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Yang X, Chen C, Wang A, Li C, Cheng G. Imaging, Genetic, and Pathological Features of Vascular Dementia. Eur Neurol 2023; 86:277-284. [PMID: 37271126 DOI: 10.1159/000531088] [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: 02/15/2022] [Accepted: 04/14/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Over the past decades, marked progress has been made in detecting vascular dementia (VD) both through maturation of diagnostic concepts and advances in brain imaging, especially MRI. We summarized the imaging, genetic, and pathological features of VD in this review. SUMMARY It is a challenge for the diagnosis and treatment of VD, particularly in patients where there is no evident temporal relation between cerebrovascular events and cognitive dysfunction. In patients with cognitive dysfunction with poststroke onset, the etiological classification is still complicated. KEY MESSAGES In this review, we summarized the clinical, imaging, and genetic as well as pathological features of VD. We hope to offer a framework to translate diagnostic criteria to daily practice, address treatment, and highlight some future perspectives.
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Affiliation(s)
- Xiaoni Yang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chao Chen
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Aishuai Wang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Changsheng Li
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Guangqing Cheng
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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2
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Mirkin S, Albensi BC. Should artificial intelligence be used in conjunction with Neuroimaging in the diagnosis of Alzheimer's disease? Front Aging Neurosci 2023; 15:1094233. [PMID: 37187577 PMCID: PMC10177660 DOI: 10.3389/fnagi.2023.1094233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Alzheimer's disease (AD) is a progressive, neurodegenerative disorder that affects memory, thinking, behavior, and other cognitive functions. Although there is no cure, detecting AD early is important for the development of a therapeutic plan and a care plan that may preserve cognitive function and prevent irreversible damage. Neuroimaging, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET), has served as a critical tool in establishing diagnostic indicators of AD during the preclinical stage. However, as neuroimaging technology quickly advances, there is a challenge in analyzing and interpreting vast amounts of brain imaging data. Given these limitations, there is great interest in using artificial Intelligence (AI) to assist in this process. AI introduces limitless possibilities in the future diagnosis of AD, yet there is still resistance from the healthcare community to incorporate AI in the clinical setting. The goal of this review is to answer the question of whether AI should be used in conjunction with neuroimaging in the diagnosis of AD. To answer the question, the possible benefits and disadvantages of AI are discussed. The main advantages of AI are its potential to improve diagnostic accuracy, improve the efficiency in analyzing radiographic data, reduce physician burnout, and advance precision medicine. The disadvantages include generalization and data shortage, lack of in vivo gold standard, skepticism in the medical community, potential for physician bias, and concerns over patient information, privacy, and safety. Although the challenges present fundamental concerns and must be addressed when the time comes, it would be unethical not to use AI if it can improve patient health and outcome.
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Affiliation(s)
- Sophia Mirkin
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Benedict C. Albensi
- Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, United States
- St. Boniface Hospital Research, Winnipeg, MB, Canada
- University of Manitoba, Winnipeg, MB, Canada
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3
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CT-Detected MTA Score Related to Disability and Behavior in Older People with Cognitive Impairment. Biomedicines 2022; 10:biomedicines10061381. [PMID: 35740403 PMCID: PMC9219852 DOI: 10.3390/biomedicines10061381] [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: 03/31/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/21/2022] Open
Abstract
Our study aims to investigate the relationship between medial temporal lobe atrophy (MTA) score, assessed by computed tomography (CT) scans, and functional impairment, cognitive deficit, and psycho-behavioral disorder severity. Overall, 239 (M = 92, F = 147; mean age of 79.3 ± 6.8 years) patients were evaluated with cognitive, neuropsychiatric, affective, and functional assessment scales. MTA was evaluated from 0 (no atrophy) to 4 (severe atrophy). The homocysteine serum was set to two levels: between 0 and 10 µmol/L, and >10 µmol/L. The cholesterol and glycemia blood concentrations were measured. Hypertension and atrial fibrillation presence/absence were collected. A total of 14 patients were MTA 0, 44 patients were MTA 1, 63 patients were MTA 2, 79 patients were MTA 3, and 39 patients were MTA 4. Cognitive (p < 0.0001) and functional (p < 0.0001) parameters decreased according to the MTA severity. According to the diagnosis distribution, AD patient percentages increased by MTA severity (p < 0.0001). In addition, the homocysteine levels increased according to MTA severity (p < 0.0001). Depression (p < 0.0001) and anxiety (p = 0.001) increased according to MTA severity. This study encourages and supports the potential role of MTA score and CT scan in the field of neurodegenerative disorder research and diagnosis.
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Ibrahim B, Suppiah S, Ibrahim N, Mohamad M, Hassan HA, Nasser NS, Saripan MI. Diagnostic power of resting-state fMRI for detection of network connectivity in Alzheimer's disease and mild cognitive impairment: A systematic review. Hum Brain Mapp 2021; 42:2941-2968. [PMID: 33942449 PMCID: PMC8127155 DOI: 10.1002/hbm.25369] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022] Open
Abstract
Resting‐state fMRI (rs‐fMRI) detects functional connectivity (FC) abnormalities that occur in the brains of patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). FC of the default mode network (DMN) is commonly impaired in AD and MCI. We conducted a systematic review aimed at determining the diagnostic power of rs‐fMRI to identify FC abnormalities in the DMN of patients with AD or MCI compared with healthy controls (HCs) using machine learning (ML) methods. Multimodal support vector machine (SVM) algorithm was the commonest form of ML method utilized. Multiple kernel approach can be utilized to aid in the classification by incorporating various discriminating features, such as FC graphs based on “nodes” and “edges” together with structural MRI‐based regional cortical thickness and gray matter volume. Other multimodal features include neuropsychiatric testing scores, DTI features, and regional cerebral blood flow. Among AD patients, the posterior cingulate cortex (PCC)/Precuneus was noted to be a highly affected hub of the DMN that demonstrated overall reduced FC. Whereas reduced DMN FC between the PCC and anterior cingulate cortex (ACC) was observed in MCI patients. Evidence indicates that the nodes of the DMN can offer moderate to high diagnostic power to distinguish AD and MCI patients. Nevertheless, various concerns over the homogeneity of data based on patient selection, scanner effects, and the variable usage of classifiers and algorithms pose a challenge for ML‐based image interpretation of rs‐fMRI datasets to become a mainstream option for diagnosing AD and predicting the conversion of HC/MCI to AD.
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Affiliation(s)
- Buhari Ibrahim
- Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Department of Physiology, Faculty of Basic Medical Sciences, Bauchi State University Gadau, Gadau, Nigeria
| | - Subapriya Suppiah
- Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Normala Ibrahim
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mazlyfarina Mohamad
- Centre for Diagnostic and Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hasyma Abu Hassan
- Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nisha Syed Nasser
- Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - M Iqbal Saripan
- Department of Computer and Communication System Engineering, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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5
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Kapoor A, Bartha R, Black SE, Borrie M, Freedman M, Gao F, Herrmann N, Mandzia J, Ozzoude M, Ramirez J, Scott CJM, Symons S, Fischer CE, Frank A, Seitz D, Wolf MU, Verhoeff NPLG, Naglie G, Reichman W, Masellis M, Mitchell SB, Tang-Wai DF, Tartaglia MC, Kumar S, Pollock BG, Rajji TK, Finger E, Pasternak SH, Swartz RH. Structural Brain Magnetic Resonance Imaging to Rule Out Comorbid Pathology in the Assessment of Alzheimer's Disease Dementia: Findings from the Ontario Neurodegenerative Disease Research Initiative (ONDRI) Study and Clinical Trials Over the Past 10 Years. J Alzheimers Dis 2021; 74:747-757. [PMID: 32116253 PMCID: PMC7242844 DOI: 10.3233/jad-191097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE Structural brain magnetic resonance imaging (MRI) is not mandatory in Alzheimer's disease (AD) research or clinical guidelines. We aimed to explore the use of structural brain MRI in AD/mild cognitive impairment (MCI) trials over the past 10 years and determine the frequency with which inclusion of standardized structural MRI acquisitions detects comorbid vascular and non-vascular pathologies. METHODS We systematically searched ClinicalTrials.gov for AD clinical trials to determine their neuroimaging criteria and then used data from an AD/MCI cohort who underwent standardized MRI protocols, to determine type and incidence of clinically relevant comorbid pathologies. RESULTS Of 210 AD clinical trials, 105 (50%) included structural brain imaging in their eligibility criteria. Only 58 (27.6%) required MRI. 16,479 of 53,755 (30.7%) AD participants were in trials requiring MRI. In the observational AD/MCI cohort, 141 patients met clinical criteria; 22 (15.6%) had relevant MRI findings, of which 15 (10.6%) were exclusionary for the study. DISCUSSION In AD clinical trials over the last 10 years, over two-thirds of participants could have been enrolled without brain MRI and half without even a brain CT. In a study sample, relevant comorbid pathology was found in 15% of participants, despite careful screening. Standardized structural MRI should be incorporated into NIA-AA diagnostic guidelines (when available) and research frameworks routinely to reduce diagnostic heterogeneity.
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Affiliation(s)
| | - Robert Bartha
- Robarts Research Institute and the Department of Medical Biophysics, the University of Western Ontario, London, ON, Canada
| | - Sandra E Black
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Michael Borrie
- Parkwood Institute, St. Joseph's Health Care Center, London, ON, Canada
| | - Morris Freedman
- University of Toronto, Toronto, ON, Canada.,Rotman Research Institute of Baycrest Health Sciences, Toronto, ON, Canada.,Baycrest Health Sciences, Toronto, ON, Canada
| | - Fuqiang Gao
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Jennifer Mandzia
- Western University, London, ON, Canada.,London Health Sciences Centre, London, ON, Canada
| | - Miracle Ozzoude
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Joel Ramirez
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | | | - Sean Symons
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Corinne E Fischer
- Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada
| | | | - Dallas Seitz
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Uri Wolf
- University of Toronto, Toronto, ON, Canada.,Baycrest Health Sciences, Toronto, ON, Canada
| | | | - Gary Naglie
- University of Toronto, Toronto, ON, Canada.,Rotman Research Institute of Baycrest Health Sciences, Toronto, ON, Canada.,Baycrest Health Sciences, Toronto, ON, Canada
| | - William Reichman
- University of Toronto, Toronto, ON, Canada.,Baycrest Health Sciences, Toronto, ON, Canada
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Sara B Mitchell
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - David F Tang-Wai
- University of Toronto, Toronto, ON, Canada.,University Health Network Memory Clinic, University of Toronto, Division of Neurology & Geriatric Medicine, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- University of Toronto, Toronto, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Kumar
- University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bruce G Pollock
- University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Elizabeth Finger
- Parkwood Institute, St. Joseph's Health Care Center, London, ON, Canada.,Western University, London, ON, Canada
| | - Stephen H Pasternak
- Robarts Research Institute and the Department of Medical Biophysics, the University of Western Ontario, London, ON, Canada.,Parkwood Institute, St. Joseph's Health Care Center, London, ON, Canada.,Western University, London, ON, Canada
| | | | - Richard H Swartz
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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6
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Brisson M, Brodeur C, Létourneau‐Guillon L, Masellis M, Stoessl J, Tamm A, Zukotynski K, Ismail Z, Gauthier S, Rosa‐Neto P, Soucy J. CCCDTD5: Clinical role of neuroimaging and liquid biomarkers in patients with cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 6:e12098. [PMID: 33532543 PMCID: PMC7821956 DOI: 10.1002/trc2.12098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 04/21/2023]
Abstract
Since 1989, four Canadian Consensus Conferences on the Diagnosis and Treatment of Dementia (CCCDTDs) have provided evidence-based dementia diagnostic and treatment guidelines for Canadian clinicians and researchers. We present the results from the Neuroimaging and Fluid Biomarkers Group of the 5th CCCDTD (CCCDTD5), which addressed topics chosen by the steering committee to reflect advances in the field and build on our previous guidelines. Recommendations on Imaging and Fluid Biomarker Use from this Conference cover a series of different fields. Prior structural imaging recommendations for both computerized tomography (CT) and magnetic resonance imaging (MRI) remain largely unchanged, but MRI is now more central to the evaluation than before, with suggested sequences described here. The use of visual rating scales for both atrophy and white matter anomalies is now included in our recommendations. Molecular imaging with [18F]-fluorodeoxyglucose ([18F]-FDG) Positron Emisson Tomography (PET) or [99mTc]-hexamethylpropyleneamine oxime/ethylene cysteinate dimer ([99mTc]-HMPAO/ECD) Single Photon Emission Tomography (SPECT), should now decidedly favor PET. The value of [18F]-FDG PET in the assessment of neurodegenerative conditions has been established with greater certainty since the previous conference, and it has now been recognized as a useful biomarker to establish the presence of neurodegeneration by a number of professional organizations around the world. Furthermore, the role of amyloid PET has been clarified and our recommendations follow those from other groups in multiple countries. SPECT with [123I]-ioflupane (DaTscanTM) is now included as a useful study in differentiating Alzheimer's disease (AD) from Lewy body disease. Finally, liquid biomarkers are in a rapid phase of development and, could lead to a revolution in the assessment AD and other neurodegenerative conditions at a reasonable cost. We hope these guidelines will be useful for clinicians, researchers, policy makers, and the lay public, to inform a current and evidence-based approach to the use of neuroimaging and liquid biomarkers in clinical dementia evaluation and management.
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Affiliation(s)
- Mélanie Brisson
- Centre hospitalier de l'université de QuébecQuebec CityCanada
| | | | | | | | - Jon Stoessl
- Vancouver Coastal Health, University of British‐ColumbiaVancouverCanada
| | | | | | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada
| | | | - Pedro Rosa‐Neto
- McGill Center for Studies in AgingCanada
- McConnell Brain Imaging Centre, Montreal Neurological InstituteMontrealCanada
| | - Jean‐Paul Soucy
- Centre hospitalier de l'université de MontréalMontrealCanada
- McConnell Brain Imaging Centre, Montreal Neurological InstituteMontrealCanada
- PERFORM Center, Concordia UniversityMontrealCanada
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7
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Schaeffer MJ, Chan L, Barber PA. The neuroimaging of neurodegenerative and vascular disease in the secondary prevention of cognitive decline. Neural Regen Res 2021; 16:1490-1499. [PMID: 33433462 PMCID: PMC8323688 DOI: 10.4103/1673-5374.303011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Structural brain changes indicative of dementia occur up to 20 years before the onset of clinical symptoms. Efforts to modify the disease process after the onset of cognitive symptoms have been unsuccessful in recent years. Thus, future trials must begin during the preclinical phases of the disease before symptom onset. Age related cognitive decline is often the result of two coexisting brain pathologies: Alzheimer’s disease (amyloid, tau, and neurodegeneration) and vascular disease. This review article highlights some of the common neuroimaging techniques used to visualize the accumulation of neurodegenerative and vascular pathologies during the preclinical stages of dementia such as structural magnetic resonance imaging, positron emission tomography, and white matter hyperintensities. We also describe some emerging neuroimaging techniques such as arterial spin labeling, diffusion tensor imaging, and quantitative susceptibility mapping. Recent literature suggests that structural imaging may be the most sensitive and cost-effective marker to detect cognitive decline, while molecular positron emission tomography is primarily useful for detecting disease specific pathology later in the disease process. Currently, the presence of vascular disease on magnetic resonance imaging provides a potential target for optimizing vascular risk reduction strategies, and the presence of vascular disease may be useful when combined with molecular and metabolic markers of neurodegeneration for identifying the risk of cognitive impairment.
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Affiliation(s)
- Morgan J Schaeffer
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Leona Chan
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Philip A Barber
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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8
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wahlund LO. Structural brain imaging as a diagnostic tool in dementia, why and how? Psychiatry Res Neuroimaging 2020; 306:111183. [PMID: 32928612 DOI: 10.1016/j.pscychresns.2020.111183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/28/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
The demands for more people to be investigated due to cognitive failure and suspected dementia are increasing as increasing numbers of us get older and the incidence of dementia increases. An important part of a dementia study includes the structural imaging of the brain. Two imaging techniques, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), are used in this context. They differ in many ways and one question is which of the methods should be used in the first instance. Considering the large number of investigations to be expected in the future it is vital that they be cost-effective. Structural imaging aims partly to find secondary causes of cognitive failure and partly to provide support in the differential diagnostic reasoning. The methods differ; CT is significantly cheaper but exposes the patient to radiation, MRI is expensive but does not use X-rays. MRI provides better imaging of cerebrovascular lesions than CT as well as better imaging of structures near the skull base. The difference in diagnostic accuracy is small and it is doubtful whether that difference justifies the large difference in cost.
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Affiliation(s)
- Lars-Olof Wahlund
- Senior Professor, Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.
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10
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Kobalava ZD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI, Barbarash OL, Boitsov SA, Vavilova TV, Villevalde SV, Galyavich AS, Glezer MG, Grineva EN, Grinstein YI, Drapkina OM, Zhernakova YV, Zvartau NE, Kislyak OA, Koziolova NA, Kosmacheva ED, Kotovskaya YV, Libis RA, Lopatin YM, Nebiridze DV, Nedoshivin AO, Ostroumova OD, Oschepkova EV, Ratova LG, Skibitsky VV, Tkacheva ON, Chazova IE, Chesnikova AI, Chumakova GA, Shalnova SA, Shestakova MV, Yakushin SS, Yanishevsky SN. Arterial hypertension in adults. Clinical guidelines 2020. ACTA ACUST UNITED AC 2020. [DOI: 10.15829/1560-4071-2020-3-3786] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Arterial hypertension in adults. Clinical guidelines 2020
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11
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Kaltoft NS, Marner L, Larsen VA, Hasselbalch SG, Law I, Henriksen OM. Hybrid FDG PET/MRI vs. FDG PET and CT in patients with suspected dementia - A comparison of diagnostic yield and propagated influence on clinical diagnosis and patient management. PLoS One 2019; 14:e0216409. [PMID: 31048902 PMCID: PMC6497285 DOI: 10.1371/journal.pone.0216409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/21/2019] [Indexed: 12/03/2022] Open
Abstract
Background Both 18F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET), computed tomography (CT) and magnetic resonance imaging (MRI) are routinely used in the evaluation of memory clinic patients. Hybrid PET/MR systems now allow simultaneous PET and MRI imaging within the duration of the PET emission scan. Purpose To compare the diagnostic yield of PET/MRI using an abbreviated MR protocol with that of separate PET and CT in a mixed memory clinic population, and the propagated influences on clinical diagnosis and patient management. Material and methods Consecutive memory clinic patients (n = 78) undergoing both CT and hybrid FDG PET/MRI scans were identified retrospectively. MRI and CT were separately evaluated for vascular and structural pathology. PET scans were classified according to the presence of neurodegenerative or vascular disease using CT or MRI, respectively, for anatomical guiding. A memory clinic expert assessed the clinical impact of the additional findings and/or change of PET classification achieved by MRI anatomical guiding as compared to CT guiding. Results MRI lead to significantly higher Fazekas scores, higher medial temporal and global cortical atrophy scores, and identified more patients with infarcts (28 vs 8, p<0.001) compared to CT. MRI changed PET classification in 13 (17%) patients. Addition of MRI to CT had minor clinical impact in 4/78 (5%) and major clinical impact in 13/78 (17%) of patients. Conclusion The study demonstrates the capabilities of PET/MRI systems for routine clinical imaging of memory clinic patients, and that even an abbreviated hybrid PET/MRI protocol provides significant additional information influencing clinical diagnosis and patient management in a substantial fraction of patients when compared to separate PET and CT.
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Affiliation(s)
- Nicolai Stefan Kaltoft
- Department of Radiology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Andree Larsen
- Department of Radiology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Dept. of Neurology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
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12
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Bayer AJ. The role of biomarkers and imaging in the clinical diagnosis of dementia. Age Ageing 2018; 47:641-643. [PMID: 29432519 DOI: 10.1093/ageing/afy004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 01/16/2018] [Indexed: 01/30/2023] Open
Abstract
Recognition of dementia relies on a good clinical history, supported by formal cognitive testing, but identifying the subtype of dementia may be wrong in 20% or more of cases. Accuracy may be improved by use of imaging and cerebrospinal fluid (CSF) biomarkers. Structural neuroimaging is recommended for most patients, not just to identify potentially reversible surgical pathology, but also to detect vascular changes and patterns of cerebral atrophy. Functional imaging can help to confirm neurodegeneration and to distinguish dementia subtypes when structural imaging has been inconclusive. Amyloid-positron emission tomography scans reflect neuritic plaque burden and identify the earliest pathological changes in Alzheimer's disease, but their value outside research settings is still uncertain. A combination of low CSF amyloid β1-42 and high CSF total-tau or phospho-tau also has high predictive power for AD pathology, but diagnostic usefulness decreases with age because of the increased prevalence of AD-type pathology in non-demented people. The need to use biomarkers more routinely will become necessary as disease-modifying treatments become available and accurate subtype diagnosis will be required at an early (ideally pre-dementia) stage. Clinicians should be considering the resources and expertise that will soon be needed for optimal dementia diagnosis.
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Affiliation(s)
- Antony J Bayer
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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13
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Venazzi A, Swardfager W, Lam B, Siqueira JDO, Herrmann N, Cogo-Moreira H. Validity of the QUADAS-2 in Assessing Risk of Bias in Alzheimer's Disease Diagnostic Accuracy Studies. Front Psychiatry 2018; 9:221. [PMID: 29887812 PMCID: PMC5982207 DOI: 10.3389/fpsyt.2018.00221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 05/07/2018] [Indexed: 01/17/2023] Open
Abstract
Accurate detection of Alzheimer's disease (AD) is of considerable clinical importance. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) is the current research standard for evaluating the quality of studies that validate diagnostic tests; however, its own construct validity has not yet been evaluated empirically. Our aim was to evaluate how well the proposed QUADAS-2 items and its domains converge to indicate the study quality criteria. This study applies confirmatory factor analysis to determine whether a measurement model would be consistent with meta-analytic data. Cochrane meta-analyses assessing the accuracy of AD diagnostic tests were identified. The seven ordinal QUADAS-2 items, intended to inform study quality based on risk of bias and applicability concerns, were extracted for each of the included studies. The QUADAS-2 pre-specified factor structure (i.e., four domains assessed in terms of risk of bias and applicability concerns) was not testable. An alternative model based on two correlated factors (i.e., risk of bias and applicability concerns) returned a poor fit model. Poor factor loadings were obtained, indicating that we cannot provide evidence that the indicators convergent validity markers in the context of AD diagnostic accuracy metanalyses, where normally the sample size is low (around 60 primary included studies). A Monte Carlo simulation suggested that such a model would require at least 90 primary studies to estimate these parameters with 80% power. The reliability of the QUADAS-2 items to inform a measurement model for study quality remains unconfirmed. Considerations for conceptualizing such a tool are discussed.
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Affiliation(s)
- Alisson Venazzi
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo, São Paulo, Brazil
| | - Walter Swardfager
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin Lam
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Division of Geriatric Psychiatry Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Hugo Cogo-Moreira
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo, São Paulo, Brazil
- Laboratory of Innovation in Psychometrics (LIP), São Paulo, Brazil
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Tully PJ, Qchiqach S, Pereira E, Debette S, Mazoyer B, Tzourio C. Development and validation of a priori risk model for extensive white matter lesions in people age 65 years or older: the Dijon MRI study. BMJ Open 2017; 7:e018328. [PMID: 29289936 PMCID: PMC5778304 DOI: 10.1136/bmjopen-2017-018328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The objective was to develop and validate a risk model for the likelihood of extensive white matter lesions (extWML) to inform clinicians on whether to proceed with or forgo diagnostic MRI. DESIGN Population-based cohort study and multivariable prediction model. SETTING Two representative samples from France. PARTICIPANTS Persons aged 60-80 years without dementia or stroke. Derivation sample n=1714; validation sample n=789. PRIMARY AND SECONDARY OUTCOME MEASURES Volume of extWML (log cm3) was obtained from T2-weighted images in a 1.5 T scanner. 20 candidate risk factors for extWML were evaluated with the C-statistic. Secondary outcomes in validation included incident stroke over 12 years follow-up. RESULTS The multivariable prediction model included six clinical risk factors (C-statistic=0.61). A cut-off of 7 points on the multivariable prediction model yielded the optimum balance in sensitivity 63.7% and specificity 54.0% and the negative predictive value was high (81.8%), but the positive predictive value was low (31.5%). In further validation, incident stroke risk was associated with continuous scores on the multivariable prediction model (HR 1.02; 95% CI 1.01 to 1.04, P=0.02) and dichotomised scores from the multivariable prediction model (HR 1.28; 95% CI 1.02 to 1.60, P=0.03). CONCLUSIONS A simple clinical risk equation for WML constituted by six variables can inform decisions whether to proceed with or forgo brain MRI. The high-negative predictive value demonstrates potential to reduce unnecessary MRI in the population aged 60-80 years.
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Affiliation(s)
- Phillip J Tully
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, F-33000 Bordeaux, France
| | - Sarah Qchiqach
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, F-33000 Bordeaux, France
| | - Edwige Pereira
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, F-33000 Bordeaux, France
| | - Stephanie Debette
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, F-33000 Bordeaux, France
| | - Bernard Mazoyer
- UMR5293, Groupe d’Imagerie Neurofonctionnelle, University Bordeaux, Institut des Maladies Neurodégénératives, Bordeaux, France
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, F-33000 Bordeaux, France
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Kern J, Kern S, Blennow K, Zetterberg H, Waern M, Guo X, Börjesson-Hanson A, Skoog I, Östling S. Calcium supplementation and risk of dementia in women with cerebrovascular disease. Neurology 2016; 87:1674-1680. [PMID: 27534711 DOI: 10.1212/wnl.0000000000003111] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/05/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine whether calcium supplementation is associated with the development of dementia in women after a 5-year follow-up. METHODS This was a longitudinal population-based study. The sample was derived from the Prospective Population Study of Women and H70 Birth Cohort Study in Gothenburg, Sweden, and included 700 dementia-free women aged 70-92 years. At baseline in 2000-2001, and at follow-up in 2005-2006, the women underwent comprehensive neuropsychiatric and somatic examinations. A CT scan was performed in 447 participants at baseline. Information on the use and dosage of calcium supplements was collected. Dementia was diagnosed according to DSM-III-R criteria. RESULTS Women treated with calcium supplements (n = 98) were at a higher risk of developing dementia (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.01-4.37, p = 0.046) and the subtype stroke-related dementia (vascular dementia and mixed dementia) (OR 4.40, 95% CI 1.54-12.61, p = 0.006) than women not given supplementation (n = 602). In stratified analyses, calcium supplementation was associated with the development of dementia in groups with a history of stroke (OR 6.77, 95% CI 1.36-33.75, p = 0.020) or presence of white matter lesions (OR 2.99, 95% CI 1.28-6.96, p = 0.011), but not in groups without these conditions. CONCLUSIONS Calcium supplementation may increase the risk of developing dementia in elderly women with cerebrovascular disease. Because our sample was relatively small and the study was observational, these findings need to be confirmed.
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Affiliation(s)
- Jürgen Kern
- From the Department of Neuropsychiatric Epidemiology (J.K., S.K., M.W., X.G., A.B.-H., I.S., S.O.) and Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (S.K., K.B., H.Z.), Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; and UCL Institute of Neurology (H.Z.), London, UK
| | - Silke Kern
- From the Department of Neuropsychiatric Epidemiology (J.K., S.K., M.W., X.G., A.B.-H., I.S., S.O.) and Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (S.K., K.B., H.Z.), Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; and UCL Institute of Neurology (H.Z.), London, UK.
| | - Kaj Blennow
- From the Department of Neuropsychiatric Epidemiology (J.K., S.K., M.W., X.G., A.B.-H., I.S., S.O.) and Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (S.K., K.B., H.Z.), Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; and UCL Institute of Neurology (H.Z.), London, UK
| | - Henrik Zetterberg
- From the Department of Neuropsychiatric Epidemiology (J.K., S.K., M.W., X.G., A.B.-H., I.S., S.O.) and Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (S.K., K.B., H.Z.), Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; and UCL Institute of Neurology (H.Z.), London, UK
| | - Margda Waern
- From the Department of Neuropsychiatric Epidemiology (J.K., S.K., M.W., X.G., A.B.-H., I.S., S.O.) and Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (S.K., K.B., H.Z.), Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; and UCL Institute of Neurology (H.Z.), London, UK
| | - Xinxin Guo
- From the Department of Neuropsychiatric Epidemiology (J.K., S.K., M.W., X.G., A.B.-H., I.S., S.O.) and Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (S.K., K.B., H.Z.), Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; and UCL Institute of Neurology (H.Z.), London, UK
| | - Anne Börjesson-Hanson
- From the Department of Neuropsychiatric Epidemiology (J.K., S.K., M.W., X.G., A.B.-H., I.S., S.O.) and Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (S.K., K.B., H.Z.), Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; and UCL Institute of Neurology (H.Z.), London, UK
| | - Ingmar Skoog
- From the Department of Neuropsychiatric Epidemiology (J.K., S.K., M.W., X.G., A.B.-H., I.S., S.O.) and Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (S.K., K.B., H.Z.), Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; and UCL Institute of Neurology (H.Z.), London, UK
| | - Svante Östling
- From the Department of Neuropsychiatric Epidemiology (J.K., S.K., M.W., X.G., A.B.-H., I.S., S.O.) and Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (S.K., K.B., H.Z.), Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; and UCL Institute of Neurology (H.Z.), London, UK
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Panegyres PK, Berry R, Burchell J. Early Dementia Screening. Diagnostics (Basel) 2016; 6:diagnostics6010006. [PMID: 26838803 PMCID: PMC4808821 DOI: 10.3390/diagnostics6010006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/30/2015] [Accepted: 01/11/2016] [Indexed: 12/20/2022] Open
Abstract
As the population of the world increases, there will be larger numbers of people with dementia and an emerging need for prompt diagnosis and treatment. Early dementia screening is the process by which a patient who might be in the prodromal phases of a dementing illness is determined as having, or not having, the hallmarks of a neurodegenerative condition. The concepts of mild cognitive impairment, or mild neurocognitive disorder, are useful in analyzing the patient in the prodromal phase of a dementing disease; however, the transformation to dementia may be as low as 10% per annum. The search for early dementia requires a comprehensive clinical evaluation, cognitive assessment, determination of functional status, corroborative history and imaging (including MRI, FDG-PET and maybe amyloid PET), cerebrospinal fluid (CSF) examination assaying Aβ1–42, T-τ and P-τ might also be helpful. Primary care physicians are fundamental in the screening process and are vital in initiating specialist investigation and treatment. Early dementia screening is especially important in an age where there is a search for disease modifying therapies, where there is mounting evidence that treatment, if given early, might influence the natural history—hence the need for cost-effective screening measures for early dementia.
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Affiliation(s)
- Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth 6005, Western Australia, Australia.
| | - Renee Berry
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth 6005, Western Australia, Australia.
| | - Jennifer Burchell
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth 6005, Western Australia, Australia.
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Abstract
BACKGROUND dementia is a highly prevalent acquired cognitive disorder that interferes with activities of daily living, relationships and quality of life. Recognition and effective management strategies are necessary to provide comprehensive care for these patients and their families. High-quality clinical practice guidelines can improve the quality and consistency of care in all aspects of dementia diagnosis and management by clarifying interventions supported by sound evidence and by alerting clinicians to interventions without proven benefit. OBJECTIVE we aimed to offer a synthesis of existing practice recommendations for the diagnosis and management of dementia, based upon moderate-to-high quality dementia guidelines. METHODS we performed a systematic search in EMBASE and MEDLINE as well as the grey literature for guidelines produced between 2008 and 2013. RESULTS thirty-nine retrieved practice guidelines were included for quality appraisal by the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool, performed by two independent reviewers. From the 12 moderate-to-high quality guidelines included, specific practice recommendations for the diagnosis and/or management of any aspect of dementia were extracted for comparison based upon the level of evidence and strength of recommendation. CONCLUSION there was a general agreement between guidelines for many practice recommendations. However, direct comparisons between guidelines were challenging due to variations in grading schemes.
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Affiliation(s)
- Jennifer Ngo
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Zhang C, Wang Y, Zhao X, Wang C, Liu L, Pu Y, Zou X, Pan Y, Du W, Li Z, Jing J, Wang D, Luo Y, Wong KS, Wang Y. Factors associated with severity of leukoaraiosis in first-ever lacunar stroke and atherosclerotic ischemic stroke patients. J Stroke Cerebrovasc Dis 2014; 23:2862-2868. [PMID: 25280817 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 07/03/2014] [Accepted: 07/11/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Leukoaraiosis (LA) is an indicator of small vessel disease, but little is known about the relationship between the severity of LA and etiologic subtype of ischemic stroke. Our study aimed to investigate the factors associated with the severity of LA and the relationship between the severity of LA and etiologic subtype of ischemic stroke. METHODS A total of 791 patients with first-ever ischemic stroke within 7 days were enrolled in our study. We evaluated cranial magnetic resonance imagings including severity of LA in periventricular and deep white matter, severity of silent lacunar infarcts (SLIs), etiologic subtype of ischemic stroke, and topographic patterns of acute cerebral infarcts. Severity of LA was graded as grade 0 when Fazekas scores = 0, grade 1 when Fazekas scores ranged from 1 to 2, and grade 2 when Fazekas scores were greater than or equal to 3. Multivariable ordinal logistic regression was used to analyze the factors associated with the severity of LA. RESULTS A total of 748 patients (94.6%) had LA, the numbers and proportions of grade 0, grade 1, and grade 2 LA were 43 patients (5.4%), 413 patients (52.2%), and 335 patients (42.4%), respectively. In multivariable ordinal logistic regression analysis, increasing age, higher diastolic blood pressure, admission National Institutes of Health Stroke Scale scores less than or equal to 3, presence of SLIs, and small artery occlusion (SAO) subtype of ischemic stroke were found to be independently associated with higher grade of LA. CONCLUSIONS LA is prevalent in first-ever ischemic stroke patients. Severe LA is more frequently associated with higher grades of SLIs and ischemic stroke due to SAO.
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Affiliation(s)
- Changqing Zhang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuehua Pu
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xinying Zou
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wanliang Du
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dongxue Wang
- Department of Nephrology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yang Luo
- Department of Nephrology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Arevalo-Rodriguez I, Segura O, Solà I, Bonfill X, Sanchez E, Alonso-Coello P. Diagnostic tools for alzheimer's disease dementia and other dementias: an overview of diagnostic test accuracy (DTA) systematic reviews. BMC Neurol 2014; 14:183. [PMID: 25248284 PMCID: PMC4189736 DOI: 10.1186/s12883-014-0183-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 09/11/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Dementia includes a group of neurodegenerative disorders characterized by progressive loss of cognitive function and a decrease in the ability to perform activities of daily living. Systematic reviews of diagnostic test accuracy (DTA) focus on how well the index test detects patients with the disease in terms of figures such as sensitivity and specificity. Although DTA reviews about dementia are essential, at present there is no information about their quantity and quality. METHODS We searched for DTA reviews in MEDLINE (1966-2013), EMBASE (1980-2013), The Cochrane Library (from its inception until December 2013) and the Database of Abstracts of Reviews of Effects (DARE). Two reviewers independently assessed the methodological quality of the reviews using the AMSTAR measurement tool, and the quality of the reporting using the PRISMA checklist. We describe the main characteristics of these reviews, including basic characteristics, type of dementia, and diagnostic test evaluated, and we summarize the AMSTAR and PRISMA scores. RESULTS We selected 24 DTA systematic reviews. Only 10 reviews (41.6%), assessed the bias of included studies and few (33%) used this information to report the review results or to develop their conclusions Only one review (4%) reported all methodological items suggested by the PRISMA tool. Assessing methodology quality by means of the AMSTAR tool, we found that six DTA reviews (25%) pooled primary data with the aid of methods that are used for intervention reviews, such as Mantel-Haenszel and separate random-effects models (25%), while five reviews (20.8%) assessed publication bias by means of funnel plots and/or Egger's Test. CONCLUSIONS Our assessment of these DTA reviews reveals that their quality, both in terms of methodology and reporting, is far from optimal. Assessing the quality of diagnostic evidence is fundamental to determining the validity of the operating characteristics of the index test and its usefulness in specific settings. The development of high quality DTA systematic reviews about dementia continues to be a challenge.
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Amendola V, Scaramuzza S, Litti L, Meneghetti M, Zuccolotto G, Rosato A, Nicolato E, Marzola P, Fracasso G, Anselmi C, Pinto M, Colombatti M. Magneto-plasmonic Au-Fe alloy nanoparticles designed for multimodal SERS-MRI-CT imaging. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2014; 10:2476-86. [PMID: 24619736 DOI: 10.1002/smll.201303372] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/18/2013] [Indexed: 05/07/2023]
Abstract
Diagnostic approaches based on multimodal imaging are needed for accurate selection of the therapeutic regimens in several diseases, although the dose of administered contrast drugs must be reduced to minimize side effects. Therefore, large efforts are deployed in the development of multimodal contrast agents (MCAs) that permit the complementary visualization of the same diseased area with different sensitivity and different spatial resolution by applying multiple diagnostic techniques. Ideally, MCAs should also allow imaging of diseased tissues with high spatial resolution during surgical interventions. Here a new system based on multifunctional Au-Fe alloy nanoparticles designed to satisfy the main requirements of an ideal MCA is reported and their biocompatibility and imaging capability are described. The MCAs show easy and versatile surface conjugation with thiolated molecules, magnetic resonance imaging (MRI) and computed X-ray tomography (CT) signals for anatomical and physiological information (i.e., diagnostic and prognostic imaging), large Raman signals amplified by surface enhanced Raman scattering (SERS) for high sensitivity and high resolution intrasurgical imaging, biocompatibility, exploitability for in vivo use and capability of selective accumulation in tumors by enhanced permeability and retention effect. Taken together, these results show that Au-Fe nanoalloys are excellent candidates as multimodal MRI-CT-SERS imaging agents.
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Affiliation(s)
- Vincenzo Amendola
- Department of Chemical Sciences, University of Padova, Padova, Italy.
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Sargento-Freitas J, Felix-Morais R, Ribeiro J, Gouveia A, Nunes C, Duque C, Madaleno J, Silva F, Machado C, Cordeiro G, Cunha L. Different locations but common associations in subcortical hypodensities of presumed vascular origin: cross-sectional study on clinical and neurosonologic correlates. BMC Neurol 2014; 14:24. [PMID: 24495346 PMCID: PMC3917903 DOI: 10.1186/1471-2377-14-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/03/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Subcortical hypodensities of presumed vascular etiology (SHPVO) are a clinical, radiological and neuropathological syndrome with a still largely unexplained pathophysiology. Parallel to the clinical heterogeneity, there is also recognised cerebral topographical diversity with undetermined etiological implications. Our aim is to assess clinical and neurosonological predictors of SHPVO according to their location. METHODS Cross sectional analysis of consecutive patients that underwent neurosonologic evaluation and head CT within one month, during a one year period. We excluded patients with absent temporal sonographic window, any pathology with a possible confounding effect on cerebral arterial pulsatility, atrial fibrillation and other etiologies of white matter diseases. The mean pulsatility index (PI) of both middle cerebral arteries was measured in the middle third of the M1 segment; intima media thickness was evaluated in the far wall of both common carotid arteries. SHPVO were rated by analysis of head CT in deep white matter (DWMH), periventricular white matter (PVWMH) and basal ganglia (BGH). We conducted a multivariate ordinal logistic regression model including all clinical, demographic and ultrasonographic characteristics to determine independent associations with SHPVO. RESULTS We included 439 patients, mean age 63.47 (SD: 14.94) years, 294 (67.0%) male. The independent predictors of SHPVO were age (OR = 1.067, 95% CI: 1.047-1.088, p < 0.001 for DWMH; OR = 1.068, 95% CI: 1.049-1.088, p < 0.001 for PVWMH; OR = 1.05, 95% CI: 1.03-1.071, p < 0.001 for BGH), hypertension (OR = 1.909, 95% CI: 1.222-2.981, p = 0.004 for DWMH; OR = 1.907, 95% CI: 1.238-2.938, p = 0.003 for PVWMH; OR = 1.775, 95% CI: 1.109-2.843, p = 0.017 for BGH) and PI (OR = 17.994, 95% CI: 6.875-47.1, p < 0.001 for DWMH; OR = 5.739, 95%CI: 2.288-14.397, p < 0.001 for PVWMH; OR = 11.844, 95% CI: 4.486-31.268, p < 0.001 for BGH) for all locations of SHPVO. CONCLUSIONS Age, hypertension and intracranial pulsatility are the main independent predictors of SHPVO across different topographic involvement and irrespective of extracranial atherosclerotic involvement.
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Affiliation(s)
- João Sargento-Freitas
- Neurosonology Laboratory, Coimbra University and Hospital Centre, Coimbra 3000-075, Portugal.
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Bermingham SL. The appropriate use of neuroimaging in the diagnostic work-up of dementia: an economic literature review and cost-effectiveness analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2014; 14:1-67. [PMID: 24592297 PMCID: PMC3937984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Structural brain imaging is often performed to establish the underlying causes of dementia. However, recommendations differ as to who should receive neuroimaging and whether computed tomography (CT) or magnetic resonance imaging (MRI) should be used. OBJECTIVES This study aimed to determine the cost-effectiveness in Ontario of offering structural imaging to all patients with mild to moderate dementia compared with offering it selectively according to guidelines from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCC). We compared the cost-effectiveness of CT and MRI as first-line strategies. METHODS We performed a systematic literature search (2000 to 2013) to identify cost-effectiveness studies of clinical prediction rules and structural imaging modalities. Studies were assessed for quality and applicability to Ontario. We also developed a model to evaluate the cost-effectiveness of clinical guidelines (image all versus according to CCC) and modalities (CT versus MRI). Transition probabilities, utilities, and costs were obtained from published literature or expert opinion. Results were expressed in terms of costs and quality adjusted life years (QALYs). RESULTS No relevant cost-effectiveness analyses were identified in the published literature. According to the base-case results of our model, the most effective and cost-effective strategy is to image patients who meet CCC criteria with CT and to follow-up with MRI for suspected cases of space-occupying lesions (SOL). However, the results were sensitive to the specificity of MRI for detecting vascular causes of dementia. At a specificity of 64%, the most cost-effective strategy is CCC followed by MRI. LIMITATIONS Studies used to estimate diagnostic accuracy were limited by a lack of a gold standard test for establishing the cause of dementia. The model does not include costs to patients and their families, nor does it account for patient preferences about diagnostic information. CONCLUSIONS Given the relative prevalence of vascular dementia and SOLs, and the improvement in QALYs associated with treatment, the strategy with the greatest combined sensitivity (CCC with CT followed by MRI for patients with SOLs) results in the greatest number of QALYs and is the least costly. Due to limitations in the clinical data and challenges in the interpretation of this evidence, the model should be considered a framework for assessing uncertainty in the evidence base rather than providing definitive answers to the research questions.
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The appropriate use of neuroimaging in the diagnostic work-up of dementia: an evidence-based analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2014; 14:1-64. [PMID: 24592296 PMCID: PMC3937983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Diagnosis of dementia is challenging and requires both ruling out potentially treatable underlying causes and ruling in a diagnosis of dementia subtype to manage patients and suitably plan for the future. OBJECTIVES This analysis sought to determine the appropriate use of neuroimaging during the diagnostic work-up of dementia, including indications for neuroimaging and comparative accuracy of alternative technologies. DATA SOURCES A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published between 2000 and 2013. REVIEW METHODS Data on diagnostic accuracy and impact on clinical decision making were abstracted from included studies. Quality of evidence was assessed using GRADE. RESULTS The search yielded 5,374 citations and 15 studies were included. Approximately 10% of dementia cases are potentially treatable, though less than 1% reverse partially or fully. Neither prediction rules nor clinical indications reliably select the subset of patients who will likely benefit from neuroimaging. Clinical utility is highest in ambiguous cases or where dementia may be mixed, and lowest for clinically diagnosed Alzheimer disease or clinically excluded vascular dementia. There is a lack of evidence that MRI is superior to CT in detecting a vascular component to dementia. Accuracy of structural imaging is moderate to high for discriminating different types of dementia. LIMITATIONS There was significant heterogeneity in estimates of diagnostic accuracy, which often prohibited a statistical summary of findings. The quality of data reported by studies prohibited calculation of likelihood ratios in the present analysis. No studies from primary care were found; thus, generalizability beyond tertiary care settings may be limited. CONCLUSIONS A diagnosis of reversible dementia is rare. Imaging has the most clinical utility in cases where there is potentially mixed dementia or ambiguity as to the type of dementia despite prolonged follow-up (e.g., 2 years or more). Both CT and MRI are useful for detecting a vascular component of dementia.
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