Bilateral studies of cerebral oxygen uptake in young and aged normal subjects and in patients with organic dementia

Effects of Ketone Bodies on Brain Metabolism and Function in Neurodegenerative Diseases

Under normal physiological conditions the brain primarily utilizes glucose for ATP generation. However, in situations where glucose is sparse, e.g., during prolonged fasting, ketone bodies become an important energy source for the brain. The brain’s utilization of ketones seems to depend mainly on the concentration in the blood, thus many dietary approaches such as ketogenic diets, ingestion of ketogenic medium-chain fatty acids or exogenous ketones, facilitate significant changes in the brain’s metabolism. Therefore, these approaches may ameliorate the energy crisis in neurodegenerative diseases, which are characterized by a deterioration of the brain’s glucose metabolism, providing a therapeutic advantage in these diseases. Most clinical studies examining the neuroprotective role of ketone bodies have been conducted in patients with Alzheimer’s disease, where brain imaging studies support the notion of enhancing brain energy metabolism with ketones. Likewise, a few studies show modest functional improvements in patients with Parkinson’s disease and cognitive benefits in patients with—or at risk of—Alzheimer’s disease after ketogenic interventions. Here, we summarize current knowledge on how ketogenic interventions support brain metabolism and discuss the therapeutic role of ketones in neurodegenerative disease, emphasizing clinical data.

Impacts of Microgravity Analogs to Spaceflight on Cerebral Autoregulation

It is well known that exposure to microgravity in astronauts leads to a plethora physiological responses such as headward fluid shift, body unloading, and cardiovascular deconditioning. When astronauts return to Earth, some encounter problems related to orthostatic intolerance. An impaired cerebral autoregulation (CA), which could be compromised by the effects of microgravity, has been proposed as one of the mechanisms responsible for orthostatic intolerance. CA is a homeostatic mechanism that maintains cerebral blood flow for any variations in cerebral perfusion pressure by adapting the vascular tone and cerebral vessel diameter. The ground-based models of microgravity are useful tools for determining the gravitational impact of spaceflight on human body. The head-down tilt bed rest (HDTBR), where the subject remains in supine position at -6 degrees for periods ranging from few days to several weeks is the most commonly used ground-based model of microgravity for cardiovascular deconditioning. head-down bed rest (HDBR) is able to replicate cephalic fluid shift, immobilization, confinement, and inactivity. Dry immersion (DI) model is another approach where the subject remains immersed in thermoneutral water covered with an elastic waterproof fabric separating the subject from the water. Regarding DI, this analog imitates absence of any supporting structure for the body, centralization of body fluids, immobilization and hypokinesia observed during spaceflight. However, little is known about the impact of microgravity on CA. Here, we review the fundamental principles and the different mechanisms involved in CA. We also consider the different approaches in order to assess CA. Finally, we focus on the effects of short- and long-term spaceflight on CA and compare these findings with two specific analogs to microgravity: HDBR and DI.

Regional Cerebral Blood Flow Statistical Patterns and Psychological Performance in Multi-Infarct Dementia and Alzheimer’s Disease

Multivariate data analysis statistical procedures were applied to identify regional cerebral blood flow (rCBF) patterns in patients with multi-infarct dementia (M.I.D.) and Alzheimer’s disease (A.D.) when compared to a control group (C). A fronto-temporal-parietal pattern was identified for the A.D. group. The M.I.D. group demonstrated a predominant temporal-parietal pattern. A discriminant function analysis classified 96% of the A.D. and C. patients correctly. One hundred percent hit rate was obtained in discriminating between M.I.D. and C. Discrimination of A.D. and M.I.D. obtained 82% diagnostic accuracy. When the three groups were compared the hit rate was 93%. Mean rCBF and mean relative weight of the gray matter (Wg) differences were found when each dementia group was compared with C.M.I.D. and A.D. did not differ in mean rCBF but significant differences were found for Wg, with M.I.D. having greater reduction. The performance on standardized psychological tests of two independent samples of A.D. and M.I.D. were compared. The Memory Quotient from the Wechsler Memory Scale was consistently more impaired for the A.D. group. No correlation between degree of psychological impairment and rCBF or W g reduction was found.

A reassessment of the blood-brain barrier transport of large neutral amino acids during acute systemic inflammation in humans

We reassessed data from a previous study on the transcerebral net exchange of large neutral amino acids (LNAAs) using a novel mathematical model of blood-brain barrier (BBB) transport. The study included twelve healthy volunteers who received a 4-h intravenous lipopolysaccharide (LPS) infusion (total dose: 0·3 ng/kg), a human experimental model of the systemic inflammatory response during the early stages of sepsis. Cerebral blood flow and arterial-to-jugular venous LNAA concentrations were measured prior to and after LPS, and the BBB transport and brain extracellular concentrations of LNAAs were calculated. The arterial concentration and unidirectional cerebral influx of phenylalanine increased after LPS. The BBB transport of tyrosine was unaffected, while its concentration in the brain extracellular fluid increased. These findings suggest that LPS infusion leads to an increased cerebral uptake of phenylalanine, which is then metabolized to tyrosine. This may reflect a neuroprotective mechanism that 'detoxifies' excess intracerebral phenylalanine in the clinical setting of sepsis.

Sources of variability of resting cerebral blood flow in healthy subjects: a study using ¹³³Xe SPECT measurements

Measurements of cerebral blood flow (CBF) show large variability among healthy subjects. The aim of the present study was to investigate the relative effect of established factors influencing CBF on the variability of resting CBF. We retrospectively analyzed spontaneous variability in 430 CBF measurements acquired in 152 healthy, young subjects using (133)Xe single-photon emission computed tomography. Cerebral blood flow was correlated positively with both end-tidal expiratory PCO₂ (PETCO₂) and female gender and inversely with hematocrit (Hct). Between- and within-subject CO₂ reactivity was not significantly different. Including PETCO₂, Hct and gender in the model reduced between-subject and within-subject variance by 14% and 13.5%, respectively. Within-subject variability was mainly influenced by PETCO₂ and between-subject variability mostly by Hct, whereas gender appeared to be of little added value when Hct was also accounted for. The present study confirms large between-subject variability in CBF measurements and that gender, Hct, and PETCO₂ explain only a small part of this variability. This implies that a large fraction of CBF variability may be due to unknown factors such as differences in neuron density or metabolism that could be subject for further studies.

A four-dimensional probabilistic atlas of the human brain

The authors describe the development of a four-dimensional atlas and reference system that includes both macroscopic and microscopic information on structure and function of the human brain in persons between the ages of 18 and 90 years. Given the presumed large but previously unquantified degree of structural and functional variance among normal persons in the human population, the basis for this atlas and reference system is probabilistic. Through the efforts of the International Consortium for Brain Mapping (ICBM), 7,000 subjects will be included in the initial phase of database and atlas development. For each subject, detailed demographic, clinical, behavioral, and imaging information is being collected. In addition, 5,800 subjects will contribute DNA for the purpose of determining genotype- phenotype-behavioral correlations. The process of developing the strategies, algorithms, data collection methods, validation approaches, database structures, and distribution of results is described in this report. Examples of applications of the approach are described for the normal brain in both adults and children as well as in patients with schizophrenia. This project should provide new insights into the relationship between microscopic and macroscopic structure and function in the human brain and should have important implications in basic neuroscience, clinical diagnostics, and cerebral disorders.

Electron microscopy of amyloid fibrils and microvessels

Senile plaques and microvessels in the cortices of brains with Alzheimer's disease were examined using serial sections under light and electron microscopes. In addition, observations were carried out by using an immunostaining method. The results obtained were as follows: (1) Every senile, plaque contains some amyloid fibrils, and many senile plaques have degenerated capillaries with amyloid fibrils. (2) Amyloid fibrils without senile plaques continue directly to the capillaries. (3) A considerable number of preamyloids are observed surrounding the capillaries when a methenamine silver stain is used. (4) Alpha 1-antichymotrypsin is found in amyloid fibrils, endothelial cells, and vascular feet or astrocytic processes. Our findings strongly suggest that amyloid fibrils forming senile plaques have a close relationship to the capillaries. Moreover, a protease inhibitor, such as alpha 1-antichymotrypsin, could possibly play an important role in producing the amyloid fibrils.

Correlation of cerebral blood flow and MCA flow velocity measured in healthy volunteers during acetazolamide and CO2 stimulation

The assessment of the cerebrovascular reserve capacity (RC) has become a widely used tool in the management of cerebrovascular disease. Discrepancies become obvious, however, if results obtained with different methods are compared. Aim of the present study, therefore, was to compare blood velocity and cerebral perfusion data in the same group of healthy test persons. In 32 volunteers regional cerebral blood flow (rCBF) was measured with the 133Xe-inhalation method. F1 as grey matter flow and the initial slope index (ISI) were computed. Simultaneously flow velocity in the middle cerebral artery (VMCA) was assessed by transcranial Doppler sonography (TCD). Measurements were performed in the resting state, during inhalation of 7% CO2 and after 1 g acetazolamide. Baseline VMCA was 62.38 +/- 16.1 cm/s, 90.84 +/- 23.85 cm/s during hypercapnia and 84.91 +/- 24.54 cm/s after acetazolamide. There was no significant change of baseline or stimulated values with age. F1 rose from baseline 76.25 +/- 12.48 ml/100 g/min to 103.90 +/- 14.6 ml/100 g/min in hypercapnia and to 98.4 +/- 14.9 ml/100 g/min after acetazolamide. The baseline F1 values and the response to CO2 decreased with age (p = 0.01) whereas for the acetazolamide reaction an age dependency could not be proven. ISI baseline values (41.5 +/- 6.1 ml/100 g/min) as well as those found after CO2 or acetazolamide decreased significantly with age. In hypercapnia changes of F1 and ISI were not too well related with changes of VMCA (F1: r = 0.599; ISI: r = 0.473), but better during acetazolamide exposure (F1: r4 = 0.715; ISI: r = 0.522). The age dependency of resting and stimulated values has to be considered when assessing the reserve capacity. There is a correlation between changes of the perfusion and flow parameters in healthy individuals which, however, may be worse in cerebrovascular disease.

Average blood flow and oxygen uptake in the human brain during resting wakefulness: a critical appraisal of the Kety-Schmidt technique

The Kety-Schmidt technique can be regarded as the reference method for measurement of global average cerebral blood flow (average CBF) and global average cerebral metabolic rate of oxygen (average CMRO2). However, in the practical application of the method, diffusion equilibrium for inert gas tracer between the brain and its venous blood is not reached. As a consequence, normal values for CBF and CMRO2 of 54 ml 100 g-1 min-1 and 3.5 ml 100 g-1 min-1 obtained with the Kety-Schmidt technique are an overestimation of the true values. Using the Kety-Schmidt technique we have performed 57 measurements of CBF and CMRO2 during EEG-verified wakeful rest in young normal adults. In order to estimate the equilibrium values for CBF and CMRO2, a simple computer-based simulation model was employed to quantitate the systematic overestimation caused by incomplete tracer equilibrium. When correcting the measured data, we find that the true average values for CBF and CMRO2 in the healthy young adult are approximately 46 ml 100 g-1 min-1 and approximately 3.0 ml 100 g-1 min-1. Previous studies have suggested that some of the variation in CMRO2 values could be ascribed to differences in cerebral venous anatomy. However in the present study, no correlation between CMRO2 and cerebral venous anatomy as imaged by magnetic resonance angiography could be established. Our data show that the interindividual variation of CMRO2 is 11% (coefficient of variation).

Intermediary metabolism disturbance in AD/SDAT and its relation to molecular events

1. Early-onset dementia of Alzheimer type (EODAT; AD) and late-onset dementia of Alzheimer type (LODAT; SDAT) are heterogenous in origin. 2. A common superordinate pathobiochemical principle in the etiopathogenesis of both types of dementia is neuronal energy failure with subsequent abnormalities in cellular Ca2+ homeostasis and glucose-related amino acid metabolism. 3. These metabolic abnormalities are assumed to occur first at axodendritic terminals of the acetylcholinergic-glutamatergic circuit and to cause morphological damage at synaptic sites. 4. Metabolic stress and structural damage at synaptic sites may induce enhanced formation of APP and its cleavage product amyloid. 5. Energy-metabolism related abnormalities along with functional and structural changes at synaptic sites of the acetylcholinergic-glutamatergic circuit may precede the formation of amyloid in DAT brain.

The use of positron emission tomography in the clinical assessment of dementia

A number of reasons can be cited for performing a test that identifies patients early in their course who have fatal and currently untreatable neurological disorders. At this stage of illness there is clinical ambiguity. The patient, family, and physician are typically faced with a battery of negative test results and an ambiguous clinical impression that can lead to periodic repetition of tests that involve cost, inconvenience, potential morbidity to the patient, and lack of definitive diagnosis. An accurate test would lead to the avoidance of these low-yield, repetitive, and costly evaluations. In addition, such studies can identify homogeneous groups of individuals with degenerative disorders leading to dementia who could be enrolled in experimental therapeutic programs. In these programs therapies could be monitored in an objective and noninvasive fashion using positron emission tomography (PET). The magnitude of the health problems resulting from the dementing illnesses is great in terms of medical practice, economics, and family hardship. The number of individuals with these disorders is predicted to increase dramatically in the future. The ability to provide an accurate diagnosis and more clear prognosis early in the disease course should diminish ambiguity for patients, families, and physicians. Ample evidence is cited in this article to show that PET has the ability to provide such information objectively and noninvasively.

Cerebral blood flow and cerebral oxygen consumption in patients with COPD on mechanical ventilation

OBJECTIVE

To investigate the effect of PaCO2 on cerebral blood flow (CBF) in chronic obstructive pulmonary disease (COPD).

DESIGN

Before-after trial.

SETTING

General ICU in a regional hospital.

PATIENTS

7 patients undergoing mechanical ventilation because of an exacerbation of COPD.

INTERVENTION

CBF and cerebral metabolic rate of oxygen (CMRO2) of COPD were measured before and after hyperventilation and were compared by those of normal patients. CBF was measured by the Kety-Schmidt technique using 15% N2O.

MEASUREMENTS/RESULTS

Hyperventilation produced a significant reduction in CBF in COPD with no concomitant change in CMRO2. CMRO2 in COPD was significantly lower than those in normal patients. The regression equation was shifted significantly more to the right in COPD.

CONCLUSION

The sensitivity of CBF in CO2 remained but CMRO2 was reduced markedly in COPD patients.

Vibration-induced regional cerebral blood flow responses in normal aging

Task-induced changes in regional CBF (rCBF) can be measured with positron emission tomography (PET) and provide a powerful tool to map brain function. Many studies using these techniques have investigated responses in healthy young subjects. Since many pathological conditions occur more commonly in older subjects, it is necessary to compare blood flow responses in these patients with appropriately age-matched controls. Furthermore, the effects of normal aging on such blood flow responses remain unknown. For both reasons, we designed this study to determine whether vibration-induced CBF responses change with advancing age in normals. CBF was measured with PET and bolus-administered H2(15)O in 26 subjects from 20 to 72 years old (mean = 39; SD = 19). Regional responses were identified by subtraction-image analysis. Left and right hand vibration produced consistent responses in contralateral primary sensorimotor area (PSA) and supplementary motor area (SMA). Response magnitudes were compared to age by linear regression. There were no substantial relationships between age and responses to vibration for PSA or SMA (PSA r = -0.28, p = 0.054; SMA r = -0.33, p = 0.13). Power analysis demonstrates a high degree of confidence (99.7% for PSA and 87% for SMA) for detecting at least a moderate correlation (r = 0.6) between response magnitude and age. We conclude that the rCBF responses to vibrotactile hand stimulation do not change with normal aging.

Age-dependent changes in the activity and isoenzymatic pattern of the phosphofructokinase in different areas of the central nervous systems

Regional activity of phosphofructokinase enzyme and the amount of the isoenzyme C in 7 areas of young, adult and aged rats brain have been studied. The phosphofructokinase activity in substantia nigra decreased in adult and aged rats, but the maximum decrease was found in the septum of aged rats. There is a regional distribution of the isoenzyme C in the different areas studied. There was a general decrease in the amount of this isoenzyme in the areas studied with the exception of the hippocampus and the amygdala. The highest decrease was found in the septal area and in the diagonal band of Broca. These results are discussed in relation to the aging in different regions.

Lateral asymmetries in primary degenerative dementia of the Alzheimer type. A correlative study of cognitive, haemodynamic and EEG data, in relation with severity, age of onset and sex

Cognitive, haemodynamic and EEG lateral asymmetries have been quantified in 20 patients with Primary Degenerative Dementia (PDD) and in 20 age-matched normal volunteers. Normalized asymmetry scores were calculated from the data obtained with a test battery, with SPECT and with quantitative EEG. Significant correlations were found between cognitive, haemodynamic and EEG scores in patients but not in controls. The functional asymmetries correlated to the Mini Mental State (MMS) score, the lowest MMS values being observed in patients with right hemisphere predominant impairment. Besides, in these patients, a significant correlation was observed between age at onset and MMS score so that, in this subgroup only, the earlier the onset the more severe the disease. Finally, the prevalence of pronounced functional asymmetry seemed to be higher in our male patients. Our study shows that lateral asymmetries are frequent in patients with PDD and that preferential lateralization of the abnormalities should be given further attention, especially with regards to age, sex and overall severity.

Ammonia is endogenously generated in the brain in the presence of presumed and verified dementia of Alzheimer type

The healthy, mature, non-starved brain was found to take up a small amount of ammonia on average 7.22 +/- 0.72 micrograms/100 g x min. In contrast, in patients thought to be suffering from incipient early-onset dementia of the Alzheimer type (DAT) the brain released a larger amount of ammonia on average 25.59 +/- 16.17 micrograms/100 g x min. In advanced DAT states, an average of 2.73 +/- 0.32 micrograms/100 g x min was released indicating the temporary nature of the severe loss of amino-N during the early stages of presumed DAT. Detrimental effects of endogenously formed ammonia on brain metabolism may affect the membrane potential, the excitability of neurons, and the energy metabolism. Ammonia may be assumed to be involved in the morphological changes in astrocytes and in the gliosis observed in early degeneration related to DAT. Endogenously generated brain ammonia thus may have a role in the cascade of cell damaging events in presumed incipient DAT.

Potassium-induced increases in oxygen consumption are diminished by age in rat hippocampal slices

Previous reports showed that cytochrome alpha,alpha 3 responded to heightened brain activity with shifts toward oxidation in adult rats but toward reduction in aged animals. To determine whether this change indicates an age-associated limitation in mitochondrial respiratory capacity, the present study compared oxygen consumption in hippocampal slices of young adult (6 month, control) and aged (26 month) rats. Slices were used to insure that results were independent of cerebrovascular factors. Age was without effect on oxygen consumption under 'resting' conditions (i.e. with slices bathed at 3.5 mM K+), but oxygen consumption was not increased as much in hippocampal slices from aged rats under heightened energy demands (produced by raising the extracellular potassium ion activity [( K+]o to 50 mM). This lesser oxygen consumption response to enhanced metabolic demand suggests that there are age-associated limits to the brain's ability to increase its metabolic rate.

Regional cerebral blood flow characteristics and variations with age in resting normal subjects

Regional cerebral blood flow (rCBF) was measured during resting in 97 normal subjects, 19-68 years old. The results showed that the mean CBF level decreased progressively with age. The decrease was more prominent in frontotemporal and inferior Rolandic areas bilaterally. Frontal areas showed the highest values in all age groups. This hyperfrontality weakened somewhat with age. Mean CBF in the right hemisphere was significantly higher than in the left, as was flow in superior frontal, inferior frontal, and parietal areas. These asymmetries were age invariant. The age-related decrease of rCBF is interpreted as reflecting aging of the brain per se, although the influence of asymptomatic brain disease can not be ruled out. The flow asymmetries are interpreted as being related to functional lateralization of some aspects of attentional activation.

Morphological changes of microvessels in the brain with Alzheimer's disease

The pathological changes of microvessels in the cerebral cortex in Alzheimer's disease were examined at the ultrastructural level. With transmission electron microscopy (TEM), the endothelial cells of many capillaries and their pericytes exhibited atrophy and swelling with a narrowed lumen. The capillary basal laminas were thickened and tortuous. After isolation of the microvessels by ultrasonic treatment and collagenase digestion, the vascular wall structure was viewed by scanning electron microscopy (SEM). Most of the terminal arterioles had smooth muscle cells with an irregular shape and arrangement and often showed a series of focal constrictions. In some areas, the capillaries were arrayed in a bundle and terminated with tapered ends. Associated with the microvessels were fine filaments which may represent amyloid fibrils. The findings indicate that diffuse atrophy and the deletion of nerve cells in the cerebral cortex might be caused, at least partly, by a circulatory disturbance through the pathomorphologically changed microvessels.

Glucose metabolism as the site of the primary abnormality in early-onset dementia of Alzheimer type?

Global cerebral blood flow, oxidative brain metabolism, and the cerebral arteriovenous differences of amino acids and ammonia were studied in 20 clinically diagnosed patients with early-onset dementia of Alzheimer type (DAT). Eleven healthy age-matched subjects and 15 healthy young volunteers served as controls. The most prominent abnormality in patients with early-onset DAT was a 44% reduction in the cerebral metabolic rate of glucose and a fourfold increase of lactate production, whereas cerebral blood flow and the cerebral metabolic rate of oxygen were found not to be altered. The cerebral amino-N balance substantially changed in patients with early-onset DAT, showing a massive loss of amino acids and ammonia from the brain, which was indicative of excess protein catabolism due to cell degeneration in the acutely diseased brain. The abnormality found in glucose metabolism may suggest a perturbed control of glycolytic breakdown of glucose and its first oxidation step at the pyruvate dehydrogenase complex level, this thus being of pivotal significance in early-onset DAT.

Ultrastructural changes of blood vessels in the cerebral cortex in Alzheimer's disease

Several parts of the cerebral cortices in five brains from patients with Alzheimer's disease were examined by light and electron microscopes. The results obtained are as follows: The initial change of the cerebral cortex in the brain occurred in the small blood vessel and capillary. The endothelial cell of the blood vessel fell into a degenerated state with swelling of the vascular feet and astroglial cells. The change in a great number of nerve cells and their processes diffusely observed in the cortices were nonspecific and could be due to primary vascular degeneration. Severe dementia in Alzheimer's disease seemed to be well explained by the histopathological findings of diffusely destroyed nerve cells and their processes. From this, Alzheimer's disease can be speculated to be a disease caused by progressive capillary degeneration.

Relations among age, visual memory, and resting cerebral metabolism in 40 healthy men

Visual memory, as measured by the Benton Visual Retention Test (BVRT), and resting regional cerebral metabolic rates for glucose (rCMRglc), as measured by positron emission tomography (PET) and [18-F]fluorodeoxyglucose, were examined in 40 very healthy men, aged 21 to 83 years. Age-related differences in visual memory were found but were significantly smaller than differences reported in the general population. This discrepancy is attributable to our rigorous health screening. The age-related differences found in this sample are estimates of the lower limit of population differences unconfounded by disease. Age-related differences on undistracted delayed visual memory were greater than differences on immediate visual memory, suggesting age-related differences in spontaneous elaborative visual information processing. No relation between visual memory and resting rCMRglc was found, supporting the hypothesis that mental abilities are unrelated to resting brain metabolism unless both functions are influenced by disease.

Energy metabolism in demented brain

The term dementia refers to a number of very complicated disorders of the brain with several morphological, biochemical and functional alterations. Several alterations occur in Alzheimer's disease. They include alteration in neurotransmitters related substances and changes in brain metabolic rate. Changes in metabolic activity are among the earliest and best documented of all modification reported in Alzheimer's brain. They appear to be correlate with the severity of the disease, and to be more marked in specific areas of the brain which appear to be clinically more involved. In this report will be discussed the observations on changes of cerebral glucose metabolic rate, cerebral oxygen consumption, cerebral blood flow reported in vivo in demented patients. The observations of changes in energy metabolism related enzymes and the relationship between these changes and those in neurotransmitters related substances will be also reviewed.

Senile dementia and Alzheimer's disease. Brain blood flow and metabolism

Dementia of Alzheimer type is not form of accelerated aging. Blood flow, oxygen consumption and glucose utilization of the normally aged brain are maintained unchanged from the 3rd to the 7th decade of life. Thereafter, these parameters may decrease. Brain blood flow and oxidative metabolism is reduced in dementia of Alzheimer type and thus is different from the aged-matched mentally healthy subjects. There is evidence that the predominant impairment among these parameters may occur in cerebral glucose metabolism. This disturbance may precede changes in cerebral oxygen consumption and blood flow. Cerebral hypometabolism of glucose is accentuated in the temporo-parietal cortex. This finding may be helpful in diagnosing dementia of Alzheimer type.

Abnormalities of regional brain metabolism in Alzheimer's disease and their relation to functional impairment

Resting brain metabolism in patients with Alzheimer's disease (AD) has consistently been demonstrated to be reduced. Moreover, the magnitude of the reduction is related to the severity of dementia. Positron emission tomography (PET), which provides regional metabolic rates for glucose in cross-sectional slices of brain, has demonstrated three alterations in AD that are related to functional deficits. First, whole brain metabolic rate is reduced, and these reductions are related to overall severity of dementia. Second, regional metabolic rates in the association cortices demonstrate relatively greater reductions than are observed in the primary sensory and motor cortices, corresponding to marked impairment of higher cognitive function and relative sparing of sensory and motor function. Third, regional metabolic rates in the association cortices demonstrate increased left-right asymmetry relative to controls. Greater metabolic asymmetry is accompanied by disproportionate neuropsychological deficits in either language or visuospatial function, depending on whether the left or right cerebral hemisphere, respectively, has a lower metabolic rate.

The effect of age on glucose and energy metabolism in brain cortex of rats

It is well documented that the mature human brain oxidizes only glucose to obtain energy under physiological, nonstarved conditions. Through adulthood to the beginning of senescence, the balance between oxygen and glucose consumption of the brain was found to be unchanged as the basis for energy production. Beyond the age of 70 yr, however, cerebral glucose consumption appears to decrease. In the present study, the effect of advancing age on glucose and energy metabolism in brain cortex of rats was investigated. The study was carried out in male Wistar rats, 6 (young adult), 12 (adult), 24 and 30 (both aged) mth of age. Male Wistar rats may be designated as being 'aged' from 24 mth of life onwards. Intermediates of glycolysis, tricarboxylic acid cycle and energy-rich compounds were measured by means of sensitive standard enzymatic methods under steady-state conditions of arterial normotension, normoxemia, normocapnia and normothermia in anesthesia with 0.5 vol% halothane and nitrous oxide/oxygen 70:30. The 12-mth-old adult rats served as controls. The glucose concentration in brain cortex was found to be about 1.5 times higher in 6-mth-old than in 12-mth-old animals but did not differ in the 12-, 24-, and 30-mth-old rats. Besides glucose, fructose-1,6-phosphate and ATP decreased from young adult to adult rats while pyruvate, malate and creatine phosphate diminish with advancing age. A tendency to reduction with aging was also evident in glucose-6-phosphate, fructose-1, 6-diphosphate, and lactate. The fall in substrate concentrations may be attributed to the reduced activity of enzymes acting in glucose breakdown. It is concluded that glucose and energy metabolism may diminish with the process of normal aging, but that the reduction is of only moderate extent.

Brain metabolic changes in young vs aged rats during hypoxia

Brain energy state and glycolytic metabolites were measured in young (6 month) and aged (28 month) male rats under normoxic (70% nitrous oxide, 30% oxygen) or hypoxic (PaO2 = 25 mm Hg) test conditions. Hypoxic ischemia was induced in one cerebral hemisphere by ligation of one carotid artery. Under normoxic test conditions brain energy metabolite concentrations were similar between young and aged rats. Brain tissue glucose, glycogen, glucose-6-phosphate and critic acid cycle intermediate concentrations were decreased in aged rats during normoxia while fructose-6-phosphate and pyruvate were increased. Decreases in brain energy state and increases in lactate/pyruvate ratios were significant in both young and aged rats during hypoxia and were greater in aged animals in hypoxic-ischemic tissues. These results indicate that brain energy state is normal in aged rats under normoxic conditions but that hypoxic-ischemia produces a greater degree of brain energy failure compared to younger animals.

Age-related reductions in cerebral vasomotor reactivity and the law of initial value: a 4-year prospective longitudinal study

A group of 51 neurologically normal, middle-aged and elderly volunteers (aged 35-86 years; mean age 63.24 years) with and without risk factors for stroke were given annual tests of cerebral vasomotor reactivity to assess any changes in the cerebral vascular capacitance associated with advancing age that might alter cerebral vasomotor reactivity. Cerebral vasomotor reactivity was estimated as the difference in bihemisphere gray matter CBF measured by the 133Xe inhalation method in the steady state breathing room air, followed by a second measurement during inhalation of 100% oxygen. There were significant and progressive reductions in cerebral vasomotor reactivity during the 4-year longitudinal study. Positive linear correlations were apparent between initial steady-state mean bihemisphere gray matter CBF levels and degrees of vasomotor reactivity, suggesting that the Law of Initial Value plays an important role. This should be borne in mind when analyzing scores of cerebral vasomotor reactivity. In the present communication, analysis of covariance was used to correct for influences of initial CBF levels on vasomotor responses tested while breathing pure oxygen.

Cerebral blood flow and metabolism in normal human aging, pathological aging, and senile dementia

A review and a reappraisal are presented of earlier data on cerebral circulatory and metabolic studies in normal active elderly men (Group I) of mean age 71 years, compared with normal young subjects of mean age 21 years, conducted at the National Institutes of Health, Bethesda, MD, U.S.A., during 1956-1958. There was no significant difference in the mean CBF and cerebral metabolic rate for oxygen (CMRO2) values between the two populations; i.e., these important parameters did not fall with chronological aging per se. There was significant depression in the mean cerebral metabolic rate for glucose (CMRG) value (by approximately 23%) in the aged compared with the young. Newer methods using positron emission tomography and appropriate isotopes have confirmed these findings in normal aging in human subjects and experimental animals. As expected, MABP and cerebral vascular resistance (CVR) were significantly elevated in the normal aged. MABP was even more elevated in elderly hypertensive subjects, and the CVR more elevated in the subjects with arteriosclerosis (Group II), who also showed a small but significant fall in CBF and in internal jugular venous PO2. The CBF showed a more pronounced fall in senile aged patients with chronic brain syndrome (Group III), in whom the CMRO2 also showed a marked drop (by approximately 22%); the CMRG fell still further (approximately 40% of that in the young). Of the few aged subjects followed up after a lapse of 11 years by a repeat estimation of the same physiological and psychological parameters and of the EEG, most showed clear worsening, together with a fall in overall physical and intellectual performance, probably related to a rise in CVR and an increase in atherosclerosis with aging.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of age on dopamine and serotonin receptors measured by positron tomography in the living human brain

D2 dopamine and S2 serotonin receptors were imaged and measured in healthy human subjects by positron emission tomography after intravenous injection of 11C-labeled 3-N-methylspiperone. Levels of receptor in the caudate nucleus, putamen, and frontal cerebral cortex declined over the age span studied (19 to 73 years). The decline in D2 receptor in males was different from that in females.

Decreased cortical glucose utilization after ibotenate lesion of the rat ventromedial globus pallidus

Rats received unilateral injections of ibotenic acid (12 micrograms) or vehicle in the ventromedial globus pallidus to lesion the primary source of cortical cholinergic innervation. At 3 or 28-32 days postinjection, the regional cerebral metabolic rate for glucose (rCMRglu) was measured by the 2-deoxy-D-[14C]glucose technique in nine cortical areas, the anterior thalamus, and the dorsal hippocampus. Effects of oxotremorine (0.1 mg/kg i.p.) on rCMRglu in these areas were assessed in ibotenic acid-lesioned and sham-treated rats. Significant effects of ibotenic acid injections and hemispheric asymmetries in rCMRglu were observed in all cortical areas (p less than or equal to 0.05), but not in the anterior thalamus or hippocampus. Cortical rCMRglu generally was lower in the lesioned hemisphere 3 days after ibotenic acid injections, but not after sham treatments. Hemispheric asymmetries were not apparent 28-32 days after pallidal lesions. Oxotremorine produced significant effects in the frontoparietal cortex and anterior thalamic nuclei. In the frontoparietal cortex, rCMRglu was 32% lower in the ibotenate-lesioned hemisphere as compared with the contralateral hemisphere. Oxotremorine did not eliminate hemispheric asymmetry, but increased rCMRglu in the lesioned frontoparietal cortex by 38%. Results support the views that cortical metabolic decrements in Alzheimer's disease are due in part to loss of subcortical cholinergic innervation and that muscarinic agonists may partially reverse these decrements.

Age-matched normal values and topographic maps for regional cerebral blood flow measurements by Xe-133 inhalation

The relationship between normal aging and regional cerebral blood flow (rCBF) computed as initial slope index (ISI) by Fourier method was investigated in 105 right-handed healthy volunteers (132 measurements) by Xe-133 inhalation method, and age-matched normal values were calculated. Mean brain ISI values showed significant negative correlation with advancing age (r = 0.70, p less than 0.001), and the regression line and its 95% confidence interval was Y = -0.32 (X - 19) + 63.5 +/- 11.2 (19 less than or equal to X less than or equal to 80). Regional ISI values also showed significant negative correlations for the entire brain (p less than 0.001). The regional reductions of ISI values with advancing age were significantly greater in the regional distribution of the middle cerebral arteries bilaterally, compared with regions in the distribution of the other arteries (p less than 0.05). Therefore, measured rCBF values for patients must be compared to age-matched normal values for mean hemispheric and each region examined. Two kinds of topographic maps, brain map showing rCBF compared to age-matched normal values and showing hemispheric differences were made by dividing patient's values by the 95% confidence limits for age-matched normal values and displaying laterality index calculated as follows, respectively. (formula; see text) These maps were useful for evaluating significantly decreased or increased regions and regional hemispheric differences.

Metabolic processes in Alzheimer's disease: adenine nucleotide content and production of 14CO2 from [U-14C]glucose in vitro in human neocortex

Samples of neocortex removed at diagnostic craniotomy from patients with Alzheimer's disease and incubated in vitro showed an increased production of 14CO2 from [U-14C]glucose compared with neurosurgical controls. This was a feature of incubations in the presence of both 5 mM K+ (142% control) and 31 mM K+ (126%). Specific labelling of the amino acid pool was unaltered, suggesting that the apparent increase of CO2 production was not merely a reflection of changes in dilution of the radiolabel from glucose. The content of adenine nucleotides was significantly less than control values in the tissue from patients with Alzheimer's disease after in vitro incubations but the adenylate energy charge was unchanged, indicating that normal energy metabolism was not grossly impaired in these preparations.

Computed tomography and positron emission transaxial tomography evaluations of normal aging and Alzheimer's disease

Young normal subjects, old normal subjects, and patients with senile dementia of the Alzheimer's type (SDAT) were studied with both computed tomography (CT) and positron emission transaxial tomography (PETT). Increases in ventricular size with both aging and disease were measured. Regional glucose metabolic rate was not affected by age, but was markedly reduced in SDAT patients. These data indicate that in normal aging, structural brain changes may be more salient than biochemical changes. Although both structural and biochemical changes occur in SDAT, the biochemical changes are more marked. The results suggest that PETT is potentially more useful than CT in the in vivo diagnosis of SDAT.