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Anderson ME, Wind EJ, Robison LS. Exploring the neuroprotective role of physical activity in cerebral small vessel disease. Brain Res 2024; 1833:148884. [PMID: 38527712 DOI: 10.1016/j.brainres.2024.148884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
Cerebral small vessel disease (cSVD) is a common neurological finding characterized by abnormalities of the small blood vessels in the brain. Previous research has established a strong connection between cSVD and stroke, as well as neurodegenerative disorders, notably Alzheimer's disease (AD) and other dementias. As the search for effective interventions continues, physical activity (PA) has emerged as a potential preventative and therapeutic avenue. This review synthesizes the human and animal literature on the influence of PA on cSVD, highlighting the importance of determining optimal exercise protocols, considering aspects such as intensity, duration, timing, and exercise type. Furthermore, the necessity of widening the age bracket in research samples is discussed, ensuring a holistic understanding of the interventions across varying pathological stages of the disease. The review also suggests the potential of exploring diverse biomarkers and risk profiles associated with clinically significant outcomes. Moreover, we review findings demonstrating the beneficial effects of PA in various rodent models of cSVD, which have uncovered numerous mechanisms of neuroprotection, including increases in neuroplasticity and integrity of the vasculature and white matter; decreases in inflammation, oxidative stress, and mitochondrial dysfunction; and alterations in amyloid processing and neurotransmitter signaling. In conclusion, this review highlights the potential of physical activity as a preventive strategy for addressing cSVD, offering insights into the need for refining exercise parameters, diversifying research populations, and exploring novel biomarkers, while shedding light on the intricate mechanisms through which exercise confers neuroprotection in both humans and animal models.
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Affiliation(s)
- Maria E Anderson
- Department of Psychology, Family, and Justice Studies, University of Saint Joseph, 1678 Asylum Ave, West Hartford, CT 06117, USA
| | - Eleanor J Wind
- Department of Psychology and Neuroscience, Nova Southeastern University, 3300 S. University Drive, Fort Lauderdale, FL 33328, USA
| | - Lisa S Robison
- Department of Psychology and Neuroscience, Nova Southeastern University, 3300 S. University Drive, Fort Lauderdale, FL 33328, USA.
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Otsuka S, Kikuchi K, Takeshita Y, Takada S, Tani A, Sakakima H, Maruyama I, Makizako H. Relationship between physical activity and cerebral white matter hyperintensity volumes in older adults with depressive symptoms and mild memory impairment: a cross-sectional study. Front Aging Neurosci 2024; 16:1337397. [PMID: 38414630 PMCID: PMC10896982 DOI: 10.3389/fnagi.2024.1337397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/24/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Cerebral white matter hyperintensities (WMHs) are commonly found in the aging brain and have been implicated in the initiation and severity of many central nervous system diseases. Furthermore, an increased WMH volume indicates reduced brain health in older adults. This study investigated the association between WMH volume and physical activity in older adults with depressive symptoms (DS) and mild memory impairment (MMI). Factors associated with the WMH volume were also investigated. Methods A total of 57 individuals aged over 65 years with DS and MMI were included in this study. The participants underwent magnetic resonance imaging to quantify WMH volumes. After WMH volume was accumulated, normalized to the total intracranial volume (TIV), the percentage of WMH volume was calculated. In addition, all participants wore a triaxial accelerometer for 2 weeks, and the average daily physical activity and number of steps were measured. The levels of blood biomarkers including cortisol, interleukin-6 (IL-6), brain-derived insulin-like growth factor-1, and brain-derived neurotrophic factor were measured. Motor and cognitive functions were also assessed. Results Faster maximum walking speed and longer time spent engaged in moderate physical activity were associated with a smaller percent of WMH volume, whereas higher serum IL-6 levels were associated with a larger percent of WMH volume. The number of steps per day, time spent engaged in low levels of physical activity, cognitive function, and all other measured biomarkers were not significantly associated with percent of WMH volume. Discussion Higher blood inflammatory cytokine levels, shorter duration of moderate physical activity, and lower maximum walking speed were associated with a higher percent of WMH volume. Our results provide useful information for maintaining brain health in older adults at a high risk of developing dementia and may contribute to the development of preventive medicine for brain health.
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Affiliation(s)
- Shotaro Otsuka
- Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kiyoshi Kikuchi
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, Kurume, Japan
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Yasufumi Takeshita
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Seiya Takada
- Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Akira Tani
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Ikuro Maruyama
- Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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Shibukawa T, Fujiyoshi A, Moniruzzaman M, Miyagawa N, Kadota A, Kondo K, Saito Y, Kadowaki S, Hisamatsu T, Yano Y, Arima H, Tooyama I, Ueshima H, Miura K. Association of step counts with cognitive function in apparently healthy middle-aged and older Japanese men. Prev Med Rep 2024; 38:102615. [PMID: 38375168 PMCID: PMC10874868 DOI: 10.1016/j.pmedr.2024.102615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/21/2024] Open
Abstract
Background Increasing physical activity may prevent cognitive decline. Previous studies primarily focused on older adults and used self-reported questionnaires to assess physical activity. We examined the relationship between step count, an objective measure of physical activity, and cognitive function in community-based middle-aged and older Japanese men. Methods The Shiga Epidemiological Study of Subclinical Atherosclerosis randomly recruited community-dwelling healthy men aged 40-79 years from Shiga, Japan, and measured their step counts over 7 consecutive days using a pedometer at baseline (2006-2008). Among men who returned for follow-up (2009-2014), we assessed their cognitive function using the Cognitive Abilities Screening Instrument (CASI) score. We restricted our analyses to those with valid 7-day average step counts at baseline and those who remained free of stroke at follow-up (n = 676). Using analysis of covariance, we calculated the adjusted means of the CASI score according to the quartiles of the average step counts. Results The mean (standard deviation) of age and unadjusted CASI score were 63.8 (9.1) years and 90.8 (5.8), respectively. The CASI score was elevated in higher quartiles of step counts (90.2, 90.4, 90.6, and 91.8 from the lowest to the highest quartile, respectively, [p for trend = 0.004]) in a model adjusted for age and education. Further adjustment for smoking, drinking, and other cardiovascular risk factors resulted in a similar pattern of association (p for trend = 0.005). Conclusion In apparently healthy middle-aged and older Japanese men, a greater 7-day average step count at baseline was associated with significantly higher cognitive function score.
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Affiliation(s)
- Takeshi Shibukawa
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Rehabilitation Units, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Department of Hygiene, Wakayama Medical School, Wakayama, Japan
| | | | - Naoko Miyagawa
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Yoshino Saito
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Sayaka Kadowaki
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Takashi Hisamatsu
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yuichiro Yano
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Hisatomi Arima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ikuo Tooyama
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
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Hisamatsu T, Tabara Y, Kadota A, Torii S, Kondo K, Yano Y, Shiino A, Nozaki K, Okamura T, Ueshima H, Miura K. Alcohol Consumption and Cerebral Small- and Large-Vessel Diseases: A Mendelian Randomization Analysis. J Atheroscler Thromb 2024; 31:135-147. [PMID: 37612092 PMCID: PMC10857837 DOI: 10.5551/jat.64222] [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: 03/08/2023] [Accepted: 07/11/2023] [Indexed: 08/25/2023] Open
Abstract
AIMS It remains inconclusive regarding alcohol intake and stroke risk because determining risk factors depends on the specific pathogenesis of stroke. We used the variant rs671 in the aldehyde dehydrogenase 2 gene (ALDH2) as an instrument to investigate the causal role of alcohol intake in cerebral small- and large-vessel diseases. METHODS We studied 682 men (mean age, 70.0 years), without stroke, in a cross-sectional Mendelian randomization analysis. We assessed small-vessel diseases (SVDs), which comprised lacunar infarcts, white matter hyperintensities (WMHs), and cerebral microbleeds, and large intracranial artery stenosis (ICAS) on brain magnetic resonance imaging. RESULTS The median (25%tiles, 75%tiles) alcohol consumption by ALDH2-rs671 inactive A allele (n=313 [45.9%]) and non-A allele (n=369 [54.1%]) carriers was 3.5 (0.0, 16.0) and 32.0 (12.9, 50.0) g/day, respectively. Non-A allele carriers had higher prevalent hypertension and lower low-density lipoprotein cholesterol concentrations than A allele carriers. In age-adjusted ordinal logistic regression for graded burden, odds ratios (95% confidence intervals) for total SVDs, lacunar infarcts, WMHs, cerebral microbleeds, and ICAS in non-Aallele carriers were 1.46 (1.09-1.94), 1.41 (0.95-2.08), 1.39 (1.05-1.85), 1.69 (1.06-2.69), and 0.70 (0.50-0.98), respectively, compared with A allele carriers. These associations attenuated to statistical non-significance after considering covariates and amount of alcohol intake. CONCLUSIONS Our findings suggest a positive association of alcohol consumption with risk of cerebral SVDs and its inverse association with risk of large-vessel disease through intermediaries, such as hypertension or low-density lipoprotein cholesterol. These findings provide insight into potential causal mechanisms linking alcohol consumption with stroke risk.
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Affiliation(s)
- Takashi Hisamatsu
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuharu Tabara
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Yuichiro Yano
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Akihiko Shiino
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
| | - Tomonori Okamura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
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Wall J, Xie H, Wang X. Temporal Interactions between Maintenance of Cerebral Cortex Thickness and Physical Activity from an Individual Person Micro-Longitudinal Perspective and Implications for Precision Medicine. J Pers Med 2024; 14:127. [PMID: 38392561 PMCID: PMC10890462 DOI: 10.3390/jpm14020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 02/24/2024] Open
Abstract
Maintenance of brain structure is essential for neurocognitive health. Precision medicine has interests in understanding how maintenance of an individual person's brain, including cerebral cortical structure, interacts with lifestyle factors like physical activity. Cortical structure, including cortical thickness, has recognized relationships with physical activity, but concepts of these relationships come from group, not individual, focused findings. Whether or how group-focused concepts apply to an individual person is fundamental to precision medicine interests but remains unclear. This issue was studied in a healthy man using concurrent micro-longitudinal tracking of magnetic resonance imaging-defined cortical thickness and accelerometer-defined steps/day over six months. These data permitted detailed examination of temporal relationships between thickness maintenance and physical activity at an individual level. Regression analyses revealed graded significant and trend-level temporal interactions between preceding activity vs. subsequent thickness maintenance and between preceding thickness maintenance vs. subsequent activity. Interactions were bidirectional, delayed/prolonged over days/weeks, positive, bilateral, directionally asymmetric, and limited in strength. These novel individual-focused findings in some ways are predicted, but in other ways remain unaddressed or undetected, by group-focused work. We suggest that individual-focused concepts of temporal interactions between maintenance of cortical structure and activity can provide needed new insight for personalized tailoring of physical activity, cortical, and neurocognitive health.
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Affiliation(s)
- John Wall
- Department of Neurosciences, University of Toledo College of Medicine & Life Sciences, Toledo, OH 43614, USA
| | - Hong Xie
- Department of Neurosciences, University of Toledo College of Medicine & Life Sciences, Toledo, OH 43614, USA
| | - Xin Wang
- Department of Neurosciences, University of Toledo College of Medicine & Life Sciences, Toledo, OH 43614, USA
- Department of Psychiatry, University of Toledo College of Medicine & Life Sciences, Toledo, OH 43614, USA
- Department of Radiology, University of Toledo College of Medicine & Life Sciences, Toledo, OH 43614, USA
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6
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Banach M, Lewek J, Surma S, Penson PE, Sahebkar A, Martin SS, Bajraktari G, Henein MY, Reiner Ž, Bielecka-Dąbrowa A, Bytyçi I. The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis. Eur J Prev Cardiol 2023; 30:1975-1985. [PMID: 37555441 DOI: 10.1093/eurjpc/zwad229] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023]
Abstract
AIMS There is good evidence showing that inactivity and walking minimal steps/day increase the risk of cardiovascular (CV) disease and general ill-health. The optimal number of steps and their role in health is, however, still unclear. Therefore, in this meta-analysis, we aimed to evaluate the relationship between step count and all-cause mortality and CV mortality. METHODS AND RESULTS We systematically searched relevant electronic databases from inception until 12 June 2022. The main endpoints were all-cause mortality and CV mortality. An inverse-variance weighted random-effects model was used to calculate the number of steps/day and mortality. Seventeen cohort studies with a total of 226 889 participants (generally healthy or patients at CV risk) with a median follow-up 7.1 years were included in the meta-analysis. A 1000-step increment was associated with a 15% decreased risk of all-cause mortality [hazard ratio (HR) 0.85; 95% confidence interval (CI) 0.81-0.91; P < 0.001], while a 500-step increment was associated with a 7% decrease in CV mortality (HR 0.93; 95% CI 0.91-0.95; P < 0.001). Compared with the reference quartile with median steps/day 3867 (2500-6675), the Quartile 1 (Q1, median steps: 5537), Quartile 2 (Q2, median steps 7370), and Quartile 3 (Q3, median steps 11 529) were associated with lower risk for all-cause mortality (48, 55, and 67%, respectively; P < 0.05, for all). Similarly, compared with the lowest quartile of steps/day used as reference [median steps 2337, interquartile range 1596-4000), higher quartiles of steps/day (Q1 = 3982, Q2 = 6661, and Q3 = 10 413) were linearly associated with a reduced risk of CV mortality (16, 49, and 77%; P < 0.05, for all). Using a restricted cubic splines model, we observed a nonlinear dose-response association between step count and all-cause and CV mortality (Pnonlineraly < 0.001, for both) with a progressively lower risk of mortality with an increased step count. CONCLUSION This meta-analysis demonstrates a significant inverse association between daily step count and all-cause mortality and CV mortality with more the better over the cut-off point of 3867 steps/day for all-cause mortality and only 2337 steps for CV mortality.
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Affiliation(s)
- Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, Lodz 93-338, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Rzgowska 281/289; 93-338 Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zyty 28, 65-046 Zielona Gora, Poland
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD 21287, USA
| | - Joanna Lewek
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, Lodz 93-338, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Rzgowska 281/289; 93-338 Lodz, Poland
| | - Stanisław Surma
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Peter E Penson
- Liverpool Centre for Cardiovascular Science, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Western Australia, Mashhad, Vakilabad Blvd., 9177948954, Iran
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD 21287, USA
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, SE 901 87 UmeåSweden
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, SE 901 87 UmeåSweden
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Center Zagreb, Mije Kišpatića 12, 10000, Zagreb, Croatia
| | - Agata Bielecka-Dąbrowa
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, Lodz 93-338, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Rzgowska 281/289; 93-338 Lodz, Poland
| | - Ibadete Bytyçi
- Clinic of Cardiology, University Clinical Centre of Kosova, Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, SE 901 87 UmeåSweden
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Backhouse EV, Bauermeister S, Wardlaw JM. Lifetime influences on imaging markers of adverse brain health and vascular disease. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100194. [PMID: 38292018 PMCID: PMC10827485 DOI: 10.1016/j.cccb.2023.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/13/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
Cerebral small vessel disease (cSVD) is highly prevalent in the general population, increases with age and vascular risk factor exposure, and is a common cause of stroke and dementia. There is great variation in cSVD burden experienced in older age, and maintaining brain health across the life course requires looking beyond an individual's current clinical status and traditional vascular risk factors. Of particular importance are social determinants of health which can be more important than healthcare or lifestyle choices in influencing later life health outcomes, including brain health. In this paper we discuss the social determinants of cerebrovascular disease, focusing on the impact of socioeconomic status on markers of cSVD. We outline the potential mechanisms behind these associations, including early life exposures, health behaviours and brain reserve and maintenance, and we highlight the importance of public health interventions to address the key determinants and risk factors for cSVD from early life stages.
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Affiliation(s)
- Ellen V Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- MRC UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Bauermeister
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- MRC UK Dementia Research Institute, University of Oxford, Oxford OX3 7JX, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- MRC UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
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8
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Liu D, Cai X, Yang Y, Wang S, Mei L, Jing J, Li S, Wang M, Chen Y, Meng X, Wei T, Wang Y, Wang Y, Pan Y. Association between Life's Essential 8 and Cerebral Small Vessel Disease. Stroke Vasc Neurol 2023:svn-2023-002628. [PMID: 37989483 DOI: 10.1136/svn-2023-002628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Given that associations of Life's Essential 8 (LE8) and cerebral small vessel disease (CSVD) or its imaging markers were unclear, we examined relationship between them. METHODS The cross-sectional study included community residents from the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events study. We calculated the total LE8 score, medical LE8 score and behavioural score, and categorised them into low (<60), moderate (60-79) or high (≥80) group. MRI markers included lacunes, white matter hyperintensities (WMH), enlarged perivascular spaces in basal ganglia (BG-EPVS) and cerebral microbleeds (CMB). In respect of, total CSVD score (0-4 points), WMH, lacunes or CMB were categorised as two grades, and BG-EPVS (N>10) was allocated one point. Based on modified total CSVD score (0-6 points), WMH or CMB was modified to three grades, and BG-EPVS (N>20) was allocated one point. RESULTS Among 3061 participants in this study, 1424 (46.5%) were male. Higher LE8 score was associated with lower total CSVD score (moderate vs low: cOR 0.78, 95% CI 0.63 to 0.96; high vs low: cOR 0.44, 95% CI 0.33 to 0.59), and the medical score was inversely related to the total CSVD score. Furthermore, the medical score was inversely related to odds of WMH (p<0.05), modified WMH (p<0.05), lacunes (p<0.05) or BG-EPVS (p<0.05), and the behavioural score were inversely related to the odds of lacunes and BG-EPVS. CONCLUSIONS Higher LE8 score which indicates better cardiovascular status was associated with lower burden of CSVD and its MRI markers. Longitudinal studies are needed to examine the causality.
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Affiliation(s)
- Dandan Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, People's Republic of China
| | - Xueli Cai
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Lishui Clinical Research Center for Neurological Diseases, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Suying Wang
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Lerong Mei
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Shan Li
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Yun Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Tiemin Wei
- Department of Cardiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
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9
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Moniruzzaman M, Kadota A, Hisamatsu T, Segawa H, Kondo K, Torii S, Miyagawa N, Fujiyoshi A, Yano Y, Watanabe Y, Shiino A, Nozaki K, Ueshima H, Miura K. Relationship between Serum Irisin Levels and MRI-Measured Cerebral Small Vessel Disease in Japanese Men. J Atheroscler Thromb 2023; 30:1045-1056. [PMID: 36384910 PMCID: PMC10406628 DOI: 10.5551/jat.63824] [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: 07/14/2022] [Accepted: 09/30/2022] [Indexed: 08/04/2023] Open
Abstract
AIM Irisin, an exercise-induced myokine, is a potential neurotrophic factor; however, its relationship with cerebral small vessel disease (CSVD) remains unknown. Therefore, we investigated whether serum irisin levels are associated with CSVD in healthy Japanese men. METHODS We analyzed data from 720 men free of stroke and participated in this observational study. Serum irisin levels were measured by enzyme-linked immunosorbent assay. CSVD was assessed on deep and subcortical white matter hyperintensities (DSWMHs), periventricular hyperintensities (PVHs), lacunar infarcts (LIs), and cerebral microbleeds (CMBs) on brain magnetic resonance imaging. We calculated the total CSVD score (ranges 0-4) to express the total CSVD burden. We computed the adjusted odds ratios (ORs), with 95% confidence intervals (CIs), of the total CSVD score and individual CSVD features using logistic regression models according to the quartiles of irisin (reference: Q1). RESULTS Serum irisin levels were associated with lower ORs of higher (vs. zero or lower score) total CSVD score, with the lowest risk (OR, 0.63; 95% CI, 0.41-0.97) being observed in Q3 compared to Q1 after adjustment of potential covariates. Similar results were obtained for younger adults (<65 years). Among individual CSVD features, irisin was associated with a reduced risk of LIs in the total sample and PVHs, LIs, and CMBs in younger adults. No relationship was observed in older adults (≥ 65 years). CONCLUSIONS Serum irisin levels were associated with less burden of total CSVD in healthy Japanese men. Serum irisin levels were also related with a reduced risk of PVHs, LIs, and CMBs, but not DSWMHs.
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Affiliation(s)
- Mohammad Moniruzzaman
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Aya Kadota
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | | | - Hiroyoshi Segawa
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Naoko Miyagawa
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Akira Fujiyoshi
- Department of Hygiene, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuichiro Yano
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Akihiko Shiino
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
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10
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Chung CP, Ihara M, Hilal S, Chen LK. Targeting cerebral small vessel disease to promote healthy aging: Preserving physical and cognitive functions in the elderly. Arch Gerontol Geriatr 2023; 110:104982. [PMID: 36868073 DOI: 10.1016/j.archger.2023.104982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
Cerebral small vessel disease (SVD), which is highly age-related, is the most common neuroimaging finding in community-dwelling elderly individuals. In addition to increasing the risk of dementia and stroke, SVD is associated with cognitive and physical (particularly gait speed) functional impairments in the elderly. Here, we provide evidence suggesting covert SVD, e.g. without clinically evident stroke or dementia, as a critical target to preserve the functional ability that enables well-being in older age. First, we discuss the relationship between covert SVD and geriatric syndrome. SVD lesions found in non-demented, stroke-free elderly are actually not "silent" but are associated with accelerated age-related functional decline. We also review the brain structural and functional abnormalities associated with covert SVD and the possible mechanisms underlying their contributions to SVD-related cognitive and physical functional impairments. Finally, we reveal current data, though limited, on the management of elderly patients with covert SVD to prevent SVD lesion progression and functional decline. Although it is important in aging health, covert SVD is still under-recognized or misjudged by physicians in both neurological and geriatric professions. Improving the acknowledgment, detection, interpretation, and understanding of SVD would be a multidisciplinary priority to maintain cognitive and physical functions in the elderly. The dilemmas and future directions of clinical practice and research for the elderly with covert SVD are also included in the present review.
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Affiliation(s)
- Chih-Ping Chung
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Center for Health Longevity and Aging Sciences, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Memory Aging and Cognition Center, National University Health System, Singapore
| | - Liang-Kung Chen
- Center for Health Longevity and Aging Sciences, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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11
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The evolution of human step counts and its association with the risk of chronic disease. Curr Biol 2022; 32:R1206-R1214. [PMID: 36347224 DOI: 10.1016/j.cub.2022.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Walking - humans' most fundamental form of moderate intensity physical activity - is associated with reduced risks of morbidity and mortality. Evolutionary perspectives have contributed much to understanding the effects of walking and other physical activities on health; however, we know comparatively little about how step counts (steps taken per day) changed over the course of human evolution, potentially affecting how selection operated on physiological responses to moderate intensity physical activity that influence morbidity and mortality. Here, we compare step counts across humans and our closest living relatives, the great apes. Compiling data from epidemiology and comparative physiology, we show how step counts more than tripled during human evolution, potentially linking higher levels of moderate intensity physical activity with reduced morbidity and mortality, and we highlight how recent decreases in step counts are an evolutionary mismatch. We raise the hypothesis that the dose-response relationship between moderate intensity physical activity and health was shifted in humans to require more steps per day to promote extended healthspan and lifespan.
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12
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Del Pozo Cruz B, Ahmadi MN, Lee IM, Stamatakis E. Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality. JAMA Intern Med 2022; 182:1139-1148. [PMID: 36094529 PMCID: PMC9468953 DOI: 10.1001/jamainternmed.2022.4000] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Recommendations for the number of steps per day may be easier to enact for some people than the current time- and intensity-based physical activity guidelines, but the evidence to support steps-based goals is limited. OBJECTIVE To describe the associations of step count and intensity with all-cause mortality and cancer and cardiovascular disease (CVD) incidence and mortality. DESIGN, SETTING, AND PARTICIPANTS This population-based prospective cohort study used data from the UK Biobank for 2013 to 2015 (median follow-up, 7 years) and included adults 40 to 79 years old in England, Scotland, and Wales. Participants were invited by email to partake in an accelerometer study. Registry-based morbidity and mortality were ascertained through October 2021. Data analyses were performed during March 2022. EXPOSURES Baseline wrist accelerometer-measured daily step count and established cadence-based step intensity measures (steps/min): incidental steps, (<40 steps/min), purposeful steps (≥40 steps/min); and peak-30 cadence (average steps/min for the 30 highest, but not necessarily consecutive, min/d). MAIN OUTCOMES AND MEASURES All-cause mortality and primary and secondary CVD or cancer mortality and incidence diagnosis. For cancer, analyses were restricted to a composite cancer outcome of 13 sites that have a known association with reduced physical activity. Cox restricted cubic spline regression models were used to assess the dose-response associations. The linear mean rate of change (MRC) in the log-relative hazard ratio for each outcome per 2000 daily step increments were also estimated. RESULTS The study population of 78 500 individuals (mean [SD] age, 61 [8] years; 43 418 [55%] females; 75 874 [97%] White individuals) was followed for a median of 7 years during which 1325 participants died of cancer and 664 of CVD (total deaths 2179). There were 10 245 incident CVD events and 2813 cancer incident events during the observation period. More daily steps were associated with a lower risk of all-cause (MRC, -0.08; 95% CI, -0.11 to -0.06), CVD (MRC, -0.10; 95% CI, -0.15 to -0.06), and cancer mortality (MRC, 95% CI, -0.11; -0.15 to -0.06) for up to approximately 10 000 steps. Similarly, accruing more daily steps was associated with lower incident disease. Peak-30 cadence was consistently associated with lower risks across all outcomes, beyond the benefit of total daily steps. CONCLUSIONS AND RELEVANCE The findings of this population-based prospective cohort study of 78 500 individuals suggest that up to 10 000 steps per day may be associated with a lower risk of mortality and cancer and CVD incidence. Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.
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Affiliation(s)
- Borja Del Pozo Cruz
- Department of Sports Science and Clinical Biomechanics, Centre for Active and Healthy Ageing, University of Southern Denmark, Odense, Denmark
| | - Matthew N Ahmadi
- Faculty of Medicine and Health, Charles Perkin Centre, School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - I-Min Lee
- Division of Preventive Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Emmanuel Stamatakis
- Faculty of Medicine and Health, Charles Perkin Centre, School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
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13
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Lu W, Yu C, Wang L, Wang F, Qiu J. Perfusion heterogeneity of cerebral small vessel disease revealed via arterial spin labeling MRI and machine learning. Neuroimage Clin 2022; 36:103165. [PMID: 36037662 PMCID: PMC9434130 DOI: 10.1016/j.nicl.2022.103165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
Cerebral small vessel disease (CSVD) is associated with altered cerebral perfusion. However, global and regional cerebral blood flow (CBF) are highly heterogeneous across CSVD patients. The aim of this study was to identify subtypes of CSVD with different CBF patterns using an advanced machine learning approach. 121 CSVD patients and 53 healthy controls received arterial spin label MRI, T1 structural MRI and clinical measurements. Regional CBF were used to identify distinct perfusion subtypes of CSVD via a semi-supervised machine learning algorithm. Statistical analyses were used to explore alterations in CBF, clinical measures, gray and white matter volume between healthy controls and different subtypes of CSVD. Correlation analysis was used to assess the association between clinical measures and altered CBF in each CSVD subtype. Three subtypes of CSVD with distinct CBF patterns were found. Subtype 1 showed decreased CBF in the temporal lobe and increased CBF in the parietal and occipital lobe. Subtype 2 exhibited decreased CBF in the right hemisphere of the brain, and increased CBF in the left cerebrum. Subtype 3 demonstrated decreased CBF in the posterior part of the brain, and increased CBF in anterior part of the brain. The three subtypes also differed significantly in gender (p = 0.005), the proportion of subjects with lacune (p = 0.002), with periventricular white matter hyperintensity (p = 0.043), and CSVD burden score (p = 0.048). In subtype 3, it was found that widespread decreased CBF was correlated with total CSVD burden score (r = -0.324, p = 0.029). Compared with healthy controls, the three CSVD subtypes also showed distinct volumetric patterns of white matter. The current results associate different subtypes with different clinical and imaging phenotypes, which can improve the understanding of brain perfusion alterations of CSVD and can facilitate precision diagnosis of CSVD.
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Affiliation(s)
- Weizhao Lu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China,School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Chunyan Yu
- School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Liru Wang
- School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Feng Wang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China,Corresponding authors at: No. 706 Taishan Street, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China (F. Wang). No. 619 Changcheng Road, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian 271000, China (J. Qiu).
| | - Jianfeng Qiu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China,School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China,Corresponding authors at: No. 706 Taishan Street, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China (F. Wang). No. 619 Changcheng Road, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian 271000, China (J. Qiu).
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14
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Kondo K, Arima H, Fujiyoshi A, Sekikawa A, Kadota A, Hisamatsu T, Torii S, Shiino A, Morino K, Miyagawa N, Segawa H, Watanabe Y, Maegawa H, Nozaki K, Miura K, Ueshima H. Differential Association of Serum n-3 Polyunsaturated Fatty Acids with Various Cerebrovascular Lesions in Japanese Men. Cerebrovasc Dis 2022; 51:774-780. [PMID: 35477146 DOI: 10.1159/000524243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/02/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND An association between a high intake of marine-derived n-3 polyunsaturated fatty acids (n-3 PUFAs) with a lower risk of coronary heart disease was previously reported. However, the association between n-3 PUFAs and cerebrovascular lesions remains unclear. We evaluated this association in a general-population-based sample of Japanese men. METHODS Participants were community-dwelling men (40-79 years old) living in Kusatsu City, Shiga, Japan. Serum concentrations of n-3 PUFAs, defined as the sum of eicosapentaenoic and docosahexaenoic acids, were measured via gas-liquid chromatography between 2006 and 2008. Magnetic resonance imaging was used to assess cerebrovascular lesions (including intracerebral large-artery stenosis, lacunar infarction, and microbleeds) and white matter lesions between 2012 and 2015. Logistic regression adjusting for conventional cardiovascular risk factors was used to estimate the odds ratio of prevalent cerebrovascular lesions per 1 standard deviation higher serum concentration of n-3 PUFAs. RESULTS Of a total of 739 men, the numbers (crude prevalence in %) of prevalent cerebral large-artery stenoses, lacunar infarctions, microbleeds, and white matter lesions were 222 (30.0), 162 (21.9), 103 (13.9), and 164 (22.2), respectively. A 1 standard deviation higher concentration of n-3 PUFAs (30.5 μmol/L) was independently associated with lower odds of cerebral large-artery stenosis (multivariable-adjusted odds ratio, 0.80; 95% confidential interval, 0.67-0.97). There were no significant associations of n-3 PUFAs with the other types of lesions. CONCLUSIONS n-3 PUFAs may have protective effects against large-artery stenosis, but not small vessel lesions, in the brain.
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Affiliation(s)
- Keiko Kondo
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akira Fujiyoshi
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Akira Sekikawa
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aya Kadota
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Takashi Hisamatsu
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sayuki Torii
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Akihiko Shiino
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Katsutaro Morino
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Naoko Miyagawa
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyoshi Segawa
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Hirotsugu Ueshima
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
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15
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Five years of exercise intervention at different intensities and development of white matter hyperintensities in community dwelling older adults, a Generation 100 sub-study. Aging (Albany NY) 2022; 14:596-622. [PMID: 35042832 PMCID: PMC8833118 DOI: 10.18632/aging.203843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
We investigated if a five-year supervised exercise intervention with moderate-intensity continuous training (MICT) or high-intensity interval training (HIIT) versus control; physical activity according to national guidelines, attenuated the growth of white matter hyperintensities (WMH). We hypothesized that supervised exercise, in particular HIIT, reduced WMH growth. Older adults from the general population participating in the RCT Generation 100 Study were scanned at 3T MRI at baseline (age 70–77), and after 1-, 3- and 5-years. At each follow-up, cardiorespiratory fitness was measured with ergospirometry, and physical activity plus clinical data collected. Manually delineated total WMH, periventricular (PWMH), deep (DWMH), and automated total white matter hypointensity volumes were obtained. No group by time interactions were present in linear mixed model analyses with the different WMH measurements as outcomes. In the combined exercise (MICT&HIIT) group, a significant group by time interaction was uncovered for PWMH volume, with a larger increase in the MICT&HIIT group. Cardiorespiratory fitness at the follow-ups or change in cardiorespiratory fitness over time were not associated with any WMH measure. Contrary to our hypothesis, taking part in MICT or HIIT over a five-year period did not attenuate WMH growth compared to being in a control group following national physical activity guidelines.
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16
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Wong A, Lam BYK, Mak MKY, Lam LCW, Au LWC, Yiu BKF, Wong C, Tong HY, Yeung SK, Chu WCW, Shi L, Leung TWH, Soo YOY, Lau AYL, Ip BYM, Kwok TCY, Ko H, Mok VCT. Aerobic exercise in older people with subclinical sporadic cerebral small vessel disease: A randomized clinical trial. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12224. [PMID: 35005205 PMCID: PMC8719349 DOI: 10.1002/trc2.12224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The benefit and risk of aerobic exercise among older people harboring advanced cerebral small vessel disease (CSVD) upon cognition, mood, and motor functions are unknown. METHODS This rater-blind randomized trial examined effects of a 24-week aerobic exercise training (60 min/session, twice/week) upon clinical (cognition, mood, motor functions) and hemodynamic (pulse pressure [PP], blood pressure [BP], pulsatility index) measures in older people harboring moderate to severe CSVD, as evidenced by confluent white matter hyperintensity and/or ≥2 lacunes on magnetic resonance imaging. We further investigated interactions between treatment conditions and hemodynamics measures. RESULTS Fifty-three and 54 subjects were randomized into the active and control group, respectively. There was no between-group difference in any of the clinical outcomes. The active group had a greater between-group reduction in systolic BP and PP than the control group. Within-group comparison showed that global cognition of the active group remained similar at end of the study compared to baseline, whereas it declined significantly in the control group. We observed "diverging" interaction effects in that greater reduction in systolic BP/PP was associated with greater improvement in memory functions and global cognition but worsening in processing speed in the active group. Side effects were comparable between the two groups. DISCUSSION Future study should investigate the mechanisms of the diverging impacts of aerobic exercise upon different cognitive domains so that the benefit-risk ratio of aerobic exercise in older people harboring more advanced CSVD can be better defined.
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Affiliation(s)
- Adrian Wong
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Bonnie Yin Ka Lam
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Margaret Kit Yi Mak
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong Kong SARChina
| | - Linda Chiu Wa Lam
- Department of PsychiatryFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Lisa Wing Chi Au
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Brian Ka Fung Yiu
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Chun Wong
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Hor Yee Tong
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Sin Ki Yeung
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional RadiologyFaculty of MedicineThe Chinese University of Hong KongShatin, New TerritoriesHong Kong SARChina
| | - Lin Shi
- Department of Imaging and Interventional RadiologyFaculty of MedicineThe Chinese University of Hong KongShatin, New TerritoriesHong Kong SARChina
- BrainNow Research InstituteShenzhenGuangdong ProvinceChina
| | - Thomas Wai Hong Leung
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Yannie Oi Yan Soo
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Alexander Yuk Lun Lau
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Bonaventure Yiu Ming Ip
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Timothy Chi Yui Kwok
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Ho Ko
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
- Li Ka Shing Institute of Health SciencesFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Vincent Chung Tong Mok
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
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17
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Sheng M, Yang J, Bao M, Chen T, Cai R, Zhang N, Chen H, Liu M, Wu X, Zhang B, Liu Y, Chao J. The relationships between step count and all-cause mortality and cardiovascular events: A dose-response meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:620-628. [PMID: 34547483 PMCID: PMC8724621 DOI: 10.1016/j.jshs.2021.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/01/2021] [Accepted: 07/21/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND A goal of 10,000 steps per day is widely advocated, but there is little evidence to support that goal. Our purpose was to examine the dose-response relationships between step count and all-cause mortality and cardiovascular disease risk. METHODS Cochrane Central Register of Controlled Trials, EMBASE, OVID, PubMed, Scopus, and Web of Science databases were systematically searched for studies published before July 9, 2021, that evaluated the association between daily steps and at least 1 outcome. RESULTS Sixteen publications (12 related to all-cause mortality, 5 related to cardiovascular disease; and 1 article contained 2 outcomes: both all-cause death and cardiovascular events) were eligible for inclusion in the meta-analysis. There was evidence of a nonlinear dose-response relationship between step count and risk of all-cause mortality or cardiovascular disease (p = 0.002 and p = 0.014 for nonlinearity, respectively). When we restricted the analyses to accelerometer-based studies, the third quartile had a 40.36% lower risk of all-cause mortality and a 35.05% lower risk of cardiovascular event than the first quartile (all-cause mortality: Q1 = 4183 steps/day, Q3 = 8959 steps/day; cardiovascular event: Q1 = 3500 steps/day, Q3 = 9500 steps/day; respectively). CONCLUSION Our meta-analysis suggests inverse associations between higher step count and risk of premature death and cardiovascular events in middle-aged and older adults, with nonlinear dose-response patterns.
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Affiliation(s)
- Mingxin Sheng
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Junyue Yang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Min Bao
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Tianzhi Chen
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - Ruixue Cai
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Na Zhang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Hongling Chen
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Minqi Liu
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Xueyu Wu
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Bowen Zhang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Yiting Liu
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Jianqian Chao
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China.
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18
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Wardlaw JM, Debette S, Jokinen H, De Leeuw FE, Pantoni L, Chabriat H, Staals J, Doubal F, Rudilosso S, Eppinger S, Schilling S, Ornello R, Enzinger C, Cordonnier C, Taylor-Rowan M, Lindgren AG. ESO Guideline on covert cerebral small vessel disease. Eur Stroke J 2021; 6:CXI-CLXII. [PMID: 34414301 PMCID: PMC8370079 DOI: 10.1177/23969873211012132] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/02/2021] [Indexed: 12/11/2022] Open
Abstract
'Covert' cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke, cognitive impairment, dependency, and death. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist with clinical decisions about management of ccSVD, specifically white matter hyperintensities and lacunes, to prevent adverse clinical outcomes. The guidelines were developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We prioritised the clinical outcomes of stroke, cognitive decline or dementia, dependency, death, mobility and mood disorders, and interventions of blood pressure lowering, antiplatelet drugs, lipid lowering, lifestyle modifications, glucose lowering and conventional treatments for dementia. We systematically reviewed the literature, assessed the evidence, formulated evidence-based recommendations where feasible, and expert consensus statements. We found little direct evidence, mostly of low quality. We recommend patients with ccSVD and hypertension to have their blood pressure well controlled; lower blood pressure targets may reduce ccSVD progression. We do not recommend antiplatelet drugs such as aspirin in ccSVD. We found little evidence on lipid lowering in ccSVD. Smoking cessation is a health priority. We recommend regular exercise which may benefit cognition, and a healthy diet, good sleep habits, avoiding obesity and stress for general health reasons. In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments. Randomised controlled trials with clinical endpoints are a priority for ccSVD.
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Affiliation(s)
- Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Stephanie Debette
- Bordeaux Population Health Center, University of Bordeaux, INSERM, UM1219, Team VINTAGE
- Department of Neurology, Institute for Neurodegenerative Disease, Bordeaux University Hospital, Bordeaux, France
| | - Hanna Jokinen
- HUS Neurocenter, Division of Neuropsychology, Helsinki University Hospital, University of Helsinki and Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Frank-Erik De Leeuw
- Radboud University Medical Center, Department of Neurology; Donders Center for Medical Neuroscience, Nijmegen, The Netherlands
| | - Leonardo Pantoni
- Stroke and Dementia Lab, 'Luigi Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | - Hugues Chabriat
- Department of Neurology, Hopital Lariboisiere, APHP, INSERM U 1161, FHU NeuroVasc, University of Paris, Paris, France
| | - Julie Staals
- Department of Neurology, School for Cardiovascular Diseases (CARIM), Maastricht UMC+, AZ Maastricht, the Netherlands
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Dept of Medicine for the Elderly, University of Edinburgh, Edinburgh, UK
| | - Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic, Barcelona, Spain
| | - Sebastian Eppinger
- University Clinic of Neurology, Medical University of Graz, Graz, Austria
| | - Sabrina Schilling
- Bordeaux Population Health Center, University of Bordeaux, INSERM, UM1219, Team VINTAGE
| | - Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy
| | - Christian Enzinger
- University Clinic of Neurology, Medical University of Graz, Graz, Austria
| | - Charlotte Cordonnier
- Univ. Lille, INSERM, CHU Lille, U1172, LilNCog – Lille Neuroscience & Cognition, Lille, France
| | - Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Arne G Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University; Section of Neurology, Skåne University Hospital, Lund, Sweden
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