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Xu D, Yu X, Hu J, Yu Y, Wang L, Jiang B, Zhang M. White matter hyperintensities in cholinergic pathways correlates of cognitive impairment in moyamoya disease. Eur Radiol 2024; 34:4596-4606. [PMID: 38092950 DOI: 10.1007/s00330-023-10489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/24/2023] [Accepted: 10/28/2023] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To investigate the effect of cholinergic pathways damage caused by white matter hyperintensities (WMHs) on cognitive function in moyamoya disease (MMD). METHODS We included 62 patients with MMD from a prospectively enrolled cohort. We evaluated the burden of cholinergic pathways damage caused by WMHs using the Cholinergic Pathways Hyperintensities Scale (CHIPS). Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Cognitive impairment was determined according to the cut-off of MMSE and education. Multivariate linear and logistic regression models were used to analyze whether CHIPS was independently associated with cognition. Receiver operating characteristic curve analysis was performed to identify the ability of CHIPS in discriminating cognitive impairment and normal cognition. RESULTS CHIPS was associated with both MMSE and MoCA (β = - 0.601 and β = - 0.672, both p < 0.001). After correcting age, sex, education, volumes of limbic areas, and other factors, CHIPS remained to be independently associated with both MMSE and MoCA (β = - 0.388 and β = - 0.334, both p < 0.001). In the logistic regression, only CHIPS was associated with cognitive impairment (odds ratio = 1.431, 95% confidence interval = 1.103 to 1.856, p = 0.007). The optimal cut-off of CHIPS score was 10, yielding a sensitivity of 87.5% and a specificity of 78.3% in identifying MMD patients with cognitive impairment. CONCLUSIONS The damage of cholinergic pathways caused by WMHs plays an independent effect on cognition and CHIPS could be a useful method in identifying MMD patients likely to be cognitive impairment. CLINICAL RELEVANCE STATEMENT This study shows that Cholinergic Pathways Hyperintensities Scale (CHIPS) could be a simple and reliable method in identifying cognitive impairment for patients with moyamoya disease. CHIPS could be helpful in clinical practice, such as guiding treatment decisions and predicting outcome. KEY POINTS • Cholinergic Pathways Hyperintensities Scale was significantly associated with cognitive screening tests in patients with moyamoya disease. • Cholinergic Pathways Hyperintensities Scale plays an independent effect on cognitive impairment in patients with moyamoya disease. • Cholinergic Pathways Hyperintensities Scale shows higher accuracy than education, volumes of limbic areas, and sex in identifying cognitive impairment in moyamoya disease.
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Affiliation(s)
- Duo Xu
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junwen Hu
- Department of Neurosurgery, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yannan Yu
- Department of Radiology, UCSF, San Francisco, CA, USA
| | - Lin Wang
- Department of Neurosurgery, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Biao Jiang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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2
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Liang ZY, Lu ZH, Qu JF, Chen YK. Clinical and imaging associations for non-ketotic hyperglycemic chorea: a case-control study. Front Endocrinol (Lausanne) 2023; 14:1323942. [PMID: 38189042 PMCID: PMC10769489 DOI: 10.3389/fendo.2023.1323942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background The non-ketotic hyperglycemic chorea (NKHC) was a rare complication for patients with diabetes mellitus, but not been well studied. In the present research, we aimed to investigate the clinical and imaging characteristics of NKHC and explore the potential association. Methods We performed a case-control study with patients diagnosed as NKHC. The patients with group of NKHC were retrospectively recruited, while the matched group were set to screened patients with diabetes mellitus but no NKHC at a 1:3 ratio. The clinical and imaging data were collected for all the participants of the two groups. Firstly, Correlation analysis was conducted to test the difference of all the variables between the NKHC group and matched group. Then, the putative associated factors for NKHC were further identified. Results Eleven men and 9 women with NKHC and 60 matched participants were analyzed. The mean age of the NKHC group was 68.5 ± 14.9 years. Participants with NKHC were more likely to have a higher glycosylated hemoglobin (HbA1c) level (13 ± 2.82 vs. 10.57 ± 2.71, P<0.001), and a higher frequency of renal dysfunction (estimated glomerular filtration rates <60 ml/min/1.73m2) (55% vs. 20%, P=0.005). Logistic regression analyses showed that both higher HbA1c and renal dysfunction were significantly correlated with NKHC. Conclusion A higher value of HbA1c and renal dysfunction may be associated with the occurrence of NKHC.
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Affiliation(s)
- Zhuo-Yuan Liang
- Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong, China
- Intelligent Brain Imaging and Brain Function Laboratory (Dongguan Key Laboratory), Dongguan People’s Hospital, Dongguan, Guangdong, China
| | - Zhi-Hao Lu
- Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong, China
- Intelligent Brain Imaging and Brain Function Laboratory (Dongguan Key Laboratory), Dongguan People’s Hospital, Dongguan, Guangdong, China
| | - Jian-Feng Qu
- Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong, China
- Intelligent Brain Imaging and Brain Function Laboratory (Dongguan Key Laboratory), Dongguan People’s Hospital, Dongguan, Guangdong, China
| | - Yang-Kun Chen
- Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong, China
- Intelligent Brain Imaging and Brain Function Laboratory (Dongguan Key Laboratory), Dongguan People’s Hospital, Dongguan, Guangdong, China
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Kakinuma T, Fujita T, Iwamoto T, Mizushiri T, Yazawa Y. Effects of tissue plasminogen activator on medium-term functional independence: A propensity score-matched analysis. Medicine (Baltimore) 2022; 101:e31108. [PMID: 36253995 PMCID: PMC9575812 DOI: 10.1097/md.0000000000031108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study revealed the effects of tissue plasminogen activator (tPA) on medium-term functional independence in patients with stroke. We retrospectively examined 240 patients from April 2016 to March 2019 and selected 68 who met our criteria. After adjusting the functional status at the onset by propensity score matching, the functional independence measure (FIM) on admission to and discharge from the convalescent rehabilitation wards was compared between the groups classified by the presence or absence of tPA. Twelve pairs were derived by propensity score matching. Upon admission to the convalescent rehabilitation ward, the median score of the FIM was significantly higher in the tPA group than in the non-tPA group (P = .028). Patients in the tPA group had higher median FIM scores at discharge than those in the non-tPA group (P = .060). The difference in the independence level of activities of daily living (ADL) between the groups with and without tPA may gradually decrease with continuous inpatient rehabilitation. However, the tPA group tended to have high levels of independence in ADL at the time of discharge.
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Affiliation(s)
- Tomohiro Kakinuma
- Department of Health and Welfare Services, National Institute of Public Health, Wako City, Saitama, Japan
- *Correspondence: Tomohiro Kakinuma, Department of Health and Welfare Services, National Institute of Public Health, Wako City, Saitama 351-0197, Japan (e-mail: )
| | - Takaaki Fujita
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Tetsuya Iwamoto
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako City, Saitama, Japan
| | - Tsuyoshi Mizushiri
- Department of Rehabilitation Medicine, Koeki Zaidan Hojin Miyagi Kosei Kyokai Nagamachi Hospital, Sendai City, Miyagi, Japan
| | - Yukako Yazawa
- Department of Stroke Neurology, Kohnan Hospital, Sendai City, Miyagi, Japan
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4
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Chang FG, Rost NS, Manson JE, Buring JE, Rist PM. Association between white matter hyperintensity volume and social functioning limitations among stroke survivors. J Stroke Cerebrovasc Dis 2022; 31:106720. [PMID: 36007263 PMCID: PMC9509456 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Existing literature on white matter hyperintensity volume (WMHV) in stroke patients has rarely focused on post-stroke outcomes related to social functioning limitations, such as transportation, social interaction, food preparation, grocery shopping, and housekeeping. Using prospective data from the VITamin D and OmegA-3 TriaL (VITAL) study, we evaluated the association between WMHV and social functioning limitations among 151 ischemic stroke patients. MATERIALS AND METHODS WMHV was ascertained from magnetic resonance imaging (MRI) collected at the time of the stroke event using a validated semiautomated method, and social functioning limitations were assessed using a stroke outcomes questionnaire administered a median of 1.25 years after the date of the MRI scan. Logistic regression was used to explore the association between WMHV and social functioning limitations. RESULTS After adjusting for age and sex, a statistically significant association was found between WMHV and limitations in social interaction (OR=2.82; 95% CI: 1.21-7.55). Increased risks were seen for limitations related to food preparation (OR=2.06; 95% CI: 0.99-4.54), transportation (OR=1.39; 95% CI: 0.85-2.27), and housekeeping (OR=1.37; 95% CI: 0.91-2.11); however, the associations did not reach statistical significance. We observed no association between WMHV and limitations in grocery shopping (OR=1.08; 95% CI: 0.61-1.89). CONCLUSIONS Future studies are needed to further explore the biological mechanisms underlying the relationship with limitations in social interaction and to replicate our findings using a larger and more diverse study sample.
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Affiliation(s)
- Flora G Chang
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
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5
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Qu JF, Zhou YQ, Liu JF, Hu HH, Cheng WY, Lu ZH, Shi L, Luo YS, Zhao L, Chen YK. Right Cortical Infarction and a Reduction in Putamen Volume May Be Correlated with Empathy in Patients after Subacute Ischemic Stroke—A Multimodal Magnetic Resonance Imaging Study. J Clin Med 2022; 11:jcm11154479. [PMID: 35956096 PMCID: PMC9369598 DOI: 10.3390/jcm11154479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023] Open
Abstract
Empathy has not been well studied in patients following ischemic stroke. We aimed to evaluate the relationships of multimodal neuroimaging parameters with the impairment of empathy in patients who had experienced subacute ischemic stroke. Patients who had experienced a first-event acute ischemic stroke were recruited, and we assessed their empathy using the Chinese version of the Empathy Quotient (EQ) 3 months after the index stroke. Multimodal magnetic resonance imaging (MRI) was conducted in all the participants to identify acute infarction and assess brain volumes, white matter integrity, and other preexisting abnormalities. We quantified the brain volumes of various subcortical structures, the ventricles, and cortical lobar atrophy. The microstructural integrity of the white matter was reflected in the mean fractional anisotropy (FA) and mean diffusivity (MD), and the regional mean values of FA and MD were quantified after mapping using the ICBM_DTI_81 Atlas. Twenty-three (56.1%) men and 18 (43.9%) women (mean age: 61.73 years, range: 41–77 years) were included. The median National Institutes of Health Stroke Scale (NIHSS) score at discharge was 1 (range: 0–4). On univariate analysis, the EQ was correlated with right cortical infarction (r = −0.39, p = 0.012), putamen volume (r = 0.382, p = 0.014), right putamen volume (r = 0.338, p = 0.031), and the FA value of the right sagittal stratum. EQ did not correlated with the MD value in any region of interest or pre-existing brain abnormalities. Multiple stepwise linear regression models were used to identify factors associated with EQ. After adjusting for age and the NIHSS score on admission, the frequency of right cortical infarcts negatively correlated with EQ (standardized β = −0.358, 95% confidence interval =−0.708 to −0.076, p = 0.016), and the putamen volume positively correlated with EQ (standardized β = 0.328, 95% confidence interval =0.044 to 0.676, p = 0.027). In conclusion, in patients who have experienced subacute ischemic stroke, right cortical infarction and a smaller putamen volume are associated with the impairment of empathy.
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Affiliation(s)
- Jian-Feng Qu
- Department of Neurology, Dongguan People’s Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan 523108, China; (J.-F.Q.); (Y.-Q.Z.); (J.-F.L.); (H.-H.H.); (W.-Y.C.); (Z.-H.L.)
| | - Yue-Qiong Zhou
- Department of Neurology, Dongguan People’s Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan 523108, China; (J.-F.Q.); (Y.-Q.Z.); (J.-F.L.); (H.-H.H.); (W.-Y.C.); (Z.-H.L.)
- Faculty of Neurology, Graduate School of Guangdong Medical University, Zhanjiang 524013, China
| | - Jian-Fei Liu
- Department of Neurology, Dongguan People’s Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan 523108, China; (J.-F.Q.); (Y.-Q.Z.); (J.-F.L.); (H.-H.H.); (W.-Y.C.); (Z.-H.L.)
- Faculty of Neurology, Graduate School of Southern Medical University, Guangzhou 510505, China
| | - Hui-Hong Hu
- Department of Neurology, Dongguan People’s Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan 523108, China; (J.-F.Q.); (Y.-Q.Z.); (J.-F.L.); (H.-H.H.); (W.-Y.C.); (Z.-H.L.)
| | - Wei-Yang Cheng
- Department of Neurology, Dongguan People’s Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan 523108, China; (J.-F.Q.); (Y.-Q.Z.); (J.-F.L.); (H.-H.H.); (W.-Y.C.); (Z.-H.L.)
| | - Zhi-Hao Lu
- Department of Neurology, Dongguan People’s Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan 523108, China; (J.-F.Q.); (Y.-Q.Z.); (J.-F.L.); (H.-H.H.); (W.-Y.C.); (Z.-H.L.)
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong, China;
| | - Yi-Shan Luo
- BrainNow Research Institute, Shenzhen 518000, China; (Y.-S.L.); (L.Z.)
| | - Lei Zhao
- BrainNow Research Institute, Shenzhen 518000, China; (Y.-S.L.); (L.Z.)
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People’s Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan 523108, China; (J.-F.Q.); (Y.-Q.Z.); (J.-F.L.); (H.-H.H.); (W.-Y.C.); (Z.-H.L.)
- Correspondence: ; Tel.: +86-13713135765
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6
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Winek K, Soreq H, Meisel A. Regulators of cholinergic signaling in disorders of the central nervous system. J Neurochem 2021; 158:1425-1438. [PMID: 33638173 PMCID: PMC8518971 DOI: 10.1111/jnc.15332] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/23/2021] [Accepted: 02/21/2021] [Indexed: 12/14/2022]
Abstract
Cholinergic signaling is crucial in cognitive processes, and degenerating cholinergic projections are a pathological hallmark in dementia. Use of cholinesterase inhibitors is currently the main treatment option to alleviate symptoms of Alzheimer's disease and has been postulated as a therapeutic strategy in acute brain damage (stroke and traumatic brain injury). However, the benefits of this treatment are still not clear. Importantly, cholinergic receptors are expressed both by neurons and by astrocytes and microglia, and binding of acetylcholine to the α7 nicotinic receptor in glial cells results in anti-inflammatory response. Similarly, the brain fine-tunes the peripheral immune response over the cholinergic anti-inflammatory axis. All of these processes are of importance for the outcome of acute and chronic neurological disease. Here, we summarize the main findings about the role of cholinergic signaling in brain disorders and provide insights into the complexity of molecular regulators of cholinergic responses, such as microRNAs and transfer RNA fragments, both of which may fine-tune the orchestra of cholinergic mRNAs. The available data suggest that these small noncoding RNA regulators may include promising biomarkers for predicting disease course and assessing treatment responses and might also serve as drug targets to attenuate signaling cascades during overwhelming inflammation and to ameliorate regenerative capacities of neuroinflammation.
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Affiliation(s)
- Katarzyna Winek
- The Edmond and Lily Safra Center for Brain SciencesThe Hebrew University of JerusalemJerusalemIsrael
- The Alexander Silberman Institute of Life SciencesThe Hebrew University of JerusalemJerusalemIsrael
| | - Hermona Soreq
- The Edmond and Lily Safra Center for Brain SciencesThe Hebrew University of JerusalemJerusalemIsrael
- The Alexander Silberman Institute of Life SciencesThe Hebrew University of JerusalemJerusalemIsrael
| | - Andreas Meisel
- Department of Neurology with Experimental NeurologyCenter for Stroke Research BerlinNeuroCure Clinical Research CenterCharité‐Universitätsmedizin BerlinBerlinGermany
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Fanciullacci C, Panarese A, Spina V, Lassi M, Mazzoni A, Artoni F, Micera S, Chisari C. Connectivity Measures Differentiate Cortical and Subcortical Sub-Acute Ischemic Stroke Patients. Front Hum Neurosci 2021; 15:669915. [PMID: 34276326 PMCID: PMC8281978 DOI: 10.3389/fnhum.2021.669915] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/08/2021] [Indexed: 01/14/2023] Open
Abstract
Brain lesions caused by cerebral ischemia lead to network disturbances in both hemispheres, causing a subsequent reorganization of functional connectivity both locally and remotely with respect to the injury. Quantitative electroencephalography (qEEG) methods have long been used for exploring brain electrical activity and functional connectivity modifications after stroke. However, results obtained so far are not univocal. Here, we used basic and advanced EEG methods to characterize how brain activity and functional connectivity change after stroke. Thirty-three unilateral post stroke patients in the sub-acute phase and ten neurologically intact age-matched right-handed subjects were enrolled. Patients were subdivided into two groups based on lesion location: cortico-subcortical (CS, n = 18) and subcortical (S, n = 15), respectively. Stroke patients were evaluated in the period ranging from 45 days since the acute event (T0) up to 3 months after stroke (T1) with both neurophysiological (resting state EEG) and clinical assessment (Barthel Index, BI) measures, while healthy subjects were evaluated once. Brain power at T0 was similar between the two groups of patients in all frequency bands considered (δ, θ, α, and β). However, evolution of θ-band power over time was different, with a normalization only in the CS group. Instead, average connectivity and specific network measures (Integration, Segregation, and Small-worldness) in the β-band at T0 were significantly different between the two groups. The connectivity and network measures at T0 also appear to have a predictive role in functional recovery (BI T1-T0), again group-dependent. The results obtained in this study showed that connectivity measures and correlations between EEG features and recovery depend on lesion location. These data, if confirmed in further studies, on the one hand could explain the heterogeneity of results so far observed in previous studies, on the other hand they could be used by researchers as biomarkers predicting spontaneous recovery, to select homogenous groups of patients for the inclusion in clinical trials.
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Affiliation(s)
- Chiara Fanciullacci
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy
| | | | - Vincenzo Spina
- Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy
| | - Michael Lassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Fiorenzo Artoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Translational Neural Engineering Laboratory, Center for Neuroprosthetics, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Translational Neural Engineering Laboratory, Center for Neuroprosthetics, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Carmelo Chisari
- Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy
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Zhong HH, Qu JF, Xiao WM, Chen YK, Liu YL, Wu ZQ, Qiu DH, Liang WC. Severity of Lesions Involving the Cortical Cholinergic Pathways May Be Associated With Cognitive Impairment in Subacute Ischemic Stroke. Front Neurol 2021; 12:606897. [PMID: 34168604 PMCID: PMC8217623 DOI: 10.3389/fneur.2021.606897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Impairment of cortical cholinergic pathways (CCP) is an important risk factor for chronic vascular cognitive impairment. However, this phenomenon has rarely been studied in post-stroke cognitive impairment (PSCI). We investigated the relationship between PSCI and CCP lesions assessed by structural magnetic resonance imaging (MRI). Patients and methods: We prospectively enrolled 103 patients within 7 days of ischemic stroke onset. CCP was measured by the cholinergic pathways hyperintensities scale (CHIPS), which semiquantitatively grades MR lesions strategically located on the CCP identified in human brains. We also measured other MRI parameters, including the location and volumes of acute infarcts, cerebral microbleeds, medial temporal lobe atrophy, and white matter lesions. Neuropsychological assessments were performed using the 60-min modified vascular dementia battery (VDB) at 3 months after the index stroke, and PSCI was defined according to VDB as well as ADL. Results: Of all 103 patients, 69 men (67.0%) and 34 women (33.0%) with a mean age of 57.22 ± 12.95 years, 55 patients (53.4%) were judged to have PSCI at 3 months, including 43 (41.7%) patients with PSCI-no dementia and 12 (11.7%) patients with poststroke dementia. According to the VBD assessment, the most commonly impaired cognitive domain was visuomotor speed (27.2%) followed by verbal memory (25.2%). Univariate analysis showed that patients with PSCI were older; had higher informant questionnaire on cognitive decline in the elderly (IQCODE) scores; had more frequent previous stroke history and atrial fibrillation; and had higher CHIPS scores, more severe white matter lesions, and medial temporal lobe atrophy. PSCI patients also had higher depression scores at 3 months. In the multivariate regression analysis, age, IQCODE score, CHIPS score, and Hamilton depression rating scale score were independent predictors of PSCI. Ordinal regression analysis for risk factors of poor functional outcomes revealed that IQCODE scores and cognitive function status were related to mRS score at 3 months after stroke. Conclusion: In patients with early subacute ischemic stroke, the severity of lesions involving the CCP may be associated with cognitive impairment at 3 months. Clinical Trial Registration: Chinese Clinical Trial Registry, identifier: ChiCTR1800014982.
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Affiliation(s)
- Huo-Hua Zhong
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Wei-Min Xiao
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Zhi-Qiang Wu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Dong-Hai Qiu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Wen-Cong Liang
- Graduate School, Guangdong Medical University, Dongguan, China
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Katz DI, Dwyer B. Clinical Neurorehabilitation: Using Principles of Neurological Diagnosis, Prognosis, and Neuroplasticity in Assessment and Treatment Planning. Semin Neurol 2021; 41:111-123. [PMID: 33663002 DOI: 10.1055/s-0041-1725132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neurorehabilitation aspires to restore a person to his or her fullest potential after incurring neurological dysfunction. In medical rehabilitation, diagnosis involves assessment of medical conditions and their effects on functioning. It is usually a team effort that involves an amalgam of diagnostic assessments by multiple disciplines, leading to a collection of rehabilitative treatment plans and goals. This article discusses a clinical neurological paradigm, using rigorous clinical assessment of neuropathological and clinical diagnosis, along with prognostication of natural history and recovery. In the context of the role of neuroplasticity in recovery, this paradigm can add significant value to rehabilitation team management and planning. It contributes to enhanced understanding of neurological impairments and syndromes as they relate to functional disability, aiding in targeting deficits and setting treatment goals. Rehabilitation strategies and goals should be informed by natural history and prognosis, and viewed in the framework of the stage of recovery. Prognostic formulations should suggest an emphasis on restorative versus compensatory strategies for functional problems. Treatment planning should be informed by evidence on how interventions modulate brain reorganization in promoting recovery. Strategies that promote adaptive neuroplasticity should be favored, especially with restorative efforts, and evidence supporting optimal techniques, timing, and dosing of rehabilitation should be considered in treatment planning.
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Affiliation(s)
- Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Encompass Health Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Brigid Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Encompass Health Braintree Rehabilitation Hospital, Braintree, Massachusetts
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10
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Goncalves DF, Guzman MS, Gros R, Massensini AR, Bartha R, Prado VF, Prado MAM. Striatal Acetylcholine Helps to Preserve Functional Outcomes in a Mouse Model of Stroke. ASN Neuro 2020; 12:1759091420961612. [PMID: 32967452 PMCID: PMC7521057 DOI: 10.1177/1759091420961612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Acetylcholine (ACh) has been suggested to facilitate plasticity and
improve functional recovery after different types of brain lesions.
Interestingly, numerous studies have shown that striatal cholinergic
interneurons are relatively resistant to acute ischemic insults, but
whether ACh released by these neurons enhances functional recovery
after stroke is unknown. We investigated the role of endogenous
striatal ACh in stroke lesion volume and functional outcomes following
middle cerebral artery occlusion to induce focal ischemia in
striatum-selective vesicular acetylcholine transporter-deficient mice
(stVAChT-KO). As transporter expression is almost completely
eliminated in the striatum of stVAChT-KO mice, ACh release is nearly
abolished in this area. Conversely, in other brain areas, VAChT
expression and ACh release are preserved. Our results demonstrate a
larger infarct size after ischemic insult in stVAChT-KO mice, with
more pronounced functional impairments and increased mortality than in
littermate controls. These changes are associated with increased
activation of GSK-3, decreased levels of β-catenin, and a higher
permeability of the blood–brain barrier in mice with loss of VAChT in
striatum neurons. These results support a framework in which
endogenous ACh secretion originating from cholinergic interneurons in
the striatum helps to protect brain tissue against ischemia-induced
damage and facilitates brain recovery by supporting blood–brain
barrier function.
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Affiliation(s)
- Daniela F Goncalves
- Robarts Research Institute, The University of Western Ontario, London, Canada.,Neuroscience Centre, Department of Physiology and Biophysics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Monica S Guzman
- Robarts Research Institute, The University of Western Ontario, London, Canada.,Department of Physiology and Pharmacology, The University of Western Ontario, London, Canada
| | - Robert Gros
- Robarts Research Institute, The University of Western Ontario, London, Canada.,Department of Physiology and Pharmacology, The University of Western Ontario, London, Canada
| | - André R Massensini
- Neuroscience Centre, Department of Physiology and Biophysics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Robert Bartha
- Robarts Research Institute, The University of Western Ontario, London, Canada.,Department of Medical Biophysics, The University of Western Ontario, London, Canada
| | - Vania F Prado
- Robarts Research Institute, The University of Western Ontario, London, Canada.,Department of Physiology and Pharmacology, The University of Western Ontario, London, Canada.,Department of Anatomy and Cell Biology, The University of Western Ontario, London, Canada
| | - Marco A M Prado
- Robarts Research Institute, The University of Western Ontario, London, Canada.,Department of Physiology and Pharmacology, The University of Western Ontario, London, Canada.,Department of Anatomy and Cell Biology, The University of Western Ontario, London, Canada
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11
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Qu JF, Chen YK, Zhong HH, Li W, Lu ZH. Preexisting Cerebral Abnormalities and Functional Outcomes After Acute Ischemic Stroke. J Geriatr Psychiatry Neurol 2019; 32:327-335. [PMID: 31480988 DOI: 10.1177/0891988719862631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to investigate the association between preexisting cerebral abnormalities in patients with acute ischemic stroke upon their functional outcomes. METHODS We recruited 272 patients with first-ever acute ischemic stroke. Cerebral abnormalities on magnetic resonance imaging included infarction, silent brain infarcts (SBI), enlarged perivascular spaces, white matter lesions (WMLs), global brain atrophy, and medial temporal lobe atrophy (MTLA). Functional outcomes were assessed using the instrumental activities of daily living (IADL) scale and basic activities of daily living (BADL) scale, at 3 and 6 months after the index stroke. RESULTS Two hundred and fifty patients completed the 3-month follow-up and 246 patients completed the 6-month follow-up. Univariate analyses showed that patients with poor IADL and BADL were older, more likely to be men, had higher National Institutes of Health Stroke Scale (NIHSS) score on admission, more frequent atrial fibrillation, and large artery atherosclerosis subtypes. They also had more frequent cortical infarcts, subcortical infarcts, infratentorial infarcts, larger infarct volume, more frequent presence of SBI, severe WMLs, and MTLA. In multiple regression analyses, NIHSS on admission, subcortical region infarct and MTLA were significant predictors of poor IADL at 3 months. National Institutes of Health Stroke Scale on admission, SBI and MTLA were significant predictors of poor IADL at 6 months. National Institutes of Health Stroke Scale on admission and MTLA were significant predictors of poor BADL at 3 months. National Institutes of Health Stroke Scale on admission and SBI were significant predictors of poor BADL at 6 months. CONCLUSIONS In patients with acute ischemic stroke, the presence of SBI, and severe MTLA represent significant predictors of poorer functional outcomes, thus highlighting the importance of preexisting cerebral abnormalities.
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Affiliation(s)
- Jian-Feng Qu
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Yang-Kun Chen
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Huo-Hua Zhong
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China.,2 Faculty of Neurology, Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Wei Li
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Zhi-Hao Lu
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China.,2 Faculty of Neurology, Guangdong Medical University, Zhanjiang, Guangdong Province, China
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