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Ebinger JE, Driver MP, Botting P, Wang M, Cheng S, Tan ZS. Association of blood pressure variability during acute care hospitalization and incident dementia. Front Neurol 2023; 14:1085885. [PMID: 36824417 PMCID: PMC9941567 DOI: 10.3389/fneur.2023.1085885] [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: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
Background and objectives Recognized as a potential risk factor for Alzheimer's disease and related dementias (ADRD), blood pressure variability (BPV) could be leveraged to facilitate identification of at-risk individuals at a population level. Granular BPV data are available during acute care hospitalization periods for potentially high-risk patients, but the incident ADRD risk association with BPV measured in this setting is unknown. Our objective was to evaluate the relation of BPV, measured during acute care hospitalization, and incidence of ADRD. Methods We retrospectively studied adults, without a prior ADRD diagnosis, who were admitted to a large quaternary care medical center in Southern California between January 1, 2013 and December 31, 2019. For all patients, determined BPV, calculated as variability independent of the mean (VIM), using blood pressure readings obtained as part of routine clinical care. We used multivariable Cox proportional hazards regression to examine the association between BP VIM during hospitalization and the development of incident dementia, determined by new ICD-9/10 coding or the new prescription of dementia medication, occurring at least 2 years after the index hospitalization. Results Of 81,892 adults hospitalized without a prior ADRD diagnosis, 2,442 (2.98%) went on to develop ADRD (2.6 to 5.2 years after hospitalization). In multivariable-adjusted Cox models, both systolic (HR 1.05, 95% CI 1.00-1.09) and diastolic (1.06, 1.02-1.10) VIM were associated with incident ADRD. In pre-specified stratified analyses, the VIM associations with incident ADRD were most pronounced in individuals over age 60 years and among those with renal disease or hypertension. Results were similar when repeated to include incident ADRD diagnoses made at least 1 or 3 years after index hospitalization. Discussion We found that measurements of BPV from acute care hospitalizations can be used to identify individuals at risk for developing a diagnosis of ADRD within approximately 5 years. Use of the readily accessible BPV measure may allow healthcare systems to risk stratify patients during periods of intense patient-provider interaction and, in turn, facilitate engagement in ADRD screening programs.
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Affiliation(s)
- Joseph E. Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States,*Correspondence: Joseph E. Ebinger ✉
| | - Matthew P. Driver
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Patrick Botting
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Minhao Wang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zaldy S. Tan
- Department of Neurology and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States,David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Farràs-Permanyer L, Mancho-Fora N, Montalà-Flaquer M, Gudayol-Ferré E, Gallardo-Moreno GB, Zarabozo-Hurtado D, Villuendas-González E, Peró-Cebollero M, Guàrdia-Olmos J. Estimation of Brain Functional Connectivity in Patients with Mild Cognitive Impairment. Brain Sci 2019; 9:E350. [PMID: 31801260 PMCID: PMC6955819 DOI: 10.3390/brainsci9120350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022] Open
Abstract
Mild cognitive impairment is defined as greater cognitive decline than expected for a person at a particular age and is sometimes considered a stage between healthy aging and Alzheimer's disease or other dementia syndromes. It is known that functional connectivity patterns change in people with this diagnosis. We studied functional connectivity patterns and functional segregation in a resting-state fMRI paradigm comparing 10 MCI patients and 10 healthy controls matched by education level, age and sex. Ninety ROIs from the automated anatomical labeling (AAL) atlas were selected for functional connectivity analysis. A correlation matrix was created for each group, and a third matrix with the correlation coefficient differences between the two matrices was created. Functional segregation was analyzed with the 3-cycle method, which is novel in studies of this topic. Finally, cluster analyses were also performed. Our results showed that the two correlation matrices were visually similar but had many differences related to different cognitive functions. Differences were especially apparent in the anterior default mode network (DMN), while the visual resting-state network (RSN) showed no differences between groups. Differences in connectivity patterns in the anterior DMN should be studied more extensively to fully understand its role in the differentiation of healthy aging and an MCI diagnosis.
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Affiliation(s)
- Laia Farràs-Permanyer
- Departament de Psicologia Social i Psicologia Quantitativa, Facultat de Psicologia, Universitat de Barcelona, 08035 Barcelona, Spain; (N.M.-F.); (M.M.-F.); (M.P.-C.)
- UBICS Institute of Complex Systems & UB Institute of Neurosciences, 08035 Barcelona, Spain
| | - Núria Mancho-Fora
- Departament de Psicologia Social i Psicologia Quantitativa, Facultat de Psicologia, Universitat de Barcelona, 08035 Barcelona, Spain; (N.M.-F.); (M.M.-F.); (M.P.-C.)
| | - Marc Montalà-Flaquer
- Departament de Psicologia Social i Psicologia Quantitativa, Facultat de Psicologia, Universitat de Barcelona, 08035 Barcelona, Spain; (N.M.-F.); (M.M.-F.); (M.P.-C.)
| | - Esteve Gudayol-Ferré
- Facultad de Psicología, Universidad Michoacana de San Nicolás Hidalgo, Morelia 58000, Mexico; (E.G.-F.); (E.V.-G.)
| | | | | | - Erwin Villuendas-González
- Facultad de Psicología, Universidad Michoacana de San Nicolás Hidalgo, Morelia 58000, Mexico; (E.G.-F.); (E.V.-G.)
| | - Maribel Peró-Cebollero
- Departament de Psicologia Social i Psicologia Quantitativa, Facultat de Psicologia, Universitat de Barcelona, 08035 Barcelona, Spain; (N.M.-F.); (M.M.-F.); (M.P.-C.)
- UBICS Institute of Complex Systems & UB Institute of Neurosciences, 08035 Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Departament de Psicologia Social i Psicologia Quantitativa, Facultat de Psicologia, Universitat de Barcelona, 08035 Barcelona, Spain; (N.M.-F.); (M.M.-F.); (M.P.-C.)
- UBICS Institute of Complex Systems & UB Institute of Neurosciences, 08035 Barcelona, Spain
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3
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Chiti A, Cecchi P, Pesaresi I, Orlandi G, Giannini N, Gialdini G, Terni E, Tognoni G, Volpi L, Pagni C, Ghicopulos I, Siciliano G, Dotti MT, Federico A, Poggesi A, Salvadori E, Pantoni L, Inzitari D, Cosottini M, Bonuccelli U. Functional magnetic resonance imaging with encoding task in patients with mild cognitive impairment and different severity of leukoaraiosis. Psychiatry Res Neuroimaging 2018; 282:126-131. [PMID: 30539733 DOI: 10.1016/j.pscychresns.2018.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 06/15/2018] [Accepted: 06/28/2018] [Indexed: 11/20/2022]
Abstract
Leukoaraiosis is one of the main contributors to mild cognitive impairment due to vascular damage (vascular MCI, VMCI), whose pathophysiology has not been fully elucidated yet. We aimed to shed light on such issue using functional MRI (fMRI). Sixteen patients with VMCI were enrolled and compared with twenty-five patients with MCI but without significant vascular damage (non-vascular MCI, NVMCI) and with fifteen healthy controls (HC). They all underwent fMRI with incidental verbal learning paradigm, using a 3T scanner. Differently from cases with NVMCI (versus HC), VMCI patients presented a higher BOLD activation in the right parieto-occipital cortex and a lower activation in the left superior and middle frontal gyri, anterior cingulum and in left fronto-opercular area when compared to HC. Cortical activation evaluated by fMRI may reflect specific patterns of damage and attempt of compensation in patients with MCI and different severity of leukoaraiosis.
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Affiliation(s)
- Alberto Chiti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy; Unit of Neurology, Ospedale Apuane, Via Mattei 21, Massa 54100, Italy.
| | - Paolo Cecchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, Pisa 56126, Italy
| | - Ilaria Pesaresi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, Pisa 56126, Italy
| | - Giovanni Orlandi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy; Unit of Neurology, Ospedale Apuane, Via Mattei 21, Massa 54100, Italy
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Gino Gialdini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Eva Terni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Gloria Tognoni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Leda Volpi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Cristina Pagni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Irene Ghicopulos
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci 16, Siena 53100, Italy
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci 16, Siena 53100, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Leonardo Pantoni
- "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Via G.B Grassi, 74, Milan 20157, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, Pisa 56126, Italy
| | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
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Zeydan B, Deelchand DK, Tosakulwong N, Lesnick TG, Kantarci OH, Machulda MM, Knopman DS, Lowe VJ, Jack CR, Petersen RC, Öz G, Kantarci K. Decreased Glutamate Levels in Patients with Amnestic Mild Cognitive Impairment: An sLASER Proton MR Spectroscopy and PiB-PET Study. J Neuroimaging 2017; 27:630-636. [PMID: 28661060 DOI: 10.1111/jon.12454] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Glutamate levels may be informative about the declining neuronal health in the central nervous system. We used an advanced proton MR spectroscopy (1 H-MRS) protocol composed of semi-localization by adiabatic selective refocusing (sLASER) localization and FAST(EST)MAP shimming for detection of alterations in brain glutamate concentrations in patients with amnestic mild cognitive impairment. METHODS Participants with amnestic mild cognitive impairment (n = 14; median age = 80) and age- and sex-matched clinically normal controls (n = 32; median age = 79) from the population-based Mayo Clinic Study of Aging were recruited prospectively to the 3T single-voxel 1 H-MRS study that examined metabolite changes in the posterior cingulate gyri. To be included, controls had to have low β-amyloid load on [11 C] Pittsburgh Compound B (PiB)-PET (standard uptake value ratio; SUVr < 1.42) and patients with amnestic mild cognitive impairment had to have high β-amyloid load (SUVr ≥ 1.42). RESULTS Glutamate concentration and the glutamate/myo-inositol ratio were lower in patients with amnestic mild cognitive impairment than clinically normal controls (P < .05). Higher global cortical PiB-PET SUVr correlated with lower glutamate/myo-inositol (r = -.3, P = .04). CONCLUSIONS The advanced sLASER with FAST(EST)MAP shimming is a promising protocol for identifying glutamate alterations. Advanced 1 H-MRS protocols may add to the understanding of early Alzheimer's disease pathophysiology through detection of glutamate concentration in posterior cingulate gyri of individuals with amnestic mild cognitive impairment.
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Affiliation(s)
- Burcu Zeydan
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Dinesh K Deelchand
- Department of Radiology, University of Minnesota, Center for Magnetic Resonance Research, Minneapolis, MN
| | - Nirubol Tosakulwong
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Orhun H Kantarci
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN
| | - David S Knopman
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Val J Lowe
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Gülin Öz
- Department of Radiology, University of Minnesota, Center for Magnetic Resonance Research, Minneapolis, MN
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
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Alberdi A, Aztiria A, Basarab A. On the early diagnosis of Alzheimer's Disease from multimodal signals: A survey. Artif Intell Med 2016; 71:1-29. [PMID: 27506128 DOI: 10.1016/j.artmed.2016.06.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/23/2016] [Accepted: 06/07/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The number of Alzheimer's Disease (AD) patients is increasing with increased life expectancy and 115.4 million people are expected to be affected in 2050. Unfortunately, AD is commonly diagnosed too late, when irreversible damages have been caused in the patient. OBJECTIVE An automatic, continuous and unobtrusive early AD detection method would be required to improve patients' life quality and avoid big healthcare costs. Thus, the objective of this survey is to review the multimodal signals that could be used in the development of such a system, emphasizing on the accuracy that they have shown up to date for AD detection. Some useful tools and specific issues towards this goal will also have to be reviewed. METHODS An extensive literature review was performed following a specific search strategy, inclusion criteria, data extraction and quality assessment in the Inspec, Compendex and PubMed databases. RESULTS This work reviews the extensive list of psychological, physiological, behavioural and cognitive measurements that could be used for AD detection. The most promising measurements seem to be magnetic resonance imaging (MRI) for AD vs control (CTL) discrimination with an 98.95% accuracy, while electroencephalogram (EEG) shows the best results for mild cognitive impairment (MCI) vs CTL (97.88%) and MCI vs AD distinction (94.05%). Available physiological and behavioural AD datasets are listed, as well as medical imaging analysis steps and neuroimaging processing toolboxes. Some issues such as "label noise" and multi-site data are discussed. CONCLUSIONS The development of an unobtrusive and transparent AD detection system should be based on a multimodal system in order to take full advantage of all kinds of symptoms, detect even the smallest changes and combine them, so as to detect AD as early as possible. Such a multimodal system might probably be based on physiological monitoring of MRI or EEG, as well as behavioural measurements like the ones proposed along the article. The mentioned AD datasets and image processing toolboxes are available for their use towards this goal. Issues like "label noise" and multi-site neuroimaging incompatibilities may also have to be overcome, but methods for this purpose are already available.
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Affiliation(s)
- Ane Alberdi
- Mondragon University, Electronics and Computing Department, Goiru Kalea, 2, Arrasate 20500, Spain.
| | - Asier Aztiria
- Mondragon University, Electronics and Computing Department, Goiru Kalea, 2, Arrasate 20500, Spain.
| | - Adrian Basarab
- Université de Toulouse, Institut de Recherche en Informatique de Toulouse, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5505, Université Paul Sabatier, 118 Route de Narbonne, 31062 Toulouse, France.
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Canadian Consensus Guidelines on Use of Amyloid Imaging in Canada: Update and Future Directions from the Specialized Task Force on Amyloid imaging in Canada. Can J Neurol Sci 2016; 43:503-12. [DOI: 10.1017/cjn.2015.401] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractPositron emission tomography (PET) imaging of brain amyloid beta is now clinically available in several countries including the United States and the United Kingdom, but not Canada. It has become an established technique in the field of neuroimaging of aging and dementia, with data incorporated in the new consensus guidelines for the diagnosis of Alzheimer disease and predementia Alzheimer’s disease–related conditions. At this point, there are three US Food and Drug Administration– and European Union–approved tracers. Guided by appropriate use criteria developed in 2013 by the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging, the utility of amyloid imaging in medical practice is now supported by a growing body of research. In this paper, we aimed to provide an update on the 2012 Canadian consensus guidelines to dementia care practitioners on proper use of amyloid imaging. We also wished to generate momentum for the industry to submit a new drug proposal to Health Canada. A group of local, national, and international dementia experts and imaging specialists met to discuss scenarios in which amyloid PET could be used appropriately. Peer-reviewed and published literature between January 2004 and May 2015 was searched. Technical and regulatory considerations pertaining to Canada were considered. The results of a survey of current practices in Canadian dementia centers were considered. A set of specific clinical and research guidelines was agreed on that defines the types of patients and clinical circumstances in which amyloid PET could be used in Canada. Future research directions were also outlined, notably the importance of studies that would assess the pharmaco-economics of amyloid imaging.
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The Effect of Task-Irrelevant Fearful-Face Distractor on Working Memory Processing in Mild Cognitive Impairment versus Healthy Controls: An Exploratory fMRI Study in Female Participants. Behav Neurol 2016; 2016:1637392. [PMID: 26949290 PMCID: PMC4753321 DOI: 10.1155/2016/1637392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/31/2015] [Accepted: 01/05/2016] [Indexed: 11/25/2022] Open
Abstract
In mild cognitive impairment (MCI), a risk state for Alzheimer's disease, patients have objective cognitive deficits with relatively preserved functioning. fMRI studies have identified anomalies during working memory (WM) processing in individuals with MCI. The effect of task-irrelevant emotional face distractor on WM processing in MCI remains unclear. We aim to explore the impact of fearful-face task-irrelevant distractor on WM processing in MCI using fMRI. Hypothesis. Compared to healthy controls (HC), MCI patients will show significantly higher BOLD signal in a priori identified regions of interest (ROIs) during a WM task with a task-irrelevant emotional face distractor. Methods. 9 right-handed female participants with MCI and 12 matched HC performed a WM task with standardized task-irrelevant fearful versus neutral face distractors randomized and counterbalanced across WM trials. MRI images were acquired during the WM task and BOLD signal was analyzed using statistical parametric mapping (SPM) to identify signal patterns during the task response phase. Results. Task-irrelevant fearful-face distractor resulted in higher activation in the amygdala, anterior cingulate, and frontal areas, in MCI participants compared to HC. Conclusions. This exploratory study suggests altered WM processing as a result of fearful-face distractor in MCI.
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Burhan AM, Marlatt NM, Palaniyappan L, Anazodo UC, Prato FS. Role of Hybrid Brain Imaging in Neuropsychiatric Disorders. Diagnostics (Basel) 2015; 5:577-614. [PMID: 26854172 PMCID: PMC4728476 DOI: 10.3390/diagnostics5040577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/21/2015] [Accepted: 11/26/2015] [Indexed: 01/09/2023] Open
Abstract
This is a focused review of imaging literature to scope the utility of hybrid brain imaging in neuropsychiatric disorders. The review focuses on brain imaging modalities that utilize hybrid (fusion) techniques to characterize abnormal brain molecular signals in combination with structural and functional changes that have been observed in neuropsychiatric disorders. An overview of clinical hybrid brain imaging technologies for human use is followed by a selective review of the literature that conceptualizes the use of these technologies in understanding basic mechanisms of major neuropsychiatric disorders and their therapeutics. Neuronal network abnormalities are highlighted throughout this review to scope the utility of hybrid imaging as a potential biomarker for each disorder.
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Affiliation(s)
- Amer M Burhan
- St. Joseph's Health Care London, Parkwood Institute, 550 Wellington Road, London, ON N6C 0A7, Canada.
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6C 2R6, Canada.
| | - Nicole M Marlatt
- St. Joseph's Health Care London, Parkwood Institute, 550 Wellington Road, London, ON N6C 0A7, Canada.
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6C 2R6, Canada.
| | | | - Frank S Prato
- Lawson Health Research Institute, London, ON N6C 2R5, Canada.
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Attems J, Jellinger KA. The overlap between vascular disease and Alzheimer's disease--lessons from pathology. BMC Med 2014; 12:206. [PMID: 25385447 PMCID: PMC4226890 DOI: 10.1186/s12916-014-0206-2] [Citation(s) in RCA: 458] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/07/2014] [Indexed: 12/15/2022] Open
Abstract
Recent epidemiological and clinico-pathological data indicate considerable overlap between cerebrovascular disease (CVD) and Alzheimer's disease (AD) and suggest additive or synergistic effects of both pathologies on cognitive decline. The most frequent vascular pathologies in the aging brain and in AD are cerebral amyloid angiopathy and small vessel disease. Up to 84% of aged subjects show morphological substrates of CVD in addition to AD pathology. AD brains with minor CVD, similar to pure vascular dementia, show subcortical vascular lesions in about two-thirds, while in mixed type dementia (AD plus vascular dementia), multiple larger infarcts are more frequent. Small infarcts in patients with full-blown AD have no impact on cognitive decline but are overwhelmed by the severity of Alzheimer pathology, while in early stages of AD, cerebrovascular lesions may influence and promote cognitive impairment, lowering the threshold for clinically overt dementia. Further studies are warranted to elucidate the many hitherto unanswered questions regarding the overlap between CVD and AD as well as the impact of both CVD and AD pathologies on the development and progression of dementia.
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Affiliation(s)
- Johannes Attems
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
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Pieramico V, Esposito R, Cesinaro S, Frazzini V, Sensi SL. Effects of non-pharmacological or pharmacological interventions on cognition and brain plasticity of aging individuals. Front Syst Neurosci 2014; 8:153. [PMID: 25228860 PMCID: PMC4151335 DOI: 10.3389/fnsys.2014.00153] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/05/2014] [Indexed: 12/21/2022] Open
Abstract
Brain aging and aging-related neurodegenerative disorders are major health challenges faced by modern societies. Brain aging is associated with cognitive and functional decline and represents the favourable background for the onset and development of dementia. Brain aging is associated with early and subtle anatomo-functional physiological changes that often precede the appearance of clinical signs of cognitive decline. Neuroimaging approaches unveiled the functional correlates of these alterations and helped in the identification of therapeutic targets that can be potentially useful in counteracting age-dependent cognitive decline. A growing body of evidence supports the notion that cognitive stimulation and aerobic training can preserve and enhance operational skills in elderly individuals as well as reduce the incidence of dementia. This review aims at providing an extensive and critical overview of the most recent data that support the efficacy of non-pharmacological and pharmacological interventions aimed at enhancing cognition and brain plasticity in healthy elderly individuals as well as delaying the cognitive decline associated with dementia.
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Affiliation(s)
- Valentina Pieramico
- Molecular Neurology Unit, Center of Excellence on Aging, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Roberto Esposito
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Stefano Cesinaro
- Molecular Neurology Unit, Center of Excellence on Aging, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Valerio Frazzini
- Molecular Neurology Unit, Center of Excellence on Aging, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Molecular Neurology Unit, Center of Excellence on Aging, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy ; Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy ; Departments of Neurology and Pharmacology, Institute for Memory Impairments and Neurological Disorders, University of California-Irvine Irvine, CA, USA
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Patterson C, Gauthier S. Diagnosis and treatment of dementia: the fourth canadian consensus conference. ALZHEIMERS RESEARCH & THERAPY 2013; 5:S1. [PMID: 24565164 PMCID: PMC3980322 DOI: 10.1186/alzrt196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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