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Butters E, Srinivasan S, O'Brien JT, Su L, Bale G. A promising tool to explore functional impairment in neurodegeneration: A systematic review of near-infrared spectroscopy in dementia. Ageing Res Rev 2023; 90:101992. [PMID: 37356550 DOI: 10.1016/j.arr.2023.101992] [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: 04/07/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
This systematic review aimed to evaluate previous studies which used near-infrared spectroscopy (NIRS) in dementia given its suitability as a diagnostic and investigative tool in this population. From 800 identified records which used NIRS in dementia and prodromal stages, 88 studies were evaluated which employed a range of tasks testing memory (29), word retrieval (24), motor (8) and visuo-spatial function (4), and which explored the resting state (32). Across these domains, dementia exhibited blunted haemodynamic responses, often localised to frontal regions of interest, and a lack of task-appropriate frontal lateralisation. Prodromal stages, such as mild cognitive impairment, revealed mixed results. Reduced cognitive performance accompanied by either diminished functional responses or hyperactivity was identified, the latter suggesting a compensatory response not present at the dementia stage. Despite clear evidence of alterations in brain oxygenation in dementia and prodromal stages, a consensus as to the nature of these changes is difficult to reach. This is likely partially due to the lack of standardisation in optical techniques and processing methods for the application of NIRS to dementia. Further studies are required exploring more naturalistic settings and a wider range of dementia subtypes.
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Affiliation(s)
- Emilia Butters
- Department of Electrical Engineering, University of Cambridge, 9 JJ Thomson Avenue, Cambridge CB3 0FA, UK; Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Sruthi Srinivasan
- Department of Electrical Engineering, University of Cambridge, 9 JJ Thomson Avenue, Cambridge CB3 0FA, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Neuroscience, University of Sheffield, 385a Glossop Rd, Broomhall, Sheffield S10 2HQ, UK
| | - Gemma Bale
- Department of Physics, University of Cambridge, 19 JJ Thomson Avenue, Cambridge CB3 0FA, UK
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Garcia-Garcia B, Mattern H, Vockert N, Yakupov R, Schreiber F, Spallazzi M, Perosa V, Haghikia A, Speck O, Düzel E, Maass A, Schreiber S. Vessel Distance Mapping: A novel methodology for assessing vascular-induced cognitive resilience. Neuroimage 2023; 274:120094. [PMID: 37028734 DOI: 10.1016/j.neuroimage.2023.120094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023] Open
Abstract
The association between cerebral blood supply and cognition has been widely discussed in the recent literature. One focus of this discussion has been the anatomical variability of the circle of Willis, with morphological differences being present in more than half of the general population. While previous studies have attempted to classify these differences and explore their contribution to hippocampal blood supply and cognition, results have been controversial. To disentangle these previously inconsistent findings, we introduce Vessel Distance Mapping (VDM) as a novel methodology for evaluating blood supply, which allows for obtaining vessel pattern metrics with respect to the surrounding structures, extending the previously established binary classification into a continuous spectrum. To accomplish this, we manually segmented hippocampal vessels obtained from high-resolution 7T time-of-flight MR angiographic imaging in older adults with and without cerebral small vessel disease, generating vessel distance maps by computing the distances of each voxel to its nearest vessel. Greater values of VDM-metrics, which reflected higher vessel distances, were associated with poorer cognitive outcomes in subjects affected by vascular pathology, while this relation was not observed in healthy controls. Therefore, a mixed contribution of vessel pattern and vessel density is proposed to confer cognitive resilience, consistent with previous research findings. In conclusion, VDM provides a novel platform, based on a statistically robust and quantitative method of vascular mapping, for addressing a variety of clinical research questions.
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Affiliation(s)
| | - Hendrik Mattern
- German Center for Neurodegenerative Diseases, 39120 Magdeburg, Germany; Biomedical Magnetic Resonance, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
| | - Niklas Vockert
- German Center for Neurodegenerative Diseases, 39120 Magdeburg, Germany
| | - Renat Yakupov
- German Center for Neurodegenerative Diseases, 39120 Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Frank Schreiber
- German Center for Neurodegenerative Diseases, 39120 Magdeburg, Germany; Department of Neurology, Otto-von-Guericke University, 39120, Magdeburg, Germany
| | - Marco Spallazzi
- Department of Medicine and Surgery, Unit of Neurology, Azienda Ospedalierouniversitaria, 43126 Parma, Italy
| | - Valentina Perosa
- Department of Neurology, Otto-von-Guericke University, 39120, Magdeburg, Germany; J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Aiden Haghikia
- German Center for Neurodegenerative Diseases, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany; Department of Neurology, Otto-von-Guericke University, 39120, Magdeburg, Germany
| | - Oliver Speck
- German Center for Neurodegenerative Diseases, 39120 Magdeburg, Germany; Biomedical Magnetic Resonance, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany; Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, 39120 Magdeburg, Germany; Department of Neurology, Otto-von-Guericke University, 39120, Magdeburg, Germany; Institute of Cognitive Neuroscience, University College London, London WCIN 3AZ, UK
| | - Anne Maass
- German Center for Neurodegenerative Diseases, 39120 Magdeburg, Germany
| | - Stefanie Schreiber
- German Center for Neurodegenerative Diseases, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany; Department of Neurology, Otto-von-Guericke University, 39120, Magdeburg, Germany
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Saka E, Atay LO, Akdemir UO, Yetim E, Balci E, Arsava EM, Topcuoglu MA. Cerebral vasomotor reactivity across the continuum of subjective cognitive impairment, amnestic mild cognitive impairment and probable Alzheimer's dementia: A transcranial Doppler and PET/MRI study. J Cereb Blood Flow Metab 2023; 43:129-137. [PMID: 36314070 PMCID: PMC9875349 DOI: 10.1177/0271678x221124656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 12/12/2022]
Abstract
Cerebrovascular dysfunction has been suggested as a physiomarker of Alzheimer's disease (AD)-associated neuronal degeneration, but the underlying mechanisms are still debated. Herein cerebral vasomotor reactivity (VMR, breath-hold index: BHI), metabolic activity (lobar SUVs, FDG PET MRI), amyloid load (Centiloid score, Flutemetamol PET MRI), hemispheric cortical thickness, white matter lesion load and cerebral blood flow (ASL) were studied in 43 consecutive subjects (mean age: 64 years, female 13), diagnosed with subjective cognitive impairment (SCI, n = 10), amnestic mild cognitive impairment (aMCI, n = 15), and probable Alzheimer's dementia (AD, n = 18). BHI was significantly reduced in AD and aMCI patients compared to SCI subjects. A highly significant inverse correlation was found between BHI and the centiloid score (r = -0.648, p < 0.001). There was moderate positive correlation between BHI and frontal, temporal and parietal FDG SUV and ASL values, and a borderline negative correlation with age and white matter lesion volume. The link between amyloid burden and VMR was independent and strong in linear regression models where all these parameters were included (β from -0.580 to -0.476, p < 0.001). In conclusion, our study confirms the negative association of cerebral amyloid accumulation and vasomotor reactivity in Alzheimer's disease with the most direct data to date in humans.
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Affiliation(s)
- Esen Saka
- Faculty of Medicine, Department of Neurology, Hacettepe
University, Ankara, Turkey
| | - Lutfiye Ozlem Atay
- Faculty of Medicine, Department of Nuclear Medicine, Gazi
University, Ankara, Turkey
| | - Umit Ozgur Akdemir
- Faculty of Medicine, Department of Nuclear Medicine, Gazi
University, Ankara, Turkey
| | - Ezgi Yetim
- Faculty of Medicine, Department of Neurology, Hacettepe
University, Ankara, Turkey
| | - Erdem Balci
- Faculty of Medicine, Department of Nuclear Medicine, Gazi
University, Ankara, Turkey
| | - Ethem Murat Arsava
- Faculty of Medicine, Department of Neurology, Hacettepe
University, Ankara, Turkey
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Zimmerman B, Rypma B, Gratton G, Fabiani M. Age-related changes in cerebrovascular health and their effects on neural function and cognition: A comprehensive review. Psychophysiology 2021; 58:e13796. [PMID: 33728712 PMCID: PMC8244108 DOI: 10.1111/psyp.13796] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022]
Abstract
The process of aging includes changes in cellular biology that affect local interactions between cells and their environments and eventually propagate to systemic levels. In the brain, where neurons critically depend on an efficient and dynamic supply of oxygen and glucose, age-related changes in the complex interaction between the brain parenchyma and the cerebrovasculature have effects on health and functioning that negatively impact cognition and play a role in pathology. Thus, cerebrovascular health is considered one of the main mechanisms by which a healthy lifestyle, such as habitual cardiorespiratory exercise and a healthful diet, could lead to improved cognitive outcomes with aging. This review aims at detailing how the physiology of the cerebral vascular system changes with age and how these changes lead to differential trajectories of cognitive maintenance or decline. This provides a framework for generating specific mechanistic hypotheses about the efficacy of proposed interventions and lifestyle covariates that contribute to enhanced cognitive well-being. Finally, we discuss the methodological implications of age-related changes in the cerebral vasculature for human cognitive neuroscience research and propose directions for future experiments aimed at investigating age-related changes in the relationship between physiology and cognitive mechanisms.
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Affiliation(s)
- Benjamin Zimmerman
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Bart Rypma
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gabriele Gratton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Neuroscience Program, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Monica Fabiani
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Neuroscience Program, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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5
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Slowed Temporal and Parietal Cerebrovascular Response in Patients with Alzheimer's Disease. Can J Neurol Sci 2021; 47:366-373. [PMID: 32051047 DOI: 10.1017/cjn.2020.30] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recent investigations now suggest that cerebrovascular reactivity (CVR) is impaired in Alzheimer's disease (AD) and may underpin part of the disease's neurovascular component. However, our understanding of the relationship between the magnitude of CVR, the speed of cerebrovascular response, and the progression of AD is still limited. This is especially true in patients with mild cognitive impairment (MCI), which is recognized as an intermediate stage between normal aging and dementia. The purpose of this study was to investigate AD and MCI patients by mapping repeatable and accurate measures of cerebrovascular function, namely the magnitude and speed of cerebrovascular response (τ) to a vasoactive stimulus in key predilection sites for vascular dysfunction in AD. METHODS Thirty-three subjects (age range: 52-83 years, 20 males) were prospectively recruited. CVR and τ were assessed using blood oxygen level-dependent MRI during a standardized carbon dioxide stimulus. Temporal and parietal cortical regions of interest (ROIs) were generated from anatomical images using the FreeSurfer image analysis suite. RESULTS Of 33 subjects recruited, 3 individuals were excluded, leaving 30 subjects for analysis, consisting of 6 individuals with early AD, 11 individuals with MCI, and 13 older healthy controls (HCs). τ was found to be significantly higher in the AD group compared to the HC group in both the temporal (p = 0.03) and parietal cortex (p = 0.01) following a one-way ANCOVA correcting for age and microangiopathy scoring and a Bonferroni post-hoc correction. CONCLUSION The study findings suggest that AD is associated with a slowing of the cerebrovascular response in the temporal and parietal cortices.
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Siniscalchi A, Gray C, Malferrari G. Ultrasound Diagnostic Method in Vascular Dementia: Current Concepts. Curr Med Imaging 2021; 17:507-512. [PMID: 33032514 DOI: 10.2174/1573405616999201008145106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing interest in identifying cerebral hemodynamics alterations as a cause of possible onset or worsening of cognitive impairment in elderly patients with vascular risk factors. INTRODUCTION Intracranial ultrasound is a non-invasive, repeatable inexpensive method for recording variation of the cerebral vascular tree in physiological and pathological conditions and the diagnosis of vascular dementia (VaD). METHODS PubMed, Embase, Cochrane library and reference lists have been searched for articles published until March 30, 2020. RESULTS Clinical studies reported different Transcranial Doppler (TCD) parameters and subsequently transcranial duplex with color code (TCCD) in patients affected by vascular dementia. The number of studies using TCCD remains limited and most of the available data are still based on TCD. However, the use of transcranial Doppler could better stratify elderly patients with initial signs of cognitive impairment. CONCLUSION Intracranial ultrasound employment to detect cerebral hemodynamic changes in VaD patients has been briefly discussed in this review.
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Affiliation(s)
- Antonio Siniscalchi
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Cleona Gray
- Vascular and Endovascular Surgery Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Giovanni Malferrari
- Stroke Unit, Neurology Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
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Suri S, Bulte D, Chiesa ST, Ebmeier KP, Jezzard P, Rieger SW, Pitt JE, Griffanti L, Okell TW, Craig M, Chappell MA, Blockley NP, Kivimäki M, Singh-Manoux A, Khir AW, Hughes AD, Deanfield JE, Jensen DEA, Green SF, Sigutova V, Jansen MG, Zsoldos E, Mackay CE. Study Protocol: The Heart and Brain Study. Front Physiol 2021; 12:643725. [PMID: 33868011 PMCID: PMC8046163 DOI: 10.3389/fphys.2021.643725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It is well-established that what is good for the heart is good for the brain. Vascular factors such as hypertension, diabetes, and high cholesterol, and genetic factors such as the apolipoprotein E4 allele increase the risk of developing both cardiovascular disease and dementia. However, the mechanisms underlying the heart-brain association remain unclear. Recent evidence suggests that impairments in vascular phenotypes and cerebrovascular reactivity (CVR) may play an important role in cognitive decline. The Heart and Brain Study combines state-of-the-art vascular ultrasound, cerebrovascular magnetic resonance imaging (MRI) and cognitive testing in participants of the long-running Whitehall II Imaging cohort to examine these processes together. This paper describes the study protocol, data pre-processing and overarching objectives. METHODS AND DESIGN The 775 participants of the Whitehall II Imaging cohort, aged 65 years or older in 2019, have received clinical and vascular risk assessments at 5-year-intervals since 1985, as well as a 3T brain MRI scan and neuropsychological tests between 2012 and 2016 (Whitehall II Wave MRI-1). Approximately 25% of this cohort are selected for the Heart and Brain Study, which involves a single testing session at the University of Oxford (Wave MRI-2). Between 2019 and 2023, participants will undergo ultrasound scans of the ascending aorta and common carotid arteries, measures of central and peripheral blood pressure, and 3T MRI scans to measure CVR in response to 5% carbon dioxide in air, vessel-selective cerebral blood flow (CBF), and cerebrovascular lesions. The structural and diffusion MRI scans and neuropsychological battery conducted at Wave MRI-1 will also be repeated. Using this extensive life-course data, the Heart and Brain Study will examine how 30-year trajectories of vascular risk throughout midlife (40-70 years) affect vascular phenotypes, cerebrovascular health, longitudinal brain atrophy and cognitive decline at older ages. DISCUSSION The study will generate one of the most comprehensive datasets to examine the longitudinal determinants of the heart-brain association. It will evaluate novel physiological processes in order to describe the optimal window for managing vascular risk in order to delay cognitive decline. Ultimately, the Heart and Brain Study will inform strategies to identify at-risk individuals for targeted interventions to prevent or delay dementia.
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Affiliation(s)
- Sana Suri
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Daniel Bulte
- Oxford Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Scott T. Chiesa
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Klaus P. Ebmeier
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Peter Jezzard
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sebastian W. Rieger
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jemma E. Pitt
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Ludovica Griffanti
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Thomas W. Okell
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Martin Craig
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Michael A. Chappell
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | | | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Ashraf W. Khir
- Mechanical Engineering, Brunel University London, Uxbridge, United Kingdom
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - John E. Deanfield
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Daria E. A. Jensen
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Sebastian F. Green
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Veronika Sigutova
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Michelle G. Jansen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Enikő Zsoldos
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Clare E. Mackay
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bonilauri A, Sangiuliano Intra F, Pugnetti L, Baselli G, Baglio F. A Systematic Review of Cerebral Functional Near-Infrared Spectroscopy in Chronic Neurological Diseases-Actual Applications and Future Perspectives. Diagnostics (Basel) 2020; 10:E581. [PMID: 32806516 PMCID: PMC7459924 DOI: 10.3390/diagnostics10080581] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The management of people affected by age-related neurological disorders requires the adoption of targeted and cost-effective interventions to cope with chronicity. Therapy adaptation and rehabilitation represent major targets requiring long-term follow-up of neurodegeneration or, conversely, the promotion of neuroplasticity mechanisms. However, affordable and reliable neurophysiological correlates of cerebral activity to be used throughout treatment stages are often lacking. The aim of this systematic review is to highlight actual applications of functional Near-Infrared Spectroscopy (fNIRS) as a versatile optical neuroimaging technology for investigating cortical hemodynamic activity in the most common chronic neurological conditions. METHODS We reviewed studies investigating fNIRS applications in Parkinson's Disease (PD), Alzheimer's Disease (AD) and Mild Cognitive Impairment (MCI) as those focusing on motor and cognitive impairment in ageing and Multiple Sclerosis (MS) as the most common chronic neurological disease in young adults. The literature search was conducted on NCBI PubMed and Web of Science databases by PRISMA guidelines. RESULTS We identified a total of 63 peer-reviewed articles. The AD spectrum is the most investigated pathology with 40 articles ranging from the traditional monitoring of tissue oxygenation to the analysis of functional resting-state conditions or cognitive functions by means of memory and verbal fluency tasks. Conversely, applications in PD (12 articles) and MS (11 articles) are mainly focused on the characterization of motor functions and their association with dual-task conditions. The most investigated cortical area is the prefrontal cortex, since reported to play an important role in age-related compensatory mechanism and neurofunctional changes associated to these chronic neurological conditions. Interestingly, only 9 articles applied a longitudinal approach. CONCLUSION The results indicate that fNIRS is mainly employed for the cross-sectional characterization of the clinical phenotypes of these pathologies, whereas data on its utility for longitudinal monitoring as surrogate biomarkers of disease progression and rehabilitation effects are promising but still lacking.
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Affiliation(s)
- Augusto Bonilauri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (A.B.); (G.B.)
| | - Francesca Sangiuliano Intra
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy; (L.P.); (F.B.)
- Faculty of Education, Free University of Bozen-Bolzano, 39100 Bolzano, Italy
| | - Luigi Pugnetti
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy; (L.P.); (F.B.)
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (A.B.); (G.B.)
| | - Francesca Baglio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy; (L.P.); (F.B.)
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Switzer AR, Cheema I, McCreary CR, Zwiers A, Charlton A, Alvarez-Veronesi A, Sekhon R, Zerna C, Stafford RB, Frayne R, Goodyear BG, Smith EE. Cerebrovascular reactivity in cerebral amyloid angiopathy, Alzheimer disease, and mild cognitive impairment. Neurology 2020; 95:e1333-e1340. [PMID: 32641520 DOI: 10.1212/wnl.0000000000010201] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 03/16/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To assess cerebrovascular reactivity in response to a visual task in participants with cerebral amyloid angiopathy (CAA), Alzheimer disease (AD), and mild cognitive impairment (MCI) using fMRI. METHODS This prospective cohort study included 40 patients with CAA, 22 with AD, 27 with MCI, and 25 healthy controls. Each participant underwent a visual fMRI task using a contrast-reversing checkerboard stimulus. Visual evoked potentials (VEPs) were used to compare visual cortex neuronal activity in 83 participants. General linear models using least-squares means, adjusted for multiple comparisons with the Tukey test, were used to estimate mean blood oxygen level-dependent (BOLD) signal change during the task and VEP differences between groups. RESULTS After adjustment for age and hypertension, estimated mean BOLD response amplitude was as follows: CAA 1.88% (95% confidence interval [CI] 1.60%-2.15%), AD 2.26% (1.91%-2.61%), MCI 2.15% (1.84%-2.46%), and control 2.65% (2.29%-3.00%). Only patients with CAA differed from controls (p = 0.01). In the subset with VEPs, group was not associated with prolonged latencies or lower amplitudes. Lower BOLD amplitude response was associated with higher white matter hyperintensity (WMH) volumes in CAA (for each 0.1% lower BOLD response amplitude, the WMH volume was 9.2% higher, 95% CI 6.0%-12.4%) but not other groups (p = 0.002 for interaction) when controlling for age and hypertension. CONCLUSIONS Mean visual BOLD response amplitude was lowest in participants with CAA compared to controls, without differences in VEP latencies and amplitudes. This suggests that the impaired visual BOLD response is due to reduced vascular reactivity in CAA. In contrast to participants with CAA, the visual BOLD response amplitude did not differ between those with AD or MCI and controls.
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Affiliation(s)
- Aaron R Switzer
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Ikreet Cheema
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Cheryl R McCreary
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Angela Zwiers
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Anna Charlton
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Ana Alvarez-Veronesi
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Ramnik Sekhon
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Charlotte Zerna
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Randall B Stafford
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Richard Frayne
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Eric E Smith
- From the Department of Clinical Neurosciences (A.R.S., C.R.M., A.Z., A.C., A.A.-V., R.S., C.Z., R.B.S., R.F., B.G.G., E.E.S), Hotchkiss Brain Institute (R.F., B.G.G., E.E.S), Department of Community Health Sciences (C.Z., E.E.S), and Department of Radiology (R.F., B.G.G., E.E.S), University of Calgary, Alberta; Faculty of Medicine (I.C.), University of Toronto, Ontario; and Seaman Family MR Research Centre (C.R.M., R.F., B.G.G.), Foothills Medical Centre, Calgary, Alberta, Canada
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11
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Moretti R, Caruso P. Small Vessel Disease-Related Dementia: An Invalid Neurovascular Coupling? Int J Mol Sci 2020; 21:E1095. [PMID: 32046035 PMCID: PMC7036993 DOI: 10.3390/ijms21031095] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
The arteriosclerosis-dependent alteration of brain perfusion is one of the major determinants in small vessel disease, since small vessels have a pivotal role in the brain's autoregulation. Nevertheless, as far as we know, endothelium distress can potentiate the flow dysregulation and lead to subcortical vascular dementia that is related to small vessel disease (SVD), also being defined as subcortical vascular dementia (sVAD), as well as microglia activation, chronic hypoxia and hypoperfusion, vessel-tone dysregulation, altered astrocytes, and pericytes functioning blood-brain barrier disruption. The molecular basis of this pathology remains controversial. The apparent consequence (or a first event, too) is the macroscopic alteration of the neurovascular coupling. Here, we examined the possible mechanisms that lead a healthy aging process towards subcortical dementia. We remarked that SVD and white matter abnormalities related to age could be accelerated and potentiated by different vascular risk factors. Vascular function changes can be heavily influenced by genetic and epigenetic factors, which are, to the best of our knowledge, mostly unknown. Metabolic demands, active neurovascular coupling, correct glymphatic process, and adequate oxidative and inflammatory responses could be bulwarks in defense of the correct aging process; their impairments lead to a potentially catastrophic and non-reversible condition.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy;
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12
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Moretti R, Peinkhofer C. B Vitamins and Fatty Acids: What Do They Share with Small Vessel Disease-Related Dementia? Int J Mol Sci 2019; 20:E5797. [PMID: 31752183 PMCID: PMC6888477 DOI: 10.3390/ijms20225797] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/21/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
Many studies have been written on vitamin supplementation, fatty acid, and dementia, but results are still under debate, and no definite conclusion has yet been drawn. Nevertheless, a significant amount of lab evidence confirms that vitamins of the B group are tightly related to gene control for endothelium protection, act as antioxidants, play a co-enzymatic role in the most critical biochemical reactions inside the brain, and cooperate with many other elements, such as choline, for the synthesis of polyunsaturated phosphatidylcholine, through S-adenosyl-methionine (SAM) methyl donation. B-vitamins have anti-inflammatory properties and act in protective roles against neurodegenerative mechanisms, for example, through modulation of the glutamate currents and a reduction of the calcium currents. In addition, they also have extraordinary antioxidant properties. However, laboratory data are far from clinical practice. Many studies have tried to apply these results in everyday clinical activity, but results have been discouraging and far from a possible resolution of the associated mysteries, like those represented by Alzheimer's disease (AD) or small vessel disease dementia. Above all, two significant problems emerge from the research: No consensus exists on general diagnostic criteria-MCI or AD? Which diagnostic criteria should be applied for small vessel disease-related dementia? In addition, no general schema exists for determining a possible correct time of implementation to have effective results. Here we present an up-to-date review of the literature on such topics, shedding some light on the possible interaction of vitamins and phosphatidylcholine, and their role in brain metabolism and catabolism. Further studies should take into account all of these questions, with well-designed and world-homogeneous trials.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy;
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13
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Caruso P, Signori R, Moretti R. Small vessel disease to subcortical dementia: a dynamic model, which interfaces aging, cholinergic dysregulation and the neurovascular unit. Vasc Health Risk Manag 2019; 15:259-281. [PMID: 31496716 PMCID: PMC6689673 DOI: 10.2147/vhrm.s190470] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background Small vessels have the pivotal role for the brain’s autoregulation. The arteriosclerosis-dependent alteration of the brain perfusion is one of the major determinants in small vessel disease. Endothelium distress can potentiate the flow dysregulation and lead to subcortical vascular dementia (sVAD). sVAD increases morbidity and disability. Epidemiological studies have shown that sVAD shares with cerebrovascular disease most of the common risk factors. The molecular basis of this pathology remains controversial. Purpose To detect the possible mechanisms between small vessel disease and sVAD, giving a broad vision on the topic, including pathological aspects, clinical and laboratory findings, metabolic process and cholinergic dysfunction. Methods We searched MEDLINE using different search terms (“vascular dementia”, “subcortical vascular dementia”, “small vessel disease”, “cholinergic afferents”, etc). Publications were selected from the past 20 years. Searches were extended to Embase, Cochrane Library, and LILIACS databases. All searches were done from January 1, 1998 up to January 31, 2018. Results A total of 560 studies showed up, and appropriate studies were included. Associations between traditional vascular risk factors have been isolated. We remarked that SVD and white matter abnormalities are seen frequently with aging and also that vascular and endothelium changes are related with age; the changes can be accelerated by different vascular risk factors. Vascular function changes can be heavily influenced by genetic and epigenetic factors. Conclusion Small vessel disease and the related dementia are two pathologies that deserve attention for their relevance and impact in clinical practice. Hypertension might be a historical problem for SVD and SVAD, but low pressure might be even more dangerous; CBF regional selective decrease seems to be a critical factor for small vessel disease-related dementia. In those patients, endothelium damage is a super-imposed condition. Several issues are still debatable, and more research is needed.
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Affiliation(s)
- Paola Caruso
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
| | - Riccardo Signori
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
| | - Rita Moretti
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
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14
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Hoiland RL, Fisher JA, Ainslie PN. Regulation of the Cerebral Circulation by Arterial Carbon Dioxide. Compr Physiol 2019; 9:1101-1154. [DOI: 10.1002/cphy.c180021] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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15
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Iwamoto E, Bock JM, Casey DP. Hypercapnia-induced shear-mediated dilation in the internal carotid artery is blunted in healthy older adults. Am J Physiol Heart Circ Physiol 2018; 315:H1279-H1286. [DOI: 10.1152/ajpheart.00335.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study aimed to elucidate the effect of aging on shear-mediated dilation of the common and internal carotid arteries (CCA and ICA, respectively). Hypercapnia-induced shear-mediated dilation in the CCA and ICA were assessed in 10 young (5 women and 5 men, 23 ± 1 yr) and 10 older (6 women/4 men, 68 ± 1 yr) healthy adults. Shear-mediated dilation was induced by two levels of hypercapnia (target end-tidal Pco2, +5 and +10 mmHg from individual baseline values) and was calculated as the percent rise in peak diameter from baseline diameter. There were no differences in shear-mediated dilation between young and older adults in either artery under lower levels of hypercapnia (CCA: 2.8 ± 0.6 vs. 2.0 ± 0.3%, P = 0.35; ICA: 4.6 ± 0.8 vs 3.6 ± 0.4%, P = 0.37). However, shear-mediated dilation in response to higher levels of hypercapnia was attenuated in older compared with young adults in the ICA (4.5 ± 0.5 vs. 7.9 ± 1.2%, P < 0.01) but not in the CCA (3.7 ± 0.6 vs. 4.5 ± 0.8%, P = 0.35). Shear-mediated dilation was significantly correlated to the percent change in shear rate in the ICA (young: r = 0.55, P = 0.01; older: r = 0.49, P = 0.03) but not in the CCA in either young or older adults (young: r = −0.30, P = 0.90; older: r = 0.16, P = 0.50). These data indicate that aging attenuates shear-mediated dilation of the ICA in response to higher levels of hypercapnia, and shear rate is an important stimulus for hypercapnic vasodilation of the ICA in both young and older adults. The present results may provide insights into age-related changes in the regulation of cerebral circulation in healthy adults. NEW & NOTEWORTHY We explored the effect of aging on shear-mediated dilation in the common and internal carotid arteries (CCA and ICA, respectively) in healthy adults. Our findings suggest that 1) aging attenuates shear-mediated dilation of the ICA but not the CCA and 2) shear rate is an important stimulus for hypercapnic vasodilation of the ICA in young and older adults. These findings may provide insights into the age-related changes in cerebrovascular regulation of healthy adults.
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Affiliation(s)
- Erika Iwamoto
- Human Integrative and Cardiovascular Physiology Laboratory, Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Joshua M. Bock
- Human Integrative and Cardiovascular Physiology Laboratory, Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Darren P. Casey
- Human Integrative and Cardiovascular Physiology Laboratory, Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Fraternal Order of Eagles Diabetes Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Isik AT, Soysal P, Stubbs B, Solmi M, Basso C, Maggi S, Schofield P, Veronese N, Mueller C. Cardiovascular Outcomes of Cholinesterase Inhibitors in Individuals with Dementia: A Meta-Analysis and Systematic Review. J Am Geriatr Soc 2018; 66:1805-1811. [DOI: 10.1111/jgs.15415] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine; Dokuz Eylul University; Izmir Turkey
| | - Pinar Soysal
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine; Dokuz Eylul University; Izmir Turkey
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology, and Neuroscience; King's College London; London United Kingdom
- South London and Maudsley National Health Service Foundation Trust; London United Kingdom
- Health, Social Care, and Education; Anglia Ruskin University; Chelmsford United Kingdom
| | - Marco Solmi
- Department of Neurosciences; University of Padova; Padova Italy
| | - Cristina Basso
- Azienda Unità Locale Socio Sanitaria 3; “Serenissima”; Mirano Italy
| | - Stefania Maggi
- National Research Council; Neuroscience Institute, Aging Branch; Padova Italy
| | - Patricia Schofield
- Health, Social Care, and Education; Anglia Ruskin University; Chelmsford United Kingdom
| | - Nicola Veronese
- Azienda Unità Locale Socio Sanitaria 3; “Serenissima”; Mirano Italy
- National Research Council; Neuroscience Institute, Aging Branch; Padova Italy
| | - Christoph Mueller
- Institute of Psychiatry, Psychology, and Neuroscience; King's College London; London United Kingdom
- South London and Maudsley National Health Service Foundation Trust; London United Kingdom
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Urbanova BS, Schwabova JP, Magerova H, Jansky P, Markova H, Vyhnalek M, Laczo J, Hort J, Tomek A. Reduced Cerebrovascular Reserve Capacity as a Biomarker of Microangiopathy in Alzheimer’s Disease and Mild Cognitive Impairment. J Alzheimers Dis 2018; 63:465-477. [DOI: 10.3233/jad-170815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Barbora Soukupova Urbanova
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Jaroslava Paulasova Schwabova
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Hana Magerova
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Petr Jansky
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Hana Markova
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Martin Vyhnalek
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Jan Laczo
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Jakub Hort
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Ales Tomek
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
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18
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Chimagomedova AS, Vasenina EE, Levin OS. [Diagnostic of prodromal dementia with Levy bodies]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:23-32. [PMID: 28980609 DOI: 10.17116/jnevro20171176223-32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The issues of diagnosis of prodromal dementia with Lewy bodies are considered. Despite numerous studies using international diagnostic criteria, clinical and diagnosis are often inconsistent. Early and more accurate detection of dementia with Lewy bodies is needed for prognosis, optimal management and effective pharmacotherapy.
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Affiliation(s)
- A Sh Chimagomedova
- Russian Medical Academy of Continued Professional Education, Moscow, Russia
| | - E E Vasenina
- Russian Medical Academy of Continued Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continued Professional Education, Moscow, Russia
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Polyakova TA, Arablinsky AV. [Neuroimaging and molecular biomarkers of dementia]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:16-22. [PMID: 28980608 DOI: 10.17116/jnevro20171176216-22] [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: 11/17/2022]
Abstract
Development of laboratory diagnosis and neuroimaging revealed a number of biomarkers for in vivo diagnosis of the most common forms of dementia (Alzheimer's disease, Lewy body dementia and vascular dementia). Currently, the highest diagnostic sensitivity and specificity of molecular biomarkers in the cerebrospinal fluid are detected for Alzheimer's disease. At the same time, the changes according to the magnetic resonance imaging are more prognostically significant for future cognitive decline than cerebrospinal fluid biomarkers. Cerebral microbleeds are an available adjuvant diagnostic marker, which increases the diagnostic value of leukoaraiosis that suggests the development of cerebral amyloid angiopathy or hypertensive microangiopathy, especially in cases of mixed pathology and severe cognitive deficits.
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Affiliation(s)
- T A Polyakova
- Russian Medical Academy for Continued Professional Education, Moscow, Russia
| | - A V Arablinsky
- Sechenov First Moscow Medical University, Moscow, Russia
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Fukui Y, Hishikawa N, Ichinose J, Sato K, Nakano Y, Morihara R, Ohta Y, Yamashita T, Abe K. Different clinical effect of four antidementia drugs for Alzheimer's disease patients depending on white matter severity. Geriatr Gerontol Int 2017; 17:1991-1999. [PMID: 28276131 DOI: 10.1111/ggi.13007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/28/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
Abstract
AIM To examine the clinical effect of four antidementia drugs (donepezil, galantamine, rivastigmine and memantine) in Alzheimer's disease patients who were divided into subgroups based on their periventricular hyperintensity (PVH) severity. METHODS A total of 551 Alzheimer's disease patients (201 men and 350 women) were divided into four subgroups based on their PVH severity (0-III). They received monotherapy for 12 months. We compared the clinical effects at the baseline, and at 3, 6 and 12 months after initiation. RESULTS The baseline age became higher with PVH grades, and the Mini-Mental State Examination and Hasegawa Dementia Scale-Revised showed a decrease that was dependent on white matter severity. Although the PVH 0 subgroup showed stable cognitive, affective and ADL functions until 12 months in all four drug groups, the PVH I subgroup showed an improved Apathy Scale from the baseline in response to memantine at 3 and 9 months (P < 0.05), and galantamine at 9 months (P < 0.01). In the PVH II subgroup, the Mini-Mental State Examination showed a significant improvement from the baseline in response to galantamine (P < 0.05) at 9 months and Hasegawa Dementia Scale-Revised (P < 0.05) at 3 months. In the PVH III subgroup, cognitive and affective functions were preserved in all four drug groups until 12 months, but activities of daily living deteriorated in the riverstigmine group at 6 and 12 months (P < 0.05). CONCLUSIONS The present study shows that these four drugs showed sensitivity dependent on white matter severity that clinically affected cognitive, affective and activities of daily living functions. Geriatr Gerontol Int 2017; 17: 1991-1999.
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Affiliation(s)
- Yusuke Fukui
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Nozomi Hishikawa
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jin Ichinose
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kota Sato
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yumiko Nakano
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Ryuta Morihara
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yasuyuki Ohta
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toru Yamashita
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Koji Abe
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Hishikawa N, Fukui Y, Sato K, Ohta Y, Yamashita T, Abe K. Comprehensive effects of galantamine and cilostazol combination therapy on patients with Alzheimer's disease with asymptomatic lacunar infarction. Geriatr Gerontol Int 2016; 17:1384-1391. [PMID: 27578455 DOI: 10.1111/ggi.12870] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/31/2016] [Accepted: 06/19/2016] [Indexed: 11/30/2022]
Abstract
AIM The coexistence of Alzheimer's disease (AD) and cerebrovascular disease pathology increases age-dependently. We comprehensively analyzed the clinical effects of galantamine or cilostazol monotherapy to the add-on combination therapy on three major factors of dementia, such as cognitive, affective and activities of daily living functions in AD patients with asymptomatic lacunar infarction. METHODS We divided 101 AD patients with asymptomatic lacunar infarction into two subgroups: group A (n = 61, first treated with galantamine and then cilostazol added) and group B (n = 40, first treated with cilostazol and galantamine added). We compared the clinical effects before and after combination therapy of galantamine and cilostazol (i.e. 3 months [M] before (-3 M), baseline (0 M), 3 and 6 M after the add-on combination). RESULTS Galantamine monotherapy increased cognitive Hasegawa dementia score-revised scores, which were further improved with add-on cilostazol. Cilostazol monotherapy also increased the cognitive tests, which were further improved with add-on galantamine. Add-on cilostazol significantly improved Geriatric Depression Scale and Abe's behavioral and psychological symptoms of dementia scores after galantamine monotherapy. Cilostazol monotherapy also significantly improved Geriatric Depression Scale scores, with further improvements in Geriatric Depression Scale, apathy scores and Abe's behavioral and psychological symptoms of dementia scores by add-on galantamine. Activities of daily living scores continuously improved with galantamine monotherapy and add-on cilostazol. CONCLUSIONS The present study provides a clinical possibility that galantamine or cilostazol monotherapy and the combination therapy maintained or even improved cognitive, affective, and activities of daily living functions in AD with asymptomatic lacunar infarction. Geriatr Gerontol Int 2017; 17: 1384-1391.
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Affiliation(s)
- Nozomi Hishikawa
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yusuke Fukui
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kota Sato
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuyuki Ohta
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Yamashita
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Abe
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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22
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Smoliński Ł, Członkowska A. Cerebral vasomotor reactivity in neurodegenerative diseases. Neurol Neurochir Pol 2016; 50:455-462. [PMID: 27553189 DOI: 10.1016/j.pjnns.2016.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022]
Abstract
Small-caliber cerebral vessels change their diameters in response to alterations of key metabolite concentrations such as carbon dioxide or oxygen. This phenomenon, termed the cerebral vasomotor reactivity (CVMR), is the basis for blood flow regulation in the brain in accordance with its metabolic status. Typically, CVMR is determined as the amount of change in cerebral blood flow in response to a vasodilating stimulus, which can be measured by various neuroimaging methods or by transcranial Doppler. It has been shown that CVMR is impaired in cerebrovascular diseases, but there is also evidence of a similar dysfunction in neurodegenerative disorders. Here, we review studies that have investigated CVMR in the common neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease and multiple sclerosis. Moreover, we discuss potential neurodegenerative mechanisms responsible for the impairment of CVMR.
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Affiliation(s)
- Łukasz Smoliński
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland.
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23
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Di Marco LY, Farkas E, Martin C, Venneri A, Frangi AF. Is Vasomotion in Cerebral Arteries Impaired in Alzheimer's Disease? J Alzheimers Dis 2016; 46:35-53. [PMID: 25720414 PMCID: PMC4878307 DOI: 10.3233/jad-142976] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A substantial body of evidence supports the hypothesis of a vascular component in the pathogenesis of Alzheimer’s disease (AD). Cerebral hypoperfusion and blood-brain barrier dysfunction have been indicated as key elements of this pathway. Cerebral amyloid angiopathy (CAA) is a cerebrovascular disorder, frequent in AD, characterized by the accumulation of amyloid-β (Aβ) peptide in cerebral blood vessel walls. CAA is associated with loss of vascular integrity, resulting in impaired regulation of cerebral circulation, and increased susceptibility to cerebral ischemia, microhemorrhages, and white matter damage. Vasomotion— the spontaneous rhythmic modulation of arterial diameter, typically observed in arteries/arterioles in various vascular beds including the brain— is thought to participate in tissue perfusion and oxygen delivery regulation. Vasomotion is impaired in adverse conditions such as hypoperfusion and hypoxia. The perivascular and glymphatic pathways of Aβ clearance are thought to be driven by the systolic pulse. Vasomotion produces diameter changes of comparable amplitude, however at lower rates, and could contribute to these mechanisms of Aβ clearance. In spite of potential clinical interest, studies addressing cerebral vasomotion in the context of AD/CAA are limited. This study reviews the current literature on vasomotion, and hypothesizes potential paths implicating impaired cerebral vasomotion in AD/CAA. Aβ and oxidative stress cause vascular tone dysregulation through direct effects on vascular cells, and indirect effects mediated by impaired neurovascular coupling. Vascular tone dysregulation is further aggravated by cholinergic deficit and results in depressed cerebrovascular reactivity and (possibly) impaired vasomotion, aggravating regional hypoperfusion and promoting further Aβ and oxidative stress accumulation.
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Affiliation(s)
- Luigi Yuri Di Marco
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - Eszter Farkas
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Chris Martin
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, UK.,IRCCS, Fondazione Ospedale S. Camillo, Venice, Italy
| | - Alejandro F Frangi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
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24
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Brothers RM, Zhang R. CrossTalk opposing view: The middle cerebral artery diameter does not change during alterations in arterial blood gases and blood pressure. J Physiol 2016; 594:4077-9. [PMID: 27010011 DOI: 10.1113/jp271884] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/12/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- R Matthew Brothers
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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25
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Choi WJ, Lee K, Kim YK, Song KJ, Jeong SM, Hwang GS. Vagolytic atropine attenuates cerebral vasodilation response during acute orthostatic hypotension. Korean J Anesthesiol 2015; 68:594-602. [PMID: 26634084 PMCID: PMC4667146 DOI: 10.4097/kjae.2015.68.6.594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/29/2015] [Accepted: 06/05/2015] [Indexed: 12/02/2022] Open
Abstract
Background Atropine is an anticholinergic drug which is commonly used in clinical practice. The effect of parasympathetic block with atropine on dynamic cerebrovascular regulation remains unclear. This study was aimed to identify effects of vagolytic atropine on cerebrovascular response during acute orthostatic hypotension in humans. Methods Continuous middle cerebral blood flow velocity (CBFV, transcranial Doppler) and arterial blood pressure (ABP, Finometer) were measured during a sit-to-stand procedure in 10 healthy subjects with placebo and vagolytic (10 µg/kg) doses of atropine. Cerebral vascular tone was assessed by cerebrovascular resistance (CVR = ABP / CBFV). Dynamic cerebral autoregulation was also assessed by transfer function analysis of ABP and CBFV. Results During the standing session, ABP fell to a similar extent in both groups by an average of 23 to 25 mmHg (26% to 29%). CBFV also fell in all subjects but significantly more in vagolytic atropine (-15.0 ± 7.0 cm/s) compared with placebo (-12.0 ± 5.8 cm/s, P < 0.05). CVR was decreased significantly in the placebo group during posture change (1.56 ± 0.44 vs. 1.38 ± 0.38, P < 0.05), in contrast, lesser decreased in the atropine group (1.60 ± 0.50 vs. 1.53 ± 0.42, P = 0.193). Transfer function coherence in the very-low-frequency range was significantly increased in the atropine group during the standing session (0.55 ± 0.14), compared with the sitting session (0.45 ± 0.14, P = 0.006). Conclusions These data present that vagolytic atropine attenuates cerebral vasodilation response to acute orthostatic hypotension, suggesting the use of atropine may need care in patients with cerebrovascular disease with vagal impairment.
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Affiliation(s)
- Woo-Jong Choi
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kichang Lee
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, MA, USA
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyo-Joon Song
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
| | - Sung-Moon Jeong
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyu-Sam Hwang
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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26
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Sadigh-Eteghad S, Mahmoudi J, Babri S, Talebi M. Effect of alpha-7 nicotinic acetylcholine receptor activation on beta-amyloid induced recognition memory impairment. Possible role of neurovascular function. Acta Cir Bras 2015; 30:736-42. [DOI: 10.1590/s0102-865020150110000003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/05/2015] [Indexed: 11/22/2022] Open
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27
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Hurr C, Harrison ML, Brothers RM. Acute flavanol consumption improves the cerebral vasodilatory capacity in college-aged African Americans. Exp Physiol 2015; 100:1030-8. [DOI: 10.1113/ep085269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/16/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Chansol Hurr
- Environmental and Autonomic Physiology Laboratory, Department of Kinesiology and Health Education; The University of Texas at Austin; Austin TX USA
| | - Michelle L. Harrison
- Environmental and Autonomic Physiology Laboratory, Department of Kinesiology and Health Education; The University of Texas at Austin; Austin TX USA
| | - R. Matthew Brothers
- Environmental and Autonomic Physiology Laboratory, Department of Kinesiology and Health Education; The University of Texas at Austin; Austin TX USA
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28
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Brickman AM, Guzman VA, Gonzalez-Castellon M, Razlighi Q, Gu Y, Narkhede A, Janicki S, Ichise M, Stern Y, Manly JJ, Schupf N, Marshall RS. Cerebral autoregulation, beta amyloid, and white matter hyperintensities are interrelated. Neurosci Lett 2015; 592:54-8. [PMID: 25748319 PMCID: PMC4430835 DOI: 10.1016/j.neulet.2015.03.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 12/12/2022]
Abstract
Emerging studies link vascular risk factors and cerebrovascular health to the prevalence and rates of progression in Alzheimer's disease (AD). The brain's ability to maintain constant blood flow across a range of cerebral perfusion pressures, or autoregulation, may both promote and result from small vessel cerebrovascular disease and AD-related amyloid pathology. Here, we examined the relationship among cerebral autoregulation, small vessel cerebrovascular disease, and amyloid deposition in 14 non-demented older adults. Reduced cerebral autoregulation, was associated with increased amyloid deposition and increased white matter hyperintensity volume, which, in turn were positively associated with each other. For the first time in humans, we demonstrate an interrelationship among AD pathology, small vessel cerebrovascular disease, and cerebral autoregulation. Vascular factors and AD pathology are not independent but rather appear to interact.
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Affiliation(s)
- Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA.
| | - Vanessa A Guzman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA
| | | | - Qolamreza Razlighi
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Yian Gu
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Atul Narkhede
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA
| | - Sarah Janicki
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Masanori Ichise
- Department of Radiology, College of Physicians and Surgeons, Columbia University, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA
| | - Randolph S Marshall
- Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
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29
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Wells JA, Holmes HE, O'Callaghan JM, Colgan N, Ismail O, Fisher EM, Siow B, Murray TK, Schwarz AJ, O'Neill MJ, Collins EC, Lythgoe MF. Increased cerebral vascular reactivity in the tau expressing rTg4510 mouse: evidence against the role of tau pathology to impair vascular health in Alzheimer's disease. J Cereb Blood Flow Metab 2015; 35:359-62. [PMID: 25515210 PMCID: PMC4348392 DOI: 10.1038/jcbfm.2014.224] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/12/2014] [Accepted: 11/16/2014] [Indexed: 02/03/2023]
Abstract
Vascular abnormalities are a key feature of Alzheimer's disease (AD). Imaging of cerebral vascular reactivity (CVR) is a powerful tool to investigate vascular health in clinical populations although the cause of reduced CVR in AD patients is not fully understood. We investigated the specific role of tau pathology in CVR derangement in AD using the rTg4510 mouse model. We observed an increase in CVR in cortical regions with tau pathology. These data suggest that tau pathology alone does not produce the clinically observed decreases in CVR and implicates amyloid pathology as the dominant etiology of impaired CVR in AD patients.
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Affiliation(s)
- Jack A Wells
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Holly E Holmes
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - James M O'Callaghan
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Niall Colgan
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Ozama Ismail
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Elizabeth Mc Fisher
- Department of Neurodegenerative Disease, Institute of Neurology, UCL, London, UK
| | - Bernard Siow
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | | | - Adam J Schwarz
- Tailored Therapeutics, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | | | - Emily C Collins
- Tailored Therapeutics, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - Mark F Lythgoe
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
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30
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Urbanova B, Tomek A, Mikulik R, Magerova H, Horinek D, Hort J. Neurosonological Examination: A Non-Invasive Approach for the Detection of Cerebrovascular Impairment in AD. Front Behav Neurosci 2014; 8:4. [PMID: 24478651 PMCID: PMC3896883 DOI: 10.3389/fnbeh.2014.00004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/03/2014] [Indexed: 12/27/2022] Open
Abstract
There has been a growing interest in vascular impairment associated with Alzheimer’s disease (AD). This interest was stimulated by the findings of higher incidence of vascular risk factors in AD. Signs of vascular impairment were investigated notably in the field of imaging methods. Our aim was to explore ultrasonographic studies of extra- and intracranial vessels in patients with AD and mild cognitive impairment (MCI) and define implications for diagnosis, treatment, and prevention of the disease. The most frequently studied parameters with extracranial ultrasound are intima-media thickness in common carotid artery, carotid atherosclerosis, and total cerebral blood flow. The transcranial ultrasound concentrates mostly on flow velocities, pulsatility indices, cerebrovascular reserve capacity, and cerebral microembolization. Studies suggest that there is morphological and functional impairment of cerebral circulation in AD compared to healthy subjects. Ultrasound as a non-invasive method could be potentially useful in identifying individuals in a higher risk of progression of cognitive decline.
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Affiliation(s)
- Barbora Urbanova
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University , Prague , Czech Republic
| | - Ales Tomek
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University , Prague , Czech Republic
| | - Robert Mikulik
- Department of Neurology, International Clinical Research Center, St. Anne's University Hospital , Brno , Czech Republic
| | - Hana Magerova
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University , Prague , Czech Republic
| | - Daniel Horinek
- Department of Neurosurgery, 1st Faculty of Medicine, Central Military Hospital, Charles University , Prague , Czech Republic ; International Clinical Research Center, St. Anne's University Hospital , Brno , Czech Republic
| | - Jakub Hort
- Department of Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University , Prague , Czech Republic ; International Clinical Research Center, St. Anne's University Hospital , Brno , Czech Republic
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31
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Glodzik L, Randall C, Rusinek H, de Leon MJ. Cerebrovascular reactivity to carbon dioxide in Alzheimer's disease. J Alzheimers Dis 2013; 35:427-40. [PMID: 23478306 DOI: 10.3233/jad-122011] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is growing evidence that cerebrovascular reactivity to carbon dioxide (CVRCO2) is impaired in Alzheimer's disease (AD). Preclinical and animal studies suggest chronic hypercontractility in brain vessels in AD. We review (a) preclinical studies of mechanisms for impaired CVRCO2 in AD; (b) clinical studies of cerebrovascular function in subjects with AD dementia, mild cognitive impairment (MCI), and normal cognition. Although results of clinical studies are inconclusive, an increasing number of reports reveal an impairment of vascular reactivity to carbon dioxide in subjects with AD, and possibly also in MCI. Thus, CVRCO2 may be an attractive means to detect an early vascular dysfunction in subjects at risk.
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Affiliation(s)
- Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
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32
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Jahn S, Seiwert B, Kretzing S, Abraham G, Regenthal R, Karst U. Metabolic studies of the Amaryllidaceous alkaloids galantamine and lycorine based on electrochemical simulation in addition to in vivo and in vitro models. Anal Chim Acta 2012. [DOI: 10.1016/j.aca.2012.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grinberg LT, Korczyn AD, Heinsen H. Cerebral amyloid angiopathy impact on endothelium. Exp Gerontol 2012; 47:838-42. [PMID: 22944481 DOI: 10.1016/j.exger.2012.08.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 08/18/2012] [Accepted: 08/20/2012] [Indexed: 12/30/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is an age-associated disease characterized by amyloid deposition in cerebral and meningeal vessel walls. CAA is detected in the majority of the individuals with dementia and also in a large number of non-demented elderly individuals. In addition, CAA is strongly associated with Alzheimer's disease (AD) pathology. Mechanical consequences including intra-cerebral or subarachnoid hemorrhage remains CAA most feared complication, but only a small fraction of CAA results in severe bleeding. On the hand the non-mechanical consequences in cerebrovascular regulation are prevalent and may be even more deleterious. Studies of animal models have provided strong evidence linking the vasoactive Aβ 1-40, the main species found in CAA, to disturbances in endothelial-dependent factors, disrupting cerebrovascular regulation Here, we aimed to review experimental findings regarding the non-mechanical consequences of CAA for cerebrovascular regulation and discuss the implications of these results to clinical practice.
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Affiliation(s)
- Lea Tenenholz Grinberg
- Department of Neurology, University of California San Francisco, 305 Parnassus Avenue, San Francisco, CA 94143, USA
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34
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Wennström M, Nielsen HM. Cell adhesion molecules in Alzheimer's disease. Degener Neurol Neuromuscul Dis 2012; 2:65-77. [PMID: 30890880 DOI: 10.2147/dnnd.s19829] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cell adhesion molecules (CAMs) mediate interactions between cells and their surroundings that are vital to processes controlling for cell survival, activation, migration, and plasticity. However, increasing evidence suggests that CAMs also mediate mechanisms involved in several neurological diseases. This article reviews the current knowledge on the role of CAMs in amyloid-β (Aβ) metabolism, cell plasticity, neuroinflammation, and vascular changes, all of which are considered central to the pathogenesis and progression of Alzheimer's disease (AD). This paper also outlines the possible roles of CAMs in current and novel AD treatment strategies.
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Affiliation(s)
- Malin Wennström
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden,
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35
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Anzola GP, Galluzzi S, Mazzucco S, Frisoni GB. Autonomic dysfunction in mild cognitive impairment: a transcranial Doppler study. Acta Neurol Scand 2011; 124:403-9. [PMID: 22017634 DOI: 10.1111/j.1600-0404.2011.01495.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The contribution of early microvascular and autonomic derangements to the pathogenesis of mild cognitive impairment (MCI) is unclear. Aim of this study is to evaluate cerebrovascular reactivity (CVR) and cardiac autonomic function in patients with MCI by means of transcranial Doppler (TCD). MATERIAL AND METHODS Fifteen patients with MCI and 28 controls underwent carotid ultrasound and TCD evaluation, including assessment of mean flow velocity (MFV) in the middle cerebral artery at baseline, after CO(2) inhalation and after hyperpnoea. End-tidal CO(2) , mean arterial blood pressure (MAP), heart rate (HR), and respiratory rate were monitored throughout the procedure, and CVR was calculated. RESULTS MAP, end-tidal CO(2) , and MFV variations during hypercapnia and hyperventilation showed no between-group differences. CVR was similar in controls and MCI (2.30 vs 2,39, respectively, P = 0.767). HR significantly increased in hypercapnia (+9.4%, P < 0.0001) and hyperventilation (+18.7%, P < 0.0001) in controls, while in MCI it significantly increased in hyperventilation (+10.4%, P = 0.002), but not in hypercapnia (+1.1%, P = 0.635). CONCLUSIONS This study demonstrates that patients with MCI have a normal CVR, but they exhibit signs of autonomic dysfunction after CO(2) challenge. Should this finding be confirmed in larger studies, HR response to CO(2) challenge could become a marker of MCI.
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Affiliation(s)
- G P Anzola
- Service of Neurology, S. Orsola Hospital, Brescia, Italy.
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36
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Obrig H, Steinbrink J. Non-invasive optical imaging of stroke. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2011; 369:4470-94. [PMID: 22006902 DOI: 10.1098/rsta.2011.0252] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The acute onset of a neurological deficit is the key clinical feature of stroke. In most cases, however, pathophysiological changes in the cerebral vasculature precede the event, often by many years. Persisting neurological deficits may also require long-term rehabilitation. Hence, stroke may be considered a chronic disease, and diagnostic and therapeutic efforts must include identification of specific risk factors, and the monitoring of and interventions in the acute and subacute stages, and should aim at a pathophysiologically based approach to optimize the rehabilitative effort. Non-invasive optical techniques have been experimentally used in all three stages of the disease and may complement the established diagnostic and monitoring tools. Here, we provide an overview of studies using the methodology in the context of stroke, and we sketch perspectives of how they may be integrated into the assessment of the highly dynamic pathophysiological processes during the acute and subacute stages of the disease and also during rehabilitation and (secondary) prevention of stroke.
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Affiliation(s)
- Hellmuth Obrig
- Department of Cognitive Neurology, University Hospital Leipzig, Liebigstraße 16, 04103 Leipzig, Germany.
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Abstract
The ability of the brain to locally augment glucose delivery and blood flow during neuronal activation, termed neurometabolic and neurovascular coupling, respectively, is compromised in Alzheimer's disease (AD). Since perfusion deficits may hasten clinical deterioration and have been correlated with negative treatment outcome, strategies to improve the cerebral circulation should form an integral element of AD therapeutic efforts. These efforts have yielded several experimental models, some of which constitute AD models proper, others which specifically recapture the AD cerebrovascular pathology, characterized by anatomical alterations in brain vessel structure, as well as molecular changes within vascular smooth muscle cells and endothelial cells forming the blood-brain barrier. The following paper will present the elements of AD neurovascular dysfunction and review the in vitro and in vivo model systems that have served to deepen our understanding of it. It will also critically evaluate selected groups of compounds, the FDA-approved cholinesterase inhibitors and thiazolidinediones, for their ability to correct neurovascular dysfunction in AD patients and models. These and several others are emerging as compounds with pleiotropic actions that may positively impact dysfunctional cerebrovascular, glial, and neuronal networks in AD.
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Menendez-Gonzalez M, Garcia-Garcia J, Calleja S, Rojo J, Ribacoba R. Vasomotor Reactivity Is Similarly Impaired in Patients with Alzheimer's Disease and Patients with Amyloid Hemorrhage. J Neuroimaging 2011; 21:e83-5. [DOI: 10.1111/j.1552-6569.2009.00438.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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van Beek AHEA, de Wit HM, Olde Rikkert MGM, Claassen JAHR. Incorrect Performance of the Breath Hold Method in the Old Underestimates Cerebrovascular Reactivity and Goes Unnoticed Without Concomitant Blood Pressure and End-Tidal CO2 Registration. J Neuroimaging 2011; 21:340-7. [DOI: 10.1111/j.1552-6569.2010.00517.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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40
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Gur AY, Gücüyener D, Korczyn AD, Uzüner N, Gilutz Y, Ozdemir G, Bornstein NM. Cerebral vasomotor reactivity and dementia after ischemic stroke. Acta Neurol Scand 2010; 122:383-8. [PMID: 20085557 DOI: 10.1111/j.1600-0404.2010.01323.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cerebral hemodynamic features of patients with post-stroke dementia (PSD) are still obscure. We compared cerebral vasomotor reactivity (VMR) assessed in the acute phase of ischemic stroke (IS) in patients with and without PSD. VMR was also assessed and compared in demented and non-demented patients in the late phase of IS. MATERIALS AND METHODS VMR was assessed by transcranial Doppler and the Diamox test (1 g acetazolamide i.v.). PSD was confirmed by the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et I'Enseignement en Neurosciences (NINDS-AIREN) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. VMR% values were compared to verify correlation with dementia. RESULTS Thirty patients with acute IS (AIS) were studied and followed for 3-6 months. An additional group of 37 patients was studied in the late post-stroke period (PIS). VMR% values in the AIS groups with and without PSD were similar (25.3 ± 20.3% and 36.5 ± 22.4%, respectively, NS). The mean VMR% in the PIS groups with and without PSD were similar (32.3 ± 19.5% and 41.2 ± 24.8%, respectively, NS). CONCLUSIONS VMR cannot predict the development of dementia after AIS and cannot identify patients with dementia in the late phase of stroke.
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Affiliation(s)
- Alexander Y Gur
- Stroke Unit, Department of Neurology, Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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41
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Tak S, Yoon SJ, Jang J, Yoo K, Jeong Y, Ye JC. Quantitative analysis of hemodynamic and metabolic changes in subcortical vascular dementia using simultaneous near-infrared spectroscopy and fMRI measurements. Neuroimage 2010; 55:176-84. [PMID: 21094685 DOI: 10.1016/j.neuroimage.2010.11.046] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 10/25/2010] [Accepted: 11/13/2010] [Indexed: 10/18/2022] Open
Abstract
Subcortical vascular dementia (SVD) is a form of vascular dementia from small vessel disease with white matter lesions and lacunes. We hypothesized that hemodynamic and metabolic changes in the cortex during a simple motor task may reflect the impaired neurovascular coupling in SVD. We used fMRI and near-infrared spectroscopy (NIRS) simultaneously, which together provided multiple hemodynamic responses as well as a robust estimation of the cerebral metabolic rate of oxygen (CMRO(2)). During the task periods, the oxy-hemoglobin, total-hemoglobin, blood oxygenation level-dependent (BOLD) response, cerebral blood flow (CBF), and CMRO(2) decreased statistically significantly in the primary motor and somatosensory cortices of SVD patients, whereas the oxygen extraction fraction increased when compared with controls. Notably, the flow-metabolism coupling ratio, n representing the ratio of oxygen supply to its utilization, showed a robust reduction in the SVD patient group (n(Control)=1.99 ± 0.23; n(SVD)=1.08 ± 0.24), which implies a loss of metabolic reserve. These results support the pathological small vessel compromise, including an increased vessel stiffness, impaired vascular reactivity, and impaired neurovascular coupling in SVD. In conclusion, simultaneous measurement by NIRS and fMRI can reveal various hemodynamic and metabolic changes and may be used for as an early detection or monitoring of SVD.
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Affiliation(s)
- Sungho Tak
- Department of Bio and Brain Engineering, KAIST, Daejeon, Republic of Korea
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42
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Jochum T, Reinhard M, Boettger MK, Piater M, Bär KJ. Impaired cerebral autoregulation during acute alcohol withdrawal. Drug Alcohol Depend 2010; 110:240-6. [PMID: 20456871 DOI: 10.1016/j.drugalcdep.2010.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 03/17/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
Abstract
Heavy alcohol consumption increases the risk for all major types of stroke and is associated with autonomic dysfunction during alcohol withdrawal syndrome (AWS). Cerebral autoregulation is the mechanism by which cerebral perfusion is maintained stable, representing an intrinsic protective system of the cerebral circulation. Here, we aimed to analyze the influence of acute AWS on cerebral hemodynamics in alcohol-dependent patients. We investigated 20 men in the unmedicated acute state of AWS and repeated the investigation 24h after initiation of clomethiazole treatment. Dynamic cerebral autoregulation (dCA) was assessed by the correlation coefficient index and transfer function analysis (phase and gain) from oscillations of arterial blood pressure and cerebral blood flow velocity (CBFV). The vasomotor reserve (VMR) was measured by the CO(2)-reactivity test. In addition, we assessed autonomic modulation by means of heart rate variability and baroreflex sensitivity. We observed impaired dynamic autoregulation as shown by a multivariate analysis of variance (p<0.038) including all parameters of dCA. Similar results were found for VMR at admission (p<0.05). Pair-wise comparison between baseline and treatment with clomethiazole revealed a significant improvement for the systolic correlation coefficient index (Sx; p<0.001). Furthermore, we found a strong association of autonomic dysfunction and impaired autoregulation indicated by a correlation between the LF/HF ratio and Sx (p<0.001). In conclusion, cerebral autoregulation and VMR are disturbed during acute AWS. Influences of autonomic dysbalance and mental state during withdrawal are suggested. The finding of an affected autoregulation during acute withdrawal might indicate an increased risk for cerebro-vascular disease.
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Affiliation(s)
- Thomas Jochum
- Department of Psychiatry and Psychotherapy, Philosophenweg 3, University Hospital, Jena, Germany
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43
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Van Beek AHEA, Claassen JAHR. The cerebrovascular role of the cholinergic neural system in Alzheimer's disease. Behav Brain Res 2010; 221:537-42. [PMID: 20060023 DOI: 10.1016/j.bbr.2009.12.047] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/26/2009] [Indexed: 10/20/2022]
Abstract
The intrinsic cholinergic innervation of the cortical microvessels contains both subcortical pathways and local cortical interneurons mediated by muscarinic and nicotinic acetylcholine receptors. Stimulation of this system leads to vasodilatation. In the extrinsic innervation, choline acts as a selective agonist for the α7-nicoticinic acetylcholine receptor on the sympathetic nerves to cause vasodilatation, and through this mechanism, cholinergic modulation may affect this sympathetic vasodilatation. Alzheimer's disease is characterized by a cerebral cholinergic deficit and cerebral blood flow is diminished. Cholinesterase inhibitors, important drugs in the treatment of Alzheimer's disease, could influence the cerebral blood flow through stimulation of the intrinsic cholinergic cerebrovascular innervation. Indeed, cholinesterase inhibitors improve cerebral blood flow in Alzheimer patients who respond to treatment. Further, cerebrovascular reactivity and neurovascular coupling are impaired in Alzheimer's disease and both can be improved by cholinesterase inhibitors. Conversely, cholinesterase inhibitors inhibit the α7-nicoticinic acetylcholine receptor on extrinsic sympathetic nerves and thus may impair vasodilatation. The net outcome of these opposing effects in clinical practice remains unknown. Moreover, it is uncertain whether the regulation of cerebral blood flow during blood pressure changes (cerebral autoregulation) is impaired in patients with Alzheimer's disease. Technological developments now allow us to dynamically measure blood pressure, cerebral blood flow, and cerebral cortical oxygenation. Using simple maneuvers like single sit-stand and repeated sit-stand maneuvers, the regulation of cerebral perfusion in patients with Alzheimer's disease can easily be measured. Sit-stand maneuvers can be considered as a provocation test for cerebral autoregulation, and provide excellent opportunities to study the cerebrovascular effects of cholinesterase inhibitors.
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Affiliation(s)
- Arenda H E A Van Beek
- Radboud University Nijmegen Medical Centre, Department of Geriatric Medicine and Alzheimer Centre Nijmegen, The Netherlands
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44
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Alzheimer's disease and endothelial dysfunction. Neurol Sci 2009; 31:1-8. [PMID: 19838624 DOI: 10.1007/s10072-009-0151-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022]
Abstract
Recent studies suggest strong interactions between cerebrovascular and Alzheimer's disease (AD) pathology. These conditions share common risk factors and individuals having both frequently show greater cognitive impairment than those affected by only one disease. Many studies point to early vascular dysregulations in AD. The exchange between vascular and neural cells occurs through mechanisms not completely understood, involving interactions among endothelial, glial, neuronal and smooth muscle cells within the neurovascular unit. Studies suggest that the dysregulation of the unit is likely associated with hypertension and other systemic diseases. Associations between hypertension and cognitive decline are not established, but other variables associated with hypertension could create a causal link. Many studies have lacked a consistent, quantitative neuropsychological approach for assessing cognitive functions. This approach is reductive, as the need for a formal neuropsychological assessment has gained broad recognition, and the definition of dementia has gone through revision processes, which are in progress.
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Modrego PJ, Rios C, Pérez Trullen JM, García-Gómara MJ, Errea JM. Carotid intima-media thickness as a predictor of response to cholinesterase inhibitors in Alzheimer's disease: an open-label trial. CNS Drugs 2009; 23:253-60. [PMID: 19320533 DOI: 10.2165/00023210-200923030-00006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cholinesterase inhibitors are modestly effective in treating patients with Alzheimer's disease. However, there may be important inter-individual variations ranging from no improvement at all to significant improvement and long periods of stabilization. Carotid atherosclerosis is associated with cognitive decline in elderly people. OBJECTIVE The objective of this study was to investigate whether carotid intima-media thickness (IMT) predicts response to cholinesterase inhibitors in Alzheimer's disease. PATIENTS AND METHODS A series of 54 patients with mild to moderate Alzheimer's disease were enrolled consecutively in an open-label trial. At baseline, all patients were assessed on the following clinical scales: Mini-Mental State Examination, Clinical Dementia Rating, the Hachinski Ischemic Scale, Blessed Dementia Rating Scale, Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), Neuropsychiatric Inventory (NPI) and a daily-living activities scale (Disability Assessment for Dementia [DAD]). Investigations included magnetic resonance imaging of the brain and a colour echo-Doppler scan of the carotid arteries to measure the maximum IMT. Patients were then commenced on galantamine treatment for 6 months, after which scores on the ADAS-cog, NPI and DAD scales were reassessed. RESULTS A total of 50 patients completed the study. Their mean age was 77.78 years (SD 6.51 years); 34 patients were female. Galantamine treatment decreased the mean NPI score from 17.68 to 13.86 points, but this difference was not statistically significant (p=0.07). On the ADAS-cog scale, a modest and nonsignificant mean difference of -0.4 points (p=0.7) was observed. A weak (correlation coefficient r=0.4) but significant correlation between IMT and changes in clinical scale score was found, with low carotid IMT being shown to be a predictor of response on both the ADAS-cog (p=0.003) and NPI (p=0.006) scales; these findings were corroborated in multivariate analysis. For men, the correlation was stronger (r=0.7 and 0.8 for the ADAS-cog and NPI scales, respectively). CONCLUSION Although the magnitude of effect was moderate, carotid IMT could be a significant predictor of clinical response to cholinesterase inhibitors in patients with Alzheimer's disease.
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Affiliation(s)
- Pedro J Modrego
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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Abstract
Cerebrovascular disease and Alzheimer disease are common diseases of aging and frequently coexist in the same brain. Accumulating evidence suggests that the presence of brain infarction, including silent infarction, influences the course of Alzheimer disease. Conversely, there is evidence that beta-amyloid can impair blood vessel function. Vascular beta-amyloid deposition, also known as cerebral amyloid angiopathy, is associated with vascular dysfunction in animal and human studies. Alzheimer disease is associated with morphological changes in capillary networks, and soluble beta-amyloid produces abnormal vascular responses to physiological and pharmacological stimuli. In this review, we discuss current evidence linking beta-amyloid metabolism with vascular function and morphological changes in animals and humans.
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Affiliation(s)
- Eric E Smith
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Stefani A, Sancesario G, Pierantozzi M, Leone G, Galati S, Hainsworth AH, Diomedi M. CSF biomarkers, impairment of cerebral hemodynamics and degree of cognitive decline in Alzheimer's and mixed dementia. J Neurol Sci 2009; 283:109-15. [PMID: 19278690 DOI: 10.1016/j.jns.2009.02.343] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The in vivo diagnosis of Alzheimer's disease (AD) may be facilitated by cerebro-spinal fluid (CSF) biomarkers in combination with imaging and clinical assessments. By determining the concentration of beta amyloid fragments, total tau (t-tau) and phospho-tau (p-tau), it is possible to detect the conversion of mild cognitive impairment (MCI) to AD or distinguish AD vs. pseudo-dementia. However, these markers are poorly sensitive to the progressive disease stages. And far from clear is their role in "mixed" forms of dementia, as far as hemodynamic deficits complicate the clinical history. We have studied cerebral hemodynamic impairment in AD patients, relative to control subjects. Mean flow velocity (MFV), pulsatility index (PI) and cerebrovascular reactivity (assayed as breath-holding index, BHI) were evaluated by bilateral transcranial Doppler (TCD) monitoring of middle cerebral arteries. MFV and BHI were significantly lower and PI was significantly higher in AD patients with respect to control subjects. The presence of white-matter changes (WMC) in the AD cases did not influence any of the hemodynamic variables. Noticeably, MMSE score was correlated to BHI reduction (P<0.005). Our results, consistent with the recent literature indicate that hemodynamic impairment is a critical marker of cognitive decline and supports once more the hypothesis of a significant pathigenic role of vascular damage in AD. Similar functional alterations might be early hallmarks in a variety of dementia subtypes, including "mixed" dementia, whose prevalence is undoubtedly increased. Assessment of hemodynamic reactivity could provide valuable correlations with individual patient's cognitive profile, which in turn would assist in the identification of critical steps in disease progression and the validation of effective therapies.
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Affiliation(s)
- Alessandro Stefani
- Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy.
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Lorenz MW, Loesel N, Thoelen N, Gonzalez M, Lienerth C, Dvorak F, Rölz W, Humpich M, Sitzer M. Effects of poor bone window on the assessment of cerebral autoregulation with transcranial Doppler sonography - a source of systematic bias and strategies to avoid it. J Neurol Sci 2009; 283:49-56. [PMID: 19268307 DOI: 10.1016/j.jns.2009.02.329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The consequences of poor insonation conditions on autoregulation parameters assessed with transcranial Doppler (TCD) are unclear. METHODS We present two new complementary methods to assess the quality of a TCD signal. Inserting a thin aluminium foil between TCD probe and skin makes a simple model to artificially worsen a good insonation window. Validation studies are presented. We assessed insonation quality and cerebral autoregulation parameters with transfer function analysis and cross correlation in 46 healthy volunteers with and without the aluminium foil model. The same studies were operated on 45 patients with good insonation windows, naïve, after worsening the bone window and during constant infusion of an ultrasound contrast agent. For studying reproducibility, we assessed autoregulation twice in 30 patients with poor bone windows, with and without constant contrast infusion. RESULTS Both methods to measure insonation quality are valid and reproducible. The aluminium foil model realistically simulates a natural poor bone window, reducing the signal quality (e.g. energy of the signal spectrum from 33.4+/-3.5 to 26.2+/-2.5 dB, p<0.001). Thereby, the autoregulation parameters are systematically biased (e.g. phase difference from 37.3+/-10.1 degrees to 25.9+/-15.1 degrees , p<0.001); while with the use of an ultrasound contrast agent this can be largely compensated (phase difference 35.7+/-10.7 degrees , p<0.001). The reproducibility is significantly improved (ICC from 0.76 to 0.90, p<0.05). CONCLUSIONS Poor bone windows can cause considerable bias in TCD autoregulation parameters. This bias might be avoided by the use of ultrasound contrast agents, which may greatly improve the credibility of TCD autoregulation assessment in elderly patients.
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Affiliation(s)
- Matthias W Lorenz
- Department of Neurology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
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Axer H, Hüge S, Wilhelm C, Axer M, Kunze A, Reichenbach JR, Freesmeyer M, Kohlhase J, Sauer H, Bär KJ. [Hereditary Alzheimer's disease with amyloid angiopathy caused by amyloid precursor protein locus]. DER NERVENARZT 2009; 80:62-67. [PMID: 18781290 DOI: 10.1007/s00115-008-2565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report a patient with early-onset autosomal dominant dementia. The CSF showed increased levels of tau protein and decreased amyloid beta (ratio 42:40) typical for Alzheimer's disease. Cerebral MRI revealed vascular lesions and white-matter changes around the posterior horns of the ventricles with only moderate atrophy of the brain. Susceptibility-weighted imaging detected multiple small hemorrhagic changes. Gene analysis revealed amyloid precursor protein (APP) locus duplication as the cause of hereditary Alzheimer's dementia. The co-occurrence of CSF changes typical for Alzheimer's disease and MRI findings of cerebral amyloid angiopathy is remarkable, as it is also described for APP locus duplication. In conjunction with a family history suggestive of hereditary dementia, such a constellation should lead to enhanced gene analysis.
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Affiliation(s)
- H Axer
- Klinik für Psychiatrie und Psychotherapie, Friedrich-Schiller-Universität, Jena, Deutschland.
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Non-invasive characterization of β-amyloid1-40 vasoactivity by functional magnetic resonance imaging in mice. Neuroscience 2008; 155:263-9. [DOI: 10.1016/j.neuroscience.2008.04.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 03/14/2008] [Accepted: 04/03/2008] [Indexed: 11/20/2022]
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