incident frailty, and 207 had incident cognitive impairment. After multivariable adjustment, there was no association between BP or dipping patterns and incident frailty or cognitive impairment. CONCLUSIONS In patients with CKD, dipping and BP patterns are not associated with incident or prevalent cognitive impairment or prevalent frailty.
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Affiliation(s)
- Lama Ghazi
- Department of Epidemiology and Community Health, Division of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Kristine Yaffe
- Departments of Epidemiology and Biostatistics and Psychiatry and Neurology, University of California, San Francisco, San Francisco, California
| | - Manjula K Tamura
- Veterans Affairs Palo Alto Health Care System, Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, California.,Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Mahboob Rahman
- Division of Nephrology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California, San Francisco, San Francisco, California.,Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Amanda H Anderson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jordana B Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael J Fischer
- Renal Section and Center of Innovation for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois.,Nephrology Division, Department of Medicine, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois
| | - Edgar R Miller
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sankar D Navaneethan
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland; and
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debbie L Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold I Feldman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul E Drawz
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota
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8
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Kim MY, Kim K, Hong CH, Lee SY, Jung YS. Sex Differences in Cardiovascular Risk Factors for Dementia. Biomol Ther (Seoul) 2018; 26:521-532. [PMID: 30464071 PMCID: PMC6254640 DOI: 10.4062/biomolther.2018.159] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/27/2018] [Accepted: 10/06/2018] [Indexed: 12/16/2022] Open
Abstract
Dementia, characterized by a progressive cognitive decline and a cumulative inability to behave independently, is highly associated with other diseases. Various cardiovascular disorders, such as coronary artery disease and atrial fibrillation, are well-known risk factors for dementia. Currently, increasing evidence suggests that sex factors may play an important role in the pathogenesis of diseases, including cardiovascular disease and dementia. Recent studies show that nearly two-thirds of patients diagnosed with Alzheimer’s disease are women; however, the incidence difference between men and women remains vague. Therefore, studies are needed to investigate sex-specific differences, which can help understand the pathophysiology of dementia and identify potential therapeutic targets for both sexes. In the present review, we summarize sex differences in the prevalence and incidence of dementia by subtypes. This review also describes sex differences in the risk factors of dementia and examines the impact of risk factors on the incidence of dementia in both sexes.
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Affiliation(s)
- Mi-Young Kim
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Kyeongjin Kim
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon 16499, Republic of Korea.,Institute on Aging, Ajou University Medical Center, Suwon 16499, Republic of Korea
| | - Sang Yoon Lee
- Department of Biomedical Sciences, Chronic Inflammatory Disease Research Center, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Yi-Sook Jung
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon 16499, Republic of Korea
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9
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Chen BT, Sethi SK, Jin T, Patel SK, Ye N, Sun CL, Rockne RC, Haacke EM, Root JC, Saykin AJ, Ahles TA, Holodny AI, Prakash N, Mortimer J, Waisman J, Yuan Y, Somlo G, Li D, Yang R, Tan H, Katheria V, Morrison R, Hurria A. Assessing brain volume changes in older women with breast cancer receiving adjuvant chemotherapy: a brain magnetic resonance imaging pilot study. Breast Cancer Res 2018; 20:38. [PMID: 29720224 PMCID: PMC5932862 DOI: 10.1186/s13058-018-0965-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/31/2018] [Indexed: 01/01/2023] Open
Abstract
Background Cognitive decline is among the most feared treatment-related outcomes of older adults with cancer. The majority of older patients with breast cancer self-report cognitive problems during and after chemotherapy. Prior neuroimaging research has been performed mostly in younger patients with cancer. The purpose of this study was to evaluate longitudinal changes in brain volumes and cognition in older women with breast cancer receiving adjuvant chemotherapy. Methods Women aged ≥ 60 years with stage I–III breast cancer receiving adjuvant chemotherapy and age-matched and sex-matched healthy controls were enrolled. All participants underwent neuropsychological testing with the US National Institutes of Health (NIH) Toolbox for Cognition and brain magnetic resonance imaging (MRI) prior to chemotherapy, and again around one month after the last infusion of chemotherapy. Brain volumes were measured using Neuroreader™ software. Longitudinal changes in brain volumes and neuropsychological scores were analyzed utilizing linear mixed models. Results A total of 16 patients with breast cancer (mean age 67.0, SD 5.39 years) and 14 age-matched and sex-matched healthy controls (mean age 67.8, SD 5.24 years) were included: 7 patients received docetaxel and cyclophosphamide (TC) and 9 received chemotherapy regimens other than TC (non-TC). There were no significant differences in segmented brain volumes between the healthy control group and the chemotherapy group pre-chemotherapy (p > 0.05). Exploratory hypothesis generating analyses focusing on the effect of the chemotherapy regimen demonstrated that the TC group had greater volume reduction in the temporal lobe (change = − 0.26) compared to the non-TC group (change = 0.04, p for interaction = 0.02) and healthy controls (change = 0.08, p for interaction = 0.004). Similarly, the TC group had a decrease in oral reading recognition scores (change = − 6.94) compared to the non-TC group (change = − 1.21, p for interaction = 0.07) and healthy controls (change = 0.09, p for interaction = 0.02). Conclusions There were no significant differences in segmented brain volumes between the healthy control group and the chemotherapy group; however, exploratory analyses demonstrated a reduction in both temporal lobe volume and oral reading recognition scores among patients on the TC regimen. These results suggest that different chemotherapy regimens may have differential effects on brain volume and cognition. Future, larger studies focusing on older adults with cancer on different treatment regimens are needed to confirm these findings. Trial registration ClinicalTrials.gov, NCT01992432. Registered on 25 November 2013. Retrospectively registered.
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Affiliation(s)
- Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, 91010, USA.
| | - Sean K Sethi
- The MRI Institute for Biomedical Research, Magnetic Resonance Innovations, Inc., Detroit, MI, USA
| | - Taihao Jin
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Sunita K Patel
- Department of Population Science, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Ningrong Ye
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Russell C Rockne
- Division of Mathematical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - E Mark Haacke
- The MRI Institute for Biomedical Research, Magnetic Resonance Innovations, Inc., Detroit, MI, USA.,Department of Biomedical Engineering, Wayne State University, Detroit, MI, 48202, USA
| | - James C Root
- Neurocognitive Research Lab, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Andrew J Saykin
- Center for Neuroimaging, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN, 46202, USA
| | - Tim A Ahles
- Neurocognitive Research Lab, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Neal Prakash
- Division of Neurology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - James Waisman
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Yuan Yuan
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - George Somlo
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Richard Yang
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Heidi Tan
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Rachel Morrison
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Arti Hurria
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, 91010, USA.,Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
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10
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Geraldes R, Esiri MM, DeLuca GC, Palace J. Age-related small vessel disease: a potential contributor to neurodegeneration in multiple sclerosis. Brain Pathol 2017; 27:707-722. [PMID: 27864848 DOI: 10.1111/bpa.12460] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system wherein, after an initial phase of transient neurological defects, slow neurological deterioration due to progressive neuronal loss ensues. Age is a major determinant of MS progression onset and disability. Over the past years, several mechanisms have been proposed to explain the key drivers of neurodegeneration and disability accumulation in MS. However, the effect of commonly encountered age-related cerebral vessel disease, namely small vessel disease (SVD), has been largely neglected and constitutes the aim of this review. SVD shares some features with MS, that is, white matter demyelination and brain atrophy, and has been shown to contribute to the neuronal damage seen in vascular cognitive impairment. Several lines of evidence suggest that an interaction between MS and SVD may influence MS-related neurodegeneration. SVD may contribute to hypoperfusion, reduced vascular reactivity and tissue hypoxia, features seen in MS. Venule and endothelium abnormalities have been documented in MS but the role of arterioles and of other neurovascular unit structures, such as the pericyte, has not been explored. Vascular risk factors (VRF) have recently been associated with faster progression in MS, though the mechanisms are unclear since very few studies have addressed the impact of VRF and SVD on MS imaging and pathology outcomes. Therapeutic agents targeting the microvasculature and the neurovascular unit may impact both SVD and MS and may benefit patients with dual pathology.
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Affiliation(s)
- Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Margaret M Esiri
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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Zhang J, Zheng Y, Wang Y, Qu S, Zhang S, Wu C, Chen J, Ouyang H, Tang C, Huang Y. Evidence of a Synergistic Effect of Acupoint Combination: A Resting-State Functional Magnetic Resonance Imaging Study. J Altern Complement Med 2016; 22:800-809. [PMID: 27548054 PMCID: PMC5067799 DOI: 10.1089/acm.2016.0016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Objective: This study aimed to find evidence of a synergistic effect of acupoint combinations by analyzing different brain regions activated after acupuncture at different acupoint combinations. Methods: A total of 57 healthy subjects were randomly distributed into three groups: LR3 plus KI3 acupoints, LR3 plus sham acupoint, or LR3 alone. They underwent a magnetic resonance imaging scan before and after acupuncture. The amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) values of different brain regions were analyzed to observe changes in brain function. Results: ALFF and ReHo produced an activated area in the cerebellum posterior lobe after acupuncture at LR3 plus KI3 acupoints versus LR3 alone. ALFF and ReHo revealed altered activity in Brodmann area 10 (BA10), BA18, and brainstem pons after acupuncture at LR3 plus sham acupoint compared with at LR3 alone. A comparison of acupuncture at LR3 plus KI3 acupoints with LR3 plus sham acupoint demonstrated an increase in BA6 of ALFF and a downregulation of ReHo. Conclusions: The increased number of brain regions with altered brain activity after acupuncture at acupoint combinations versus a single acupoint are evidence of the synergistic effect of acupoint combinations. BA6 was significantly activated after acupuncture at LR3 plus KI3 acupoints compared with at LR3 plus sham acupoint, suggesting that BA6 is the specific region of synergistic effect of acupoint combinations of LR3 plus KI3 acupoints. Affected brain regions were different between acupuncture at LR3 plus sham acupoint and LR3 alone, which indicates that the sham acupoint may have some psychological effect. However, the specific mechanism of acupoint combinations requires further research.
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Affiliation(s)
- Jiping Zhang
- 1 School of Traditional Chinese Medicine, Southern Medical University , Guangzhou, China
| | - Yu Zheng
- 1 School of Traditional Chinese Medicine, Southern Medical University , Guangzhou, China
| | - Yanjie Wang
- 1 School of Traditional Chinese Medicine, Southern Medical University , Guangzhou, China
| | - Shanshan Qu
- 1 School of Traditional Chinese Medicine, Southern Medical University , Guangzhou, China
| | - Shaoqun Zhang
- 1 School of Traditional Chinese Medicine, Southern Medical University , Guangzhou, China
| | - Chunxiao Wu
- 1 School of Traditional Chinese Medicine, Southern Medical University , Guangzhou, China
| | - Junqi Chen
- 2 Department of Rehabilitation Medicine, Third Affiliated Hospital of Southern Medical University , Guangzhou, China
| | - Huailiang Ouyang
- 3 Department of Traditional Chinese Medicine, Zhujiang Hospital of Southern Medical University , Guangdong, China
| | - Chunzhi Tang
- 4 Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine , Guangzhou, China
| | - Yong Huang
- 1 School of Traditional Chinese Medicine, Southern Medical University , Guangzhou, China
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Hughes TM, Sink KM. Hypertension and Its Role in Cognitive Function: Current Evidence and Challenges for the Future. Am J Hypertens 2016; 29:149-57. [PMID: 26563965 DOI: 10.1093/ajh/hpv180] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/06/2015] [Indexed: 12/17/2022] Open
Abstract
This review summarizes evidence from studies of blood pressure and dementia-related biomarkers into our understanding of cognitive health and highlights the challenges facing studies, particularly randomized trials, of hypertension and cognition. Several lines of research suggest that elevated blood pressure, especially at midlife, is associated with cognitive decline and dementia and that treatment of hypertension could prevent these conditions. Further, studies of hypertension and brain structure show that blood pressure is associated with several forms of small vessel disease that can result in vascular dementia or interact with Alzheimer's pathology to lower the pathologic threshold at which Alzheimer's signs and symptoms manifest. In addition, recent studies of hypertension and Alzheimer's biomarkers show that elevated blood pressure and pulse pressure are associated with the extent of brain beta amyloid (Aβ) deposition and altered cerebral spinal fluid profiles of Aβ and tau indicative of Alzheimer's pathology. However, in spite of strong evidence of biological mechanisms, results from randomized trials of antihypertensive therapy for the prevention of cardiovascular or cerebrovascular disease that include cognitive endpoints do not strongly support the observational evidence that treatment of hypertension should be better for cognition. We propose that future clinical trials should consider including dementia biomarkers and assess genetic and cardiometabolic risk factors that have been associated with progression of the underlying disease pathology to help bridge these gaps.
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Affiliation(s)
- Timothy M Hughes
- Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kaycee M Sink
- Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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Yano Y, Ning H, Muntner P, Reis JP, Calhoun DA, Viera AJ, Levine DA, Jacobs DR, Shimbo D, Liu K, Greenland P, Lloyd-Jones D. Nocturnal Blood Pressure in Young Adults and Cognitive Function in Midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Hypertens 2015; 28:1240-7. [PMID: 25783740 PMCID: PMC4580541 DOI: 10.1093/ajh/hpv028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/02/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nocturnal blood pressure (BP) is associated with risk for cardiovascular events. However, the relationship between nocturnal BP in young adults and cognitive function in midlife remains unclear. METHODS We used data from the ambulatory BP monitoring substudy of the Coronary Artery Risk Development in Young Adults Study, including 224 participants (mean age 30 years, 45% men, 63% African Americans). At the 20-year follow-up, the Stroop test (executive function), Digit Symbol Substitution Test (psychomotor speed), and Rey Auditory Verbal Learning Test (verbal memory) were assessed. RESULTS Baseline mean office, daytime, and nocturnal BP were 109/73, 120/74, and 107/59 mm Hg, respectively. Nocturnal BP dipping, calculated as (nocturnal systolic BP [SBP]--daytime SBP) × 100/daytime SBP, was divided into quartiles (Q1: -39.3% to -16.9%; Q2: -16.8% to -13.2%, Q3 [reference]: -13.1% to -7.8%, and Q4: -7.7% to +56.4%). In multiple regression analyses, the least nocturnal SBP dipping (Q4 vs. reference) and higher nocturnal diastolic BP level were associated with worse Stroop scores, with adjustments for demographic and clinical characteristics, and cumulative exposure to office BP during follow-up (β [standard error]: 0.37 [0.18] and 0.19 [0.07], respectively; all P < 0.05). Digit Symbol Substitution Test and Rey Auditory Verbal Learning Test were not significantly associated with nocturnal SBP dipping or nocturnal SBP/diastolic BP levels. CONCLUSIONS Among healthy young adults, less nocturnal SBP dipping and higher nocturnal diastolic BP levels were associated with lower executive function in midlife, independent of multiple measures of office BP during long-term follow-up.
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Affiliation(s)
- Yuichiro Yano
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA;
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alaska, USA
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - David A Calhoun
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alaska, USA
| | - Anthony J Viera
- Hypertension Research Program and Department of Family Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Deborah A Levine
- Departments of Internal Medicine and Neurology and Stroke Program, University of Michigan Health System, Veterans Affairs Health Services Research and Development Center of Excellence, Ann Arbor, Michigan, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daichi Shimbo
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University, New York, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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15
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Alipour H, Goldust M. The association between blood pressure components and cognitive functions and cognitive reserve. Clin Exp Hypertens 2015; 38:95-9. [DOI: 10.3109/10641963.2015.1047946] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Houman Alipour
- Faculty of Medicine, Tabriz University of Medical Sciences, Aras Branch, Tabriz, Iran and
| | - Mohamad Goldust
- Young Researchers and Elite Club, Qaemshahr Branch, Islamic Azad University, Qaemshahr, Iran
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16
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Foster-Dingley JC, van der Grond J, Moonen JEF, van den Berg-Huijsmans AA, de Ruijter W, van Buchem MA, de Craen AJM, van der Mast RC. Lower Blood Pressure Is Associated With Smaller Subcortical Brain Volumes in Older Persons. Am J Hypertens 2015; 28:1127-33. [PMID: 25714132 DOI: 10.1093/ajh/hpv006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Both high and low blood pressure (BP) have been positively as well as negatively associated with brain volumes in a variety of populations. The objective of this study was to investigate whether BP is associated with cortical and subcortical brain volumes in older old persons with mild cognitive deficits. METHODS Within the Discontinuation of Antihypertensive Treatment in the Elderly trial, the cross-sectional relation of BP parameters with both cortical and subcortical brain volumes was investigated in 220 older old persons with mild cognitive deficits (43% men, mean age = 80.7 (SD = 4.1), median Mini-Mental State Examination score = 26 (interquartile range: 25-27)), using linear regression analysis. All analyses were adjusted for age, gender, volume of white matter hyperintensities, and duration of antihypertensive treatment. Brain volumes were determined on 3DT1-weighted brain magnetic resonance imaging scans. RESULTS Lower systolic BP, diastolic BP, and mean arterial pressure (MAP) were significantly associated with lower volumes of thalamus and putamen (all P ≤ 0.01). In addition, lower MAP was also associated with reduced hippocampal volume (P = 0.035). There were no associations between any of the BP parameters with cortical gray matter or white matter volume. CONCLUSION In an older population using antihypertensive medication with mild cognitive deficits, a lower BP, rather than a high BP is associated with reduced volumes of thalamus, putamen, and hippocampus.
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Affiliation(s)
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Justine E F Moonen
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Wouter de Ruijter
- Department of Public health and Primary care, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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17
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Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: Relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res 2015; 93:1778-94. [DOI: 10.1002/jnr.23634] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/02/2015] [Accepted: 08/04/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE/Melbourne School of Engineering, The University of Melbourne; Parkville Victoria Australia
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18
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Madsen SK, Rajagopalan P, Joshi SH, Toga AW, Thompson PM. Higher homocysteine associated with thinner cortical gray matter in 803 participants from the Alzheimer's Disease Neuroimaging Initiative. Neurobiol Aging 2015; 36 Suppl 1:S203-10. [PMID: 25444607 PMCID: PMC4268346 DOI: 10.1016/j.neurobiolaging.2014.01.154] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 12/03/2013] [Accepted: 01/04/2014] [Indexed: 12/24/2022]
Abstract
A significant portion of our risk for dementia in old age is associated with lifestyle factors (diet, exercise, and cardiovascular health) that are modifiable, at least in principle. One such risk factor, high-homocysteine levels in the blood, is known to increase risk for Alzheimer's disease and vascular disorders. Here, we set out to understand how homocysteine levels relate to 3D surface-based maps of cortical gray matter distribution (thickness, volume, and surface area) computed from brain magnetic resonance imaging in 803 elderly subjects from the Alzheimer's Disease Neuroimaging Initiative data set. Individuals with higher plasma levels of homocysteine had lower gray matter thickness in bilateral frontal, parietal, occipital, and right temporal regions and lower gray matter volumes in left frontal, parietal, temporal, and occipital regions, after controlling for diagnosis, age, and sex and after correcting for multiple comparisons. No significant within-group associations were found in cognitively healthy people, patients with mild cognitive impairment, or patients with Alzheimer's disease. These regional differences in gray matter structure may be useful biomarkers to assess the effectiveness of interventions, such as vitamin B supplements, that aim to prevent homocysteine-related brain atrophy by normalizing homocysteine levels.
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Affiliation(s)
- Sarah K Madsen
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Priya Rajagopalan
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shantanu H Joshi
- Department of Neurology, UCLA School of Medicine, Los Angeles, CA, USA
| | - Arthur W Toga
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Paul M Thompson
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Psychiatry, Semel Institute, UCLA School of Medicine, Los Angeles, CA, USA.
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19
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Vicario A, Cerezo GH. At the Heart of Brain Disorders - Preventing Cognitive Decline and Dementia. Eur Cardiol 2015; 10:60-63. [PMID: 30310425 DOI: 10.15420/ecr.2015.10.01.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vascular risk factors are shared by heart and brain. Vascular brain injury (small vessel disease, stroke) alone or combined with neurodegenerative pathology (β-amyloid depositions) brings about either cognitive decline and vascular dementia or Alzheimer's disease. Long-term exposure to vascular risk factors precedes the onset of neurocognitive diseases by one or two decades. Early detection and control of modifiable vascular risk factors seem to be the only current strategies to prevent cognitive impairment and dementia.
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20
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Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients. J Hypertens 2014; 32:423-31. [PMID: 24351802 DOI: 10.1097/hjh.0000000000000025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients. METHODS We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points). RESULTS CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima-media thickness (IMT)], hazard ratio 2.5-2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction. CONCLUSION Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients.
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21
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Peng J, Lu F, Wang Z, Zhong M, Sun L, Hu N, Liu Z, Zhang W. Excessive lowering of blood pressure is not beneficial for progression of brain white matter hyperintensive and cognitive impairment in elderly hypertensive patients: 4-year follow-up study. J Am Med Dir Assoc 2014; 15:904-10. [PMID: 25239015 DOI: 10.1016/j.jamda.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 07/08/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study was designed to explore the appropriate blood pressure (BP) target required to reduce cognitive decline and brain white matter lesions (WMLs) in elderly hypertensive patients. METHODS Elderly patients (n = 294, ≥80 years of age) being treated for hypertension were enrolled in a longitudinal study examining cognitive impairment after an initial assessment and a period of 4 years. All patients underwent neurological and cognitive assessment, laboratory examination, and magnetic resonance imaging of the brain. RESULTS The 4-year follow-up examination revealed that body mass index, alcohol consumption, systolic blood pressure (SBP), diastolic blood pressure, and Mini-Mental State Examination (MMSE) all showed a significant decline, whereas fasting plasma glucose, white matter hyperintensities (WMH) volume, and the WMH/total intracranial volume (TIV) ratio were significantly increased when compared with baseline observations. Interestingly, the decline in MMSE, as well as the increment of WMH and WMH/TIV ratio was smaller in patients with SBP ranging from 140 to 160 mm Hg than in those whose SBP was lower than 140 mm Hg or higher than 160 mm Hg (P < .05). Furthermore, we observed that a 15 to 35 mm Hg targeted lowering of SBP in the elderly patients was more beneficial to our cognitive analysis than treatments that achieved less than 15 mm Hg or greater than 35 mm Hg (P < .05). CONCLUSIONS In elderly hypertensive patients, there exists a beneficial target for SBP lowering beyond which treatment may not be beneficial for improving or delaying the progression of cognitive impairment and WMLs.
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Affiliation(s)
- Jie Peng
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China
| | - Zhihao Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Ming Zhong
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Lixin Sun
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Na Hu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhendong Liu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China.
| | - Wei Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
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Cheshire WP. Highlights in clinical autonomic neurosciences: Brain volume and autonomic regulation. Auton Neurosci 2014; 183:4-7. [PMID: 24862160 DOI: 10.1016/j.autneu.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Advances in volumetric magnetic resonance imaging (MRI) technology are beginning to provide structural correlates to functional dysautonomic syndromes in the brain. This paper highlights several interesting recent discoveries in which measurable variations in general or regional subcortical or cortical brain volume corresponded to changes in blood pressure or heart rate. Although these MRI findings currently lack diagnostic value in routine clinical practice, they may provide important clues to the pathophysiology of autonomic disorders and to links between autonomic and cognitive disorders. If validated by further studies, they also have potential implications for the management of orthostatic hypotension, particularly when combined with hypertension.
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Affiliation(s)
- William P Cheshire
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA.
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23
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Affiliation(s)
- Costantino Iadecola
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY.
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24
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Avet J, Pichot V, Barthélémy JC, Laurent B, Garcin A, Roche F, Celle S. Leukoaraiosis and ambulatory blood pressure load in a healthy elderly cohort study: The PROOF study. Int J Cardiol 2014; 172:59-63. [DOI: 10.1016/j.ijcard.2013.11.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/11/2013] [Accepted: 11/18/2013] [Indexed: 11/27/2022]
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Abstract
As life expectancy lengthens, dementia is becoming a significant human condition in terms of its prevalence and cost to society worldwide. It is important in that context to understand the preventable and treatable causes of dementia. This article exposes the link between dementia and heart disease in all its forms, including coronary artery disease, myocardial infarction, atrial fibrillation, valvular disease, and heart failure. This article also explores the cardiovascular risk factors and emphasizes that several of them are preventable and treatable. In addition to medical therapies, the lifestyle changes that may be useful in retarding the onset of dementia are also summarized.
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Affiliation(s)
- B Ng Justin
- Departments of Neuroscience and Psychology, McGill University, Montreal, QC, Canada
| | - Michele Turek
- Division of Cardiology, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Antoine M Hakim
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- Canadian Stroke Network, Ottawa, ON, Canada
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Death by a thousand cuts in Alzheimer's disease: hypoxia--the prodrome. Neurotox Res 2013; 24:216-43. [PMID: 23400634 DOI: 10.1007/s12640-013-9379-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/10/2013] [Accepted: 01/21/2013] [Indexed: 12/30/2022]
Abstract
A wide range of clinical consequences may be associated with obstructive sleep apnea (OSA) including systemic hypertension, cardiovascular disease, pulmonary hypertension, congestive heart failure, cerebrovascular disease, glucose intolerance, impotence, gastroesophageal reflux, and obesity, to name a few. Despite this, 82 % of men and 93 % of women with OSA remain undiagnosed. OSA affects many body systems, and induces major alterations in metabolic, autonomic, and cerebral functions. Typically, OSA is characterized by recurrent chronic intermittent hypoxia (CIH), hypercapnia, hypoventilation, sleep fragmentation, peripheral and central inflammation, cerebral hypoperfusion, and cerebral glucose hypometabolism. Upregulation of oxidative stress in OSA plays an important pathogenic role in the milieu of hypoxia-induced cerebral and cardiovascular dysfunctions. Strong evidence underscores that cerebral amyloidogenesis and tau phosphorylation--two cardinal features of Alzheimer's disease (AD), are triggered by hypoxia. Mice subjected to hypoxic conditions unambiguously demonstrated upregulation in cerebral amyloid plaque formation and tau phosphorylation, as well as memory deficit. Hypoxia triggers neuronal degeneration and axonal dysfunction in both cortex and brainstem. Consequently, neurocognitive impairment in apneic/hypoxic patients is attributable to a complex interplay between CIH and stimulation of several pathological trajectories. The framework presented here helps delineate the emergence and progression of cognitive decline, and may yield insight into AD neuropathogenesis. The global impact of CIH should provide a strong rationale for treating OSA and snoring clinically, in order to ameliorate neurocognitive impairment in aged/AD patients.
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