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Zhou F, Liu BF, Wang C, Zhang J, Dong GM, Jin HT, Ma BP, Zhong XM. Acute toxicity, 28-day repeated-dose toxicity and toxicokinetic study of timosaponin BII in beagle dogs. JOURNAL OF ASIAN NATURAL PRODUCTS RESEARCH 2022; 24:860-876. [PMID: 34698619 DOI: 10.1080/10286020.2021.1993834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
The safety evaluation of timosaponin BII (TBII) in beagle dogs with toxicokinetic study was performed. For the acute oral toxicity study, the minimum lethal dose (MLD) of TBII was more than 2000 mg/kg and suggested the characteristics of absorption saturation. For the 28-day repeated dose oral toxicity and toxicokinetic studies, there was no significant effect on all test parameters except for prolonged APTT in the 60 and 180 mg/kg groups, which recovered after withdrawal. The increase of drug exposure of 180 mg/kg group was not proportional to the increase of administration dose, showing the characteristics of absorption saturation.
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Affiliation(s)
- Fei Zhou
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Bao-Feng Liu
- Shandong Xinbo Pharmaceutical R&D, Ltd, Dezhou 251500, China
| | - Can Wang
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences&Peking Union Medical College, Beijing 100050, China
| | - Jie Zhang
- Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Guo-Ming Dong
- Beijing Hwellso Pharmaceutical Corporation, Ltd, Beijing 100081, China
| | - Hong-Tao Jin
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences&Peking Union Medical College, Beijing 100050, China
| | - Bai-Ping Ma
- Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Xiao-Ming Zhong
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
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Stella F, Pais MV, Loureiro JC, Radanovic M, Forlenza OV. Neuropsychiatric symptoms and cerebrovascular risk in non-demented elders: cross-sectional study using the mild behavioural impairment checklist (MBI-C). Psychogeriatrics 2022; 22:55-66. [PMID: 34704636 DOI: 10.1111/psyg.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) may represent early clinical manifestations of evolving brain diseases. Studies underpin the occurrence of NPS in the context of mild cognitive impairment (MCI) and prodromal Alzheimer's disease, where symptoms referred to as 'mild behavioural impairment' (MBI) have been shown to predict conversion to dementia and to hasten cognitive/functional decline. However, the association between NPS and cerebrovascular risk factors has been poorly investigated, despite the high prevalence of the latter among individuals with MCI. The aim of the present study was to investigate the association between MBI and cerebrovascular risk in a clinical sample of non-demented elders. METHODS Sixty-five MCI and 15 cognitively unimpaired older adults were cross-sectionally assessed with the Mild Behavioural Impairment Checklist (MBI-C), using the cut-off score > 6.5 to define positive screening. Participants were submitted to the Hachinski Ischaemic Score (HIS) to account for cerebrovascular symptoms, vascular risk, and related comorbidities. Neuroimaging scans (magnetic resonance imaging and/or 18F-fluorodeoxyglucose-positron emission tomography) and apolipoprotein E genotype were obtained. RESULTS Positive associations were found between total MBI-C scores and increasing number of comorbidities present (0-2 comorbidities), but not with three comorbidities. Two domains of the MBI-C-impulse dyscontrol and social inappropriateness-followed the same trend of the MBI-C total score, with higher scores with the increasing numbers of comorbidities. No significant associations were found between MBI symptoms and HIS or cerebrovascular burden in neuroimaging assessment. CONCLUSION We found weak associations between MBI-C total score and the presence of comorbidities with cerebrovascular risk, but not with structural or functional neuroimaging abnormalities or HIS. This finding may represent that the presence of comorbidities adds limited risk to the occurrence of MBI in this sample of non-demented elders.
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Affiliation(s)
- Florindo Stella
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil.,UNESP-Universidade Estadual Paulista, Instituto de Biociências, Sao Paulo, Brazil
| | - Marcos V Pais
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Júlia C Loureiro
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Marcia Radanovic
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
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Bir SC, Khan MW, Javalkar V, Toledo EG, Kelley RE. Emerging Concepts in Vascular Dementia: A Review. J Stroke Cerebrovasc Dis 2021; 30:105864. [PMID: 34062312 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105864] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Vascular dementia (VaD) is the second most common cause of dementia and a major health concern worldwide. A comprehensive review on VaD is warranted for better understanding and guidance for the practitioner. We provide an updated overview of the epidemiology, pathophysiological mechanisms, neuroimaging patterns as well as current diagnostic and therapeutic approaches. MATERIALS AND METHODS A narrative review of current literature in VaD was performed based on publications from the database of PubMed, Scopus and Google Scholar up to January, 2021. RESULTS VaD can be the result of ischemic or hemorrhagic tissue injury in a particular region of the brain which translates into clinically significant cognitive impairment. For example, a cerebral infarct in the speech area of the dominant hemisphere would translate into clinically significant impairment as would involvement of projection pathways such as the arcuate fasciculus. Specific involvement of the angular gyrus of the dominant hemisphere, with resultant Gerstman's syndrome, could have a pronounced effect on functional ability despite being termed a "minor stroke". Small vessel cerebrovascular disease can have a cumulate effect on cognitive function over time. It is unfortunately well recognized that "good" functional recovery in acute ischemic or haemorrhagic stroke, including subarachnoid haemorrhage, does not necessarily translate into good cognitive recovery. The victim may often be left unable to have gainful employment, drive a car safely or handle their affairs independently. CONCLUSIONS This review should serve as a compendium of updated information on VaD and provide guidance in terms of newer diagnostic and potential therapeutic approaches.
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Affiliation(s)
- Shyamal C Bir
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA
| | - Muhammad W Khan
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA
| | - Vijayakumar Javalkar
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA
| | | | - Roger E Kelley
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA.
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Mur J, McCartney DL, Chasman DI, Visscher PM, Muniz-Terrera G, Cox SR, Russ TC, Marioni RE. Variation in VKORC1 Is Associated with Vascular Dementia. J Alzheimers Dis 2021; 80:1329-1337. [PMID: 33682710 PMCID: PMC8150662 DOI: 10.3233/jad-201256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The genetic variant rs9923231 (VKORC1) is associated with differences in the coagulation of blood and consequentially with sensitivity to the drug warfarin. Variation in VKORC1 has been linked in a gene-based test to dementia/Alzheimer's disease in the parents of participants, with suggestive evidence for an association for rs9923231 (p = 1.8×10-7), which was included in the genome-wide significant KAT8 locus. OBJECTIVE Our study aimed to investigate whether the relationship between rs9923231 and dementia persists only for certain dementia sub-types, and if those taking warfarin are at greater risk. METHODS We used logistic regression and data from 238,195 participants from UK Biobank to examine the relationship between VKORC1, risk of dementia, and the interplay with warfarin use. RESULTS Parental history of dementia, APOE variant, atrial fibrillation, diabetes, hypertension, and hypercholesterolemia all had strong associations with vascular dementia (p < 4.6×10-6). The T-allele in rs9923231 was linked to a lower warfarin dose (βperT - allele = -0.29, p < 2×10-16) and risk of vascular dementia (OR = 1.17, p = 0.010), but not other dementia sub-types. However, the risk of vascular dementia was not affected by warfarin use in carriers of the T-allele. CONCLUSION Our study reports for the first time an association between rs9923231 and vascular dementia, but further research is warranted to explore potential mechanisms and specify the relationship between rs9923231 and features of vascular dementia.
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Affiliation(s)
- Jure Mur
- Lothian Birth Cohorts group, Department of Psychology, University of Edinburgh, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Daniel L. McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Daniel I. Chasman
- Division of Preventive Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Peter M. Visscher
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - Simon R. Cox
- Lothian Birth Cohorts group, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Tom C. Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - Riccardo E. Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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Ismail M, Alsalahi A, Khaza’ai H, Imam MU, Ooi DJ, Samsudin MN, Idrus Z, Sokhini MHM, A. Aljaberi M. Correlation of Mortality Burdens of Cerebrovascular Disease and Diabetes Mellitus with Domestic Consumption of Soya and Palm Oils. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155410. [PMID: 32731336 PMCID: PMC7432948 DOI: 10.3390/ijerph17155410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebrovascular diseases (CBVDs) and diabetes mellitus (DM) are interrelated and cumbersome global health burdens. However, the relationship between edible oils consumption and mortality burdens of CBVDs and DM has not yet been evaluated. This review aims to explore correlations between per capita mortality burdens of CBVDs and DM, as well as food consumption of palm or soya oils in 11 randomly selected countries in 2005, 2010, and 2016. METHODS After obtaining data on food consumption of palm and soya oils and mortality burdens of CBVDs and DM, correlations between the consumption of oils and mortality burdens of diseases were explored. RESULTS There was a positive correlation between the consumption of soya oil with the mortality burden of CBVDs in Australia, Switzerland, and Indonesia, as well as the mortality burden of DM in the USA. The consumption of palm oil had a positive correlation with the mortality burden of DM in Jordan only. CONCLUSIONS Food consumption of soya oil in several countries possibly contributes to the mortality burden of CBVDs or DM more than food consumption of palm oil, which could be a possible risk factor in the mortality burdens of CBVDs and DM.
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Affiliation(s)
- Maznah Ismail
- Laboratory of Molecular Biomedicine, Institute of Bioscience, Universiti Putra Malaysia, UPM 43400, Serdang, Selangor, Malaysia;
- Correspondence: ; Tel.: +60-19-6655808 or +603-97692115
| | - Abdulsamad Alsalahi
- Laboratory of Molecular Biomedicine, Institute of Bioscience, Universiti Putra Malaysia, UPM 43400, Serdang, Selangor, Malaysia;
- Department of Pharmacology, Faculty of Pharmacy, Sana’a University, Mazbah District, Sana’a Secretariat 1247, Yemen
| | - Huzwah Khaza’ai
- Department of Biomedicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM 43400, Serdang, Selangor, Malaysia;
| | - Mustapha Umar Imam
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, Sokoto 840231, Nigeria;
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, Usmanu Danfodiyo University, Sokoto 840231, Nigeria
| | - Der Jiun Ooi
- Department of Oral Biology & Biomedical Sciences, Faculty of Dentistry, MAHSA University, Jenjarom Selangor 42610, Malaysia;
| | - Mad Nasir Samsudin
- Department of Agribusiness and Bioresource Economics, Faculty of Agriculture, Universiti Putra Malaysia, UPM 43400, Serdang, Selangor, Malaysia;
| | - Zulkifli Idrus
- Institute of Tropical Agriculture and Food Security, Universiti Putra Malaysia, UPM 43400, Serdang, Selangor, Malaysia;
| | - Muhammed Ha’iz Mohd Sokhini
- Ethical Classic Business, Duopharma Marketing Sdn. Bhd. Lot No 2,4,6,8 & 10, Jalan P/7, Seksyen 13, Kawasan Perusahaan, Bandar Baru Bangi 43650, Selangor, Malaysia;
| | - Musheer A. Aljaberi
- Community Health Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM 43400, Serdang, Selangor, Malaysia;
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Rauchmann BS, Ghaseminejad F, Mekala S, Perneczky R. Cerebral Microhemorrhage at MRI in Mild Cognitive Impairment and Early Alzheimer Disease: Association with Tau and Amyloid β at PET Imaging. Radiology 2020; 296:134-142. [PMID: 32368960 DOI: 10.1148/radiol.2020191904] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Growing evidence indicates an association between cerebral microhemorrhages (MHs) and amyloid β accumulation in Alzheimer disease (AD), but to the knowledge of the authors the association with tau burden is unknown. Purpose To investigate the association between cerebral MH load and tau pathologic structure measured in healthy older individuals and individuals along the AD spectrum, stratified by using the A (amyloid β)/T (tau)/N (neurodegeneration) biomarker classification system. Materials and methods In this prospective cohort study, participants from the AD Neuroimaging Initiative were included (healthy control participants, participants with mild cognitive impairment, and participants with AD dementia; data from October 2005 to January 2019). T2*-weighted gradient-echo MRI was performed to quantify MH, fluorine 18 (18F) flortaucipir (AV-1451) PET was performed to quantify tau, and 18F-florbetaben/18F- florbetapir (AV45) PET was performed to quantify amyloid β to study associations of MH with regional and global tau and amyloid β load. Associations with cerebrospinal fluid (CSF) biomarkers (amyloid β1-42, total tau, phosphorylated tau 181) were also assessed. Analysis of covariance and Spearman rank correlation test for cross-sectional analysis and Wilcoxon signed rank test for longitudinal analyses were used, controlling for multiple comparisons (Bonferroni significance threshold, P < .008). Results Evaluated were 343 participants (mean age, 75 years ± 7; 186 women), including 205 participants who were A-TN- (mean age, 73 years ± 7; 115 women), 80 participants who were A+TN- (mean age, 76 years ± 7; 38 women), and 58 participants who were A+TN+ (mean age, 77 ± 8; 34 women). MH count was associated with global (Spearman ρ = 0.27; P = .004) and frontal (ρ = 0.27; P = .005) amyloid β load and global tau load (ρ = 0.31; P = .001). In a longitudinal analysis, MH count increased significantly over approximately 5 years in the entire cohort (T-1, 81 [range, 0-6 participants]; T0, 214 [range, 0-58 participants]; P < .001), in A+TN+ (T-1, 20 [range, 0-5 participants]; T0, 119 [range, 1-58 participants]; P < .001), A+TN- (T-1, 31 [range, 0-6 participants]; T0, 43 [range, 0-8 participants]; P = .03), and A-TN- (T-1, 30 [range, 0-4 participants]; T0, 52 [range, 0-6 participants]; P = .007). A higher MH count was associated with higher future global (ρ = 0.29; P = .008) and parietal (ρ = 0.31; P = .005) amyloid β and parietal tau load (ρ = 0.31; P = .005). Conclusion Cerebral microhemorrhage load is associated spatially with tau accumulation, both cross-sectionally and longitudinally. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Boris-Stephan Rauchmann
- From the Department of Radiology (B.S.R.) and Division of Mental Health of Older Adults, Department of Psychiatry and Psychotherapy (B.S.R., S.M., R.P.), University Hospital, Ludwig-Maximilians-Universität München, Nussbaumstr 7, 80336 Munich, Germany; Department of Psychiatry, University of British Columbia, Vancouver, Canada (F.G.); German Center for Neurodegenerative Diseases Munich, Germany (R.P.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (R.P.); and Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, England (R.P.)
| | - Farhad Ghaseminejad
- From the Department of Radiology (B.S.R.) and Division of Mental Health of Older Adults, Department of Psychiatry and Psychotherapy (B.S.R., S.M., R.P.), University Hospital, Ludwig-Maximilians-Universität München, Nussbaumstr 7, 80336 Munich, Germany; Department of Psychiatry, University of British Columbia, Vancouver, Canada (F.G.); German Center for Neurodegenerative Diseases Munich, Germany (R.P.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (R.P.); and Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, England (R.P.)
| | - Shailaja Mekala
- From the Department of Radiology (B.S.R.) and Division of Mental Health of Older Adults, Department of Psychiatry and Psychotherapy (B.S.R., S.M., R.P.), University Hospital, Ludwig-Maximilians-Universität München, Nussbaumstr 7, 80336 Munich, Germany; Department of Psychiatry, University of British Columbia, Vancouver, Canada (F.G.); German Center for Neurodegenerative Diseases Munich, Germany (R.P.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (R.P.); and Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, England (R.P.)
| | - Robert Perneczky
- From the Department of Radiology (B.S.R.) and Division of Mental Health of Older Adults, Department of Psychiatry and Psychotherapy (B.S.R., S.M., R.P.), University Hospital, Ludwig-Maximilians-Universität München, Nussbaumstr 7, 80336 Munich, Germany; Department of Psychiatry, University of British Columbia, Vancouver, Canada (F.G.); German Center for Neurodegenerative Diseases Munich, Germany (R.P.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (R.P.); and Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, England (R.P.)
| | -
- From the Department of Radiology (B.S.R.) and Division of Mental Health of Older Adults, Department of Psychiatry and Psychotherapy (B.S.R., S.M., R.P.), University Hospital, Ludwig-Maximilians-Universität München, Nussbaumstr 7, 80336 Munich, Germany; Department of Psychiatry, University of British Columbia, Vancouver, Canada (F.G.); German Center for Neurodegenerative Diseases Munich, Germany (R.P.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (R.P.); and Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, England (R.P.)
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Brini S, Sohrabi HR, Hebert JJ, Forrest MRL, Laine M, Hämäläinen H, Karrasch M, Peiffer JJ, Martins RN, Fairchild TJ. Bilingualism Is Associated with a Delayed Onset of Dementia but Not with a Lower Risk of Developing it: a Systematic Review with Meta-Analyses. Neuropsychol Rev 2020; 30:1-24. [PMID: 32036490 PMCID: PMC7089902 DOI: 10.1007/s11065-020-09426-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/03/2020] [Indexed: 12/14/2022]
Abstract
Some studies have linked bilingualism with a later onset of dementia, Alzheimer's disease (AD), and mild cognitive impairment (MCI). Not all studies have observed such relationships, however. Differences in study outcomes may be due to methodological limitations and the presence of confounding factors within studies such as immigration status and level of education. We conducted the first systematic review with meta-analysis combining cross-sectional studies to explore if bilingualism might delay symptom onset and diagnosis of dementia, AD, and MCI. Primary outcomes included the age of symptom onset, the age at diagnosis of MCI or dementia, and the risk of developing MCI or dementia. A secondary outcome included the degree of disease severity at dementia diagnosis. There was no difference in the age of MCI diagnosis between monolinguals and bilinguals [mean difference: 3.2; 95% confidence intervals (CI): -3.4, 9.7]. Bilinguals vs. monolinguals reported experiencing AD symptoms 4.7 years (95% CI: 3.3, 6.1) later. Bilinguals vs. monolinguals were diagnosed with dementia 3.3 years (95% CI: 1.7, 4.9) later. Here, 95% prediction intervals showed a large dispersion of effect sizes (-1.9 to 8.5). We investigated this dispersion with a subgroup meta-analysis comparing studies that had recruited participants with dementia to studies that had recruited participants with AD on the age of dementia and AD diagnosis between mono- and bilinguals. Results showed that bilinguals vs. monolinguals were 1.9 years (95% CI: -0.9, 4.7) and 4.2 (95% CI: 2.0, 6.4) older than monolinguals at the time of dementia and AD diagnosis, respectively. The mean difference between the two subgroups was not significant. There was no significant risk reduction (odds ratio: 0.89; 95% CI: 0.68-1.16) in developing dementia among bilinguals vs. monolinguals. Also, there was no significant difference (Hedges' g = 0.05; 95% CI: -0.13, 0.24) in disease severity at dementia diagnosis between bilinguals and monolinguals, despite bilinguals being significantly older. The majority of studies had adjusted for level of education suggesting that education might not have played a role in the observed delay in dementia among bilinguals vs. monolinguals. Although findings indicated that bilingualism was on average related to a delayed onset of dementia, the magnitude of this relationship varied across different settings. This variation may be due to unexplained heterogeneity and different sources of bias in the included studies. Registration: PROSPERO CRD42015019100.
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Affiliation(s)
- Stefano Brini
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia.
- Turku Brain and Mind Center, Turku, Finland.
- Health Services Research and Management School of Health Sciences, City, University of London, London, UK.
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland.
| | - Hamid R Sohrabi
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Department of Biomedical Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Jeffrey J Hebert
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Mitchell R L Forrest
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
| | - Matti Laine
- Turku Brain and Mind Center, Turku, Finland
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Heikki Hämäläinen
- Turku Brain and Mind Center, Turku, Finland
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Jeremiah J Peiffer
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
| | - Ralph N Martins
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Department of Biomedical Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
- Australian Alzheimer's Research Foundation, Perth, Western Australia, Australia
| | - Timothy J Fairchild
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Western Australia, Australia
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Hu Y, Chen W, Wu L, Jiang L, Chen L, Tang N. Clinical observation of the efficacy and mechanism of the Wenfei Jiangzhuo formula in lung and kidney deficiency-type vascular dementia. ALL LIFE 2020. [DOI: 10.1080/26895293.2020.1729869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Yueqiang Hu
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
- Key Laboratory of Guangxi Basic Chinese Medicine, Nanning, People’s Republic of China
| | - Wei Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
- Key Laboratory of Guangxi Basic Chinese Medicine, Nanning, People’s Republic of China
| | - Lin Wu
- Key Laboratory of Guangxi Basic Chinese Medicine, Nanning, People’s Republic of China
- Scientific Laboratorial Centre Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
| | - Lingfei Jiang
- Graduate College of Guangxi University of Traditional Chinese Medicine, Nanning, People’s Republic of China
| | - Lianmei Chen
- Graduate College of Guangxi University of Traditional Chinese Medicine, Nanning, People’s Republic of China
| | - Nong Tang
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, People’s Republic of China
- Key Laboratory of Guangxi Basic Chinese Medicine, Nanning, People’s Republic of China
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Rochoy M, Chazard E, Gautier S, Bordet R. Vascular dementia encoding in the French nationwide discharge summary database (PMSI): Variability over the 2007-2017 period. Ann Cardiol Angeiol (Paris) 2019; 68:150-154. [PMID: 30409382 DOI: 10.1016/j.ancard.2018.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Vascular dementia (VaD) is the second leading cause of dementia. Diagnostic criteria have evolved from the concept of multiple infarctions to different subtypes: acute onset VaD, subcortical VaD, mixed cortical and subcortical VaD. Our aim was to analyze the evolution in the coding of these different subtypes of VaD in the French nationwide exhaustive hospital discharge database (PMSI) between 2007 and 2017. METHOD We included all principal diagnoses of VaD in the PMSI hospital stays from 2007 to 2017. RESULTS Between 2007 and 2017, we show a relative decrease in the number of hospital stays for VaD compared to all hospital stays (0.0437% to 0.0404%). The 11,654 hospital stays for VaD in 2017 represent 13.5% of mental organic disorders. Subtype analysis shows a decrease in hospital stays for multiple infarctions between 2007 and 2017 (-50%), an increase for subcortical or mixed VaD (+20%), acute onset VaD (+184%) and an increase in "other VaD" (+85%). CONCLUSION These data suggest a slight decrease in hospital stays for VaD, possibly related to better control of cardiovascular risk factors. They also suggest that the coding should be consistent with the evolution of diagnostic criteria.
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Affiliation(s)
- M Rochoy
- University Lille, 59000 Lille, France; U1171, Inserm, Degenerative and Vascular Cognitive Disorders, 59000 Lille, France; Département de médecine générale, 1 Place de Verdun, 59000 Lille, France.
| | - E Chazard
- University Lille, 59000 Lille, France; EA2694, Public Health Department, 59000 Lille, France
| | - S Gautier
- University Lille, 59000 Lille, France; U1171, Inserm, Degenerative and Vascular Cognitive Disorders, 59000 Lille, France
| | - R Bordet
- University Lille, 59000 Lille, France; U1171, Inserm, Degenerative and Vascular Cognitive Disorders, 59000 Lille, France
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10
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Abstract
Neurodegenerative disorders are progressive, debilitating impairments of neurologic function. Dementia affects cognition and function. Persons with cognitive deficits should undergo a full workup and may be treated with cholinesterase inhibitors and/or memantine. Behavioral and psychological symptoms of dementia may be assessed and treated individually. Parkinson disease is a disorder of movement. Levodopa is the standard treatment of dopamine-related movement symptoms. Associated symptoms should be assessed and treated. Other neurodegenerative syndromes are less common but highly debilitating. Currently, there are no curative or disease-modifying therapies for neurodegenerative disorders. Novel therapies or research are in the pipeline.
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Affiliation(s)
- Abby Luck Parish
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
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11
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Zhang X, Su J, Gao C, Ni W, Gao X, Li Y, Zhang J, Lei Y, Gu Y. Progression in Vascular Cognitive Impairment: Pathogenesis, Neuroimaging Evaluation, and Treatment. Cell Transplant 2019; 28:18-25. [PMID: 30488737 PMCID: PMC6322135 DOI: 10.1177/0963689718815820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Vascular cognitive impairment (VCI) defines an entire spectrum of neurologic disorders from mild cognitive impairment to dementia caused by cerebral vascular disease. The pathogenesis of VCI includes ischemic factors (e.g., large vessel occlusion and small vessel dysfunction); hemorrhagic factors (e.g., intracerebral hemorrhage and subarachnoid hemorrhage); and other factors (combined with Alzheimer's disease). Clinical evaluations of VCI mainly refer to neuropsychological testing and imaging assessments, including structural and functional neuroimaging, with different advantages. At present, the main treatment for VCI focuses on neurological protection, cerebral blood flow reconstruction, and neurological rehabilitation, such as pharmacological treatment, revascularization, and cognitive training. In this review, we discuss the pathogenesis, neuroimaging evaluation, and treatment of VCI.
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Affiliation(s)
- Xin Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiabin Su
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Gao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Ni
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinjie Gao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Lei
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Yu Lei and Yuxiang Gu, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, No. 12 Middle Wulumuqi Road, Shanghai 200040, China. Emails: ;
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Yu Lei and Yuxiang Gu, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, No. 12 Middle Wulumuqi Road, Shanghai 200040, China. Emails: ;
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12
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Nichols E, Szoeke CEI, Vollset SE, Abbasi N, Abd-Allah F, Abdela J, Aichour MTE, Akinyemi RO, Alahdab F, Asgedom SW, Awasthi A, Barker-Collo SL, Baune BT, Béjot Y, Belachew AB, Bennett DA, Biadgo B, Bijani A, Bin Sayeed MS, Brayne C, Carpenter DO, Carvalho F, Catalá-López F, Cerin E, Choi JYJ, Dang AK, Degefa MG, Djalalinia S, Dubey M, Duken EE, Edvardsson D, Endres M, Eskandarieh S, Faro A, Farzadfar F, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Gebre AK, Geremew D, Ghasemi-Kasman M, Gnedovskaya EV, Gupta R, Hachinski V, Hagos TB, Hamidi S, Hankey GJ, Haro JM, Hay SI, Irvani SSN, Jha RP, Jonas JB, Kalani R, Karch A, Kasaeian A, Khader YS, Khalil IA, Khan EA, Khanna T, Khoja TAM, Khubchandani J, Kisa A, Kissimova-Skarbek K, Kivimäki M, Koyanagi A, Krohn KJ, Logroscino G, Lorkowski S, Majdan M, Malekzadeh R, März W, Massano J, Mengistu G, Meretoja A, Mohammadi M, Mohammadi-Khanaposhtani M, Mokdad AH, Mondello S, Moradi G, Nagel G, Naghavi M, Naik G, Nguyen LH, Nguyen TH, Nirayo YL, Nixon MR, Ofori-Asenso R, Ogbo FA, Olagunju AT, Owolabi MO, Panda-Jonas S, Passos VMDA, Pereira DM, Pinilla-Monsalve GD, Piradov MA, Pond CD, Poustchi H, Qorbani M, Radfar A, Reiner RC, Robinson SR, Roshandel G, Rostami A, Russ TC, Sachdev PS, Safari H, Safiri S, Sahathevan R, Salimi Y, Satpathy M, Sawhney M, Saylan M, Sepanlou SG, Shafieesabet A, Shaikh MA, Sahraian MA, Shigematsu M, Shiri R, Shiue I, Silva JP, Smith M, Sobhani S, Stein DJ, Tabarés-Seisdedos R, Tovani-Palone MR, Tran BX, Tran TT, Tsegay AT, Ullah I, Venketasubramanian N, Vlassov V, Wang YP, Weiss J, Westerman R, Wijeratne T, Wyper GM, Yano Y, Yimer EM, Yonemoto N, Yousefifard M, Zaidi Z, Zare Z, Vos T, Feigin VL, Murray CJL. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18:88-106. [PMID: 30497964 PMCID: PMC6291454 DOI: 10.1016/s1474-4422(18)30403-4] [Citation(s) in RCA: 1339] [Impact Index Per Article: 267.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists. METHODS GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-sweetened beverages). FINDINGS In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8-51·0), increased from 20.2 million (17·4-23·5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0-2·4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3-31·4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1-2·8) deaths. Overall, 28·8 million (95% UI 24·5-34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4-10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages. INTERPRETATION The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide. FUNDING Bill & Melinda Gates Foundation.
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Costa C, Romoli M, Liguori C, Farotti L, Eusebi P, Bedetti C, Siliquini S, Cesarini EN, Romigi A, Mercuri NB, Parnetti L, Calabresi P. Alzheimer's disease and late-onset epilepsy of unknown origin: two faces of beta amyloid pathology. Neurobiol Aging 2018; 73:61-67. [PMID: 30317034 DOI: 10.1016/j.neurobiolaging.2018.09.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/10/2018] [Accepted: 09/06/2018] [Indexed: 12/20/2022]
Abstract
Although amyloid pathology plays a role in epilepsy, little is known about the relationship between beta amyloid and progression to Alzheimer's disease (AD) among patients with late-onset epilepsy of unknown origin (LOEU). This multicenter, observational, prospective study enrolled 40 consecutive nondemented adults diagnosed with LOEU, together with 43 age- and sex-matched healthy controls. All patients completed neuropsychological tests, core CSF AD biomarkers assessment (Aβ1-42, total tau, and phosphorylated tau), and follow-up for a mean of 3 years to verify cognitive decline. Despite age and baseline cognitive performance were similar to healthy controls, patients with LOEU had significant prevalence of CSF pathological Aβ1-42 (<500 pg/mL; 37.5%), 7.5% displaying an AD-like CSF pattern. Moreover, 17.5% of patients with LOEU converted to AD dementia, versus none among healthy controls (p < 0.005). Patients with LOEU with pathological Aβ1-42 had a hazard ratio 3.4 (CI 0.665-17.73) for progression to AD dementia at follow-up. Patients with LOEU have a high prevalence of abnormal CSF Aβ1-42 and progression to AD dementia compared with healthy controls, and therefore should be monitored for cognitive decline.
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Affiliation(s)
- Cinzia Costa
- Department of Medicine, Neurology Clinic, University Hospital of Perugia, Italy.
| | - Michele Romoli
- Department of Medicine, Neurology Clinic, University Hospital of Perugia, Italy
| | | | - Lucia Farotti
- Department of Medicine, Neurology Clinic, University Hospital of Perugia, Italy
| | - Paolo Eusebi
- Department of Medicine, Neurology Clinic, University Hospital of Perugia, Italy
| | - Chiara Bedetti
- Department of Medicine, Neurology Clinic, University Hospital of Perugia, Italy
| | - Sabrina Siliquini
- Department of Medicine, Neurology Clinic, University Hospital of Perugia, Italy
| | | | - Andrea Romigi
- Neurophysiopathology Unit, Department of Systems Medicine, Sleep and Epilepsy Medicine Centre, Tor Vergata University and Hospital, Rome, Italy
| | - Nicola B Mercuri
- IRCCS "Santa Lucia", Rome, Italy; Neurophysiopathology Unit, Department of Systems Medicine, Sleep and Epilepsy Medicine Centre, Tor Vergata University and Hospital, Rome, Italy
| | - Lucilla Parnetti
- Department of Medicine, Neurology Clinic, University Hospital of Perugia, Italy
| | - Paolo Calabresi
- Department of Medicine, Neurology Clinic, University Hospital of Perugia, Italy; IRCCS "Santa Lucia", Rome, Italy
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14
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Mehaffey JH, Hawkins RB, Tracci MC, Robinson WP, Cherry KJ, Kern JA, Upchurch GR. Preoperative dementia is associated with increased cost and complications after vascular surgery. J Vasc Surg 2018; 68:1203-1208. [PMID: 29606569 DOI: 10.1016/j.jvs.2018.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/09/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Dementia represents a major risk factor for medical complications and has been linked to higher rates of complication after surgery. Given the systemic nature of vascular disease, medical comorbidities significantly increase cost and complications after vascular surgery. We hypothesize that the presence of dementia is an independent predictor of increased postoperative complications and higher health care costs after vascular surgery. METHODS The Vascular Quality Initiative database was queried for all patients undergoing vascular surgery at a single academic medical center from 2012 to 2017. All modules were included (open abdominal aortic aneurysm, suprainguinal bypass, lower extremity bypass, amputation, carotid endarterectomy, endovascular aortic aneurysm repair, thoracic endovascular aortic aneurysm repair, and peripheral endovascular intervention). An institutional clinical data repository was queried to identify patients with International Classification of Diseases, Ninth Revision diagnosis codes for dementia as well as total hospital cost and long-term survival using Social Security records from the Virginia Department of Health. Hierarchical logistic and linear regression models were fit to assess risk-adjusted predictors of any complication and inflation-adjusted cost. Kaplan-Meier and Cox proportional hazards models were used for survival analysis. RESULTS A total of 2318 patients underwent vascular surgery and were captured by the Vascular Quality Initiative during the past 5 years, with 88 (3.8%) having a diagnosis of dementia. Patients with dementia were older and had higher rates of medical comorbidities, and the most common procedure was major amputation. In addition, dementia patients had a significantly higher rate of any complication (52% vs 16%; P < .0001) and increased 90-day mortality (14% vs 4.8%; P = .0002). Furthermore, dementia was associated with significant resource utilization, including preoperative length of stay (LOS), postoperative LOS, intensive care unit LOS, and inflation-adjusted total hospital cost (all P < .0001). Hierarchical modeling demonstrated that dementia was the strongest preoperative predictor for any complication (odds ratio, 8.64; P < .0001) and had the largest risk-adjusted impact on total hospital cost ($22,069; P < .0001). Finally, survival analysis demonstrated that dementia is independently associated with reduced survival after vascular surgery (hazard ratio, 1.37; P = .018). CONCLUSIONS This study demonstrated that dementia is one of the strongest predictors of any complication and increased hospital cost after vascular surgery. Given the high risk of clinical and financial maladies, patients with dementia should be carefully considered and counseled before undergoing vascular surgery.
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Affiliation(s)
- J Hunter Mehaffey
- Division of Vascular and Endovascular Surgery and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Robert B Hawkins
- Division of Vascular and Endovascular Surgery and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Margaret C Tracci
- Division of Vascular and Endovascular Surgery and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - William P Robinson
- Division of Vascular and Endovascular Surgery and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Kenneth J Cherry
- Division of Vascular and Endovascular Surgery and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - John A Kern
- Division of Vascular and Endovascular Surgery and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Gilbert R Upchurch
- Division of Vascular and Endovascular Surgery and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
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15
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de la Torre JC. Are Major Dementias Triggered by Poor Blood Flow to the Brain? Theoretical Considerations. J Alzheimers Dis 2018; 57:353-371. [PMID: 28211814 DOI: 10.3233/jad-161266] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There is growing evidence that chronic brain hypoperfusion plays a central role in the development of Alzheimer's disease (AD) long before dyscognitive symptoms or amyloid-β accumulation in the brain appear. This commentary proposes that dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and Creutzfeldt-Jakob disease (CJD) may also develop from chronic brain hypoperfusion following a similar but not identical neurometabolic breakdown as AD. The argument to support this conclusion is that chronic brain hypoperfusion, which is found at the early stages of the three dementias reviewed here, will reduce oxygen delivery and lower oxidative phosphorylation promoting a steady decline in the synthesis of the cell energy fuel adenosine triphosphate (ATP). This process is known to lead to oxidative stress. Virtually all neurodegenerative diseases, including FTD, DLB, and CJD, are characterized by oxidative stress that promotes inclusion bodies which differ in structure, location, and origin, as well as which neurological disorder they typify. Inclusion bodies have one thing in common; they are known to diminish autophagic activity, the protective intracellular degradative process that removes malformed proteins, protein aggregates, and damaged subcellular organelles that can disrupt neuronal homeostasis. Neurons are dependent on autophagy for their normal function and survival. When autophagic activity is diminished or impaired in neurons, high levels of unfolded or misfolded proteins overwhelm and downregulate the neuroprotective activity of unfolded protein response which is unable to get rid of dysfunctional organelles such as damaged mitochondria and malformed proteins at the synapse. The endpoint of this neuropathologic process results in damaged synapses, impaired neurotransmission, cognitive decline, and dementia.
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16
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Zhang J, Wang G, Zhang F, Zhao Q. Improvement of postoperative cognitive dysfunction and attention network function of patients with ischemic cerebrovascular disease via dexmedetomidine. Exp Ther Med 2018; 15:2968-2972. [PMID: 29599834 PMCID: PMC5867479 DOI: 10.3892/etm.2018.5806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/04/2018] [Indexed: 12/19/2022] Open
Abstract
The protective effect of dexmedetomidine on cognitive dysfunction and decreased attention network function of patients with ischemic cerebrovascular disease after stenting was investigated. Fifty-eight patients with ischemic cerebrovascular disease undergoing stenting in Guizhou Provincial People's Hospital were selected and randomly divided into control group (n=29) and dexmedetomidine group (n=29). The dexmedetomidine group was treated with dexmedetomidine before induced anesthesia, while the control group was given the same dose of normal saline; and the normal volunteers of the same age were selected as the normal group (n=29). At 3 days after operation, the levels of serum S100B and nerve growth factor (NGF) in each group were detected using the enzyme-linked immunosorbent assay, and the level of brain-derived neurotrophic factor (BDNF) was detected via western blotting. Montreal cognitive assessment (MoCA) and attention network test (ANT) were performed. Moreover, the cognitive function and attention network function, and the effects of dexmedetomidine on cognitive function and attention network function were evaluated. The concentrations of serum S100B and NGF in dexmedetomidine group was lower than those in control group (P<0.01). The results of western blotting showed that the levels of serum BDNF in control group and dexmedetomidine group were significantly lower than that in normal group (P<0.01), and it was higher in dexmedetomidine group than that in control group (P<0.01). Besides, both MoCA and ANT results revealed that the visual space and executive function scores, attention scores, delayed memory scores, targeted network efficiency and executive control network efficiency in dexmedetomidine group were obviously higher than those in control group (P<0.01). The cognitive function and attention network function of patients with ischemic cerebrovascular disease have a certain degree of damage, and the preoperative administration of dexmedetomidine can effectively improve the patient's cognitive dysfunction and attention network function after operation.
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Affiliation(s)
- Jingchao Zhang
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, P.R. China
| | - Guoliang Wang
- Department of Hepatobiliary Surgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, P.R. China
| | - Fangxiang Zhang
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, P.R. China
| | - Qian Zhao
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, P.R. China
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Levin OS, Chimagomedova AS, Polyakova TA, Arablinsky AV. 60 years towards definition of dyscirculatory (vascular) encephalopathy: can we put new wine into old wineskins? Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:13-26. [DOI: 10.17116/jnevro201811806213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Wallin A, Román GC, Esiri M, Kettunen P, Svensson J, Paraskevas GP, Kapaki E. Update on Vascular Cognitive Impairment Associated with Subcortical Small-Vessel Disease. J Alzheimers Dis 2018; 62:1417-1441. [PMID: 29562536 PMCID: PMC5870030 DOI: 10.3233/jad-170803] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 02/06/2023]
Abstract
Subcortical small-vessel disease (SSVD) is a disorder well characterized from the clinical, imaging, and neuropathological viewpoints. SSVD is considered the most prevalent ischemic brain disorder, increasing in frequency with age. Vascular risk factors include hypertension, diabetes, hyperlipidemia, elevated homocysteine, and obstructive sleep apnea. Ischemic white matter lesions are the hallmark of SSVD; other pathological lesions include arteriolosclerosis, dilatation of perivascular spaces, venous collagenosis, cerebral amyloid angiopathy, microbleeds, microinfarcts, lacunes, and large infarcts. The pathogenesis of SSVD is incompletely understood but includes endothelial changes and blood-brain barrier alterations involving metalloproteinases, vascular endothelial growth factors, angiotensin II, mindin/spondin, and the mammalian target of rapamycin pathway. Metabolic and genetic conditions may also play a role but hitherto there are few conclusive studies. Clinical diagnosis of SSVD includes early executive dysfunction manifested by impaired capacity to use complex information, to formulate strategies, and to exercise self-control. In comparison with Alzheimer's disease (AD), patients with SSVD show less pronounced episodic memory deficits. Brain imaging has advanced substantially the diagnostic tools for SSVD. With the exception of cortical microinfarcts, all other lesions are well visualized with MRI. Diagnostic biomarkers that separate AD from SSVD include reduction of cerebrospinal fluid amyloid-β (Aβ)42 and of the ratio Aβ42/Aβ40 often with increased total tau levels. However, better markers of small-vessel function of intracerebral blood vessels are needed. The treatment of SSVD remains unsatisfactory other than control of vascular risk factors. There is an urgent need of finding targets to slow down and potentially halt the progression of this prevalent, but often unrecognized, disorder.
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Affiliation(s)
- Anders Wallin
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden and Memory Clinic at Department of Neuropsychiatry, Sahlgrenska University, Hospital, Gothenburg, Sweden
| | - Gustavo C. Román
- Department of Neurology, Methodist Neurological Institute, Houston, TX, USA
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Margaret Esiri
- Neuropathology Department, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Petronella Kettunen
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden and Memory Clinic at Department of Neuropsychiatry, Sahlgrenska University, Hospital, Gothenburg, Sweden
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Johan Svensson
- Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - George P. Paraskevas
- 1st Department of Neurology, Neurochemistry Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Kapaki
- 1st Department of Neurology, Neurochemistry Unit, National and Kapodistrian University of Athens, Athens, Greece
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Castrillo JI, Lista S, Hampel H, Ritchie CW. Systems Biology Methods for Alzheimer’s Disease Research Toward Molecular Signatures, Subtypes, and Stages and Precision Medicine: Application in Cohort Studies and Trials. Methods Mol Biol 2018; 1750:31-66. [PMID: 29512064 DOI: 10.1007/978-1-4939-7704-8_3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Juan I Castrillo
- Genetadi Biotech S.L. Parque Tecnológico de Bizkaia, Derio, Bizkaia, Spain.
| | - Simone Lista
- AXA Research Fund & UPMC Chair, F-75013, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l'hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l'hôpital, F-75013, Paris, France
| | - Harald Hampel
- AXA Research Fund & UPMC Chair, F-75013, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l'hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l'hôpital, F-75013, Paris, France
| | - Craig W Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Alves GS, de Carvalho LDA, Sudo FK, Briand L, Laks J, Engelhardt E. A panel of clinical and neuropathological features of cerebrovascular disease through the novel neuroimaging methods. Dement Neuropsychol 2017; 11:343-355. [PMID: 29354214 PMCID: PMC5769992 DOI: 10.1590/1980-57642016dn11-040003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED The last decade has witnessed substantial progress in acquiring diagnostic biomarkers for the diagnostic workup of cerebrovascular disease (CVD). Advanced neuroimaging methods not only provide a strategic contribution for the differential diagnosis of vascular dementia (VaD) and vascular cognitive impairment (VCI), but also help elucidate the pathophysiological mechanisms ultimately leading to small vessel disease (SVD) throughout its course. OBJECTIVE In this review, the novel imaging methods, both structural and metabolic, were summarized and their impact on the diagnostic workup of age-related CVD was analysed. Methods: An electronic search between January 2010 and 2017 was carried out on PubMed/MEDLINE, Institute for Scientific Information Web of Knowledge and EMBASE. RESULTS The use of full functional multimodality in simultaneous Magnetic Resonance (MR)/Positron emission tomography (PET) may potentially improve the clinical characterization of VCI-VaD; for structural imaging, MRI at 3.0 T enables higher-resolution scanning with greater imaging matrices, thinner slices and more detail on the anatomical structure of vascular lesions. CONCLUSION Although the importance of most of these techniques in the clinical setting has yet to be recognized, there is great expectancy in achieving earlier and more refined therapeutic interventions for the effective management of VCI-VaD.
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Affiliation(s)
| | | | - Felipe Kenji Sudo
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, RJ, Brazil
- Instituto D'Or de Ensino e Pesquisa, Rio de Janeiro, RJ, Brazil
| | - Lucas Briand
- Departamento de Medicina Interna, Universidade Federal do Ceará, CE, Brazil
| | - Jerson Laks
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brazil
- Programa de Pós-Graduação em Biomedicina Translacional (BIOTRANS), Unigranrio, Duque de Caxias, RJ, Brazil
| | - Eliasz Engelhardt
- Setor de Neurologia Cognitiva e do Comportamento, Instituto de Neurologia Deolindo Couto (INDC-CDA/IPUB), Rio de Janeiro, RJ, Brazil
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21
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Lin N, Liu B, Zhang J, Long Y, Dong G, Jin H, Ma B. Acute toxicity, 28-day repeated-dose toxicity and toxicokinetic study of timosaponin BII in rats. Regul Toxicol Pharmacol 2017; 90:244-257. [PMID: 28947379 DOI: 10.1016/j.yrtph.2017.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
Timosaponin BII (TBII), a major steroidal saponin isolated from Anemarrhena asphodeloides Bge., displays a variety of promising pharmacological activities, such as neuroprotection, enhancement of learning and memory, vascular protection and inhibition of platelet aggregation; therefore, it has been developed as a pharmaceutical for prevention or treatment of dementia. Given the safety concerns surrounding timosaponins and the absence of studies on the safety of TBII, the potential toxicity of TBII was evaluated in toxicity and toxicokinetic studies in rats. In the acute oral toxicity study, loose stools were observed in rats receiving 4000 mg/kg, and the symptoms recovered within 1 day. In the 28-day repeated-dose oral toxicity and toxicokinetic study, rats receiving 540 mg/kg showed loose stools and a slight deceleration of body weight growth in both sexes, and the females also showed a slight decrease in food consumption. Moreover, urinalysis indicated reversible treatment-related toxicity in rats receiving 540 mg/kg. The toxicokinetic study demonstrated a dose-dependent increase in systematic exposure to TBII after 28 successive days of oral treatment with TBII. The accumulation coefficients of TBII were 4.35, 1.70 and 1.81, respectively, in rats that received 60, 180 and 540 mg/kg. The no-observed-adverse-effect level (NOAEL) is proposed to be 180 mg/kg.
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Affiliation(s)
- Ni Lin
- Capital Medical University, Beijing 100069, People's Republic of China; New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100050, People's Republic of China
| | - Baofeng Liu
- Shandong Xinbo Pharmaceutical R&D., Ltd., Shandong 251500, People's Republic of China
| | - Jie Zhang
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Yongpeng Long
- Beijing Hwellso Pharmaceutical Corporation Ltd., Beijing 100081, People's Republic of China
| | - Guoming Dong
- Beijing Hwellso Pharmaceutical Corporation Ltd., Beijing 100081, People's Republic of China
| | - Hongtao Jin
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100050, People's Republic of China.
| | - Baiping Ma
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China.
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22
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Ikram MA, Bersano A, Manso-Calderón R, Jia JP, Schmidt H, Middleton L, Nacmias B, Siddiqi S, Adams HHH. Genetics of vascular dementia - review from the ICVD working group. BMC Med 2017; 15:48. [PMID: 28260527 PMCID: PMC5338082 DOI: 10.1186/s12916-017-0813-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vascular dementia is a common disorder resulting in considerable morbidity and mortality. Determining the extent to which genes play a role in disease susceptibility and their pathophysiological mechanisms could improve our understanding of vascular dementia, leading to a potential translation of this knowledge to clinical practice. DISCUSSION In this review, we discuss what is currently known about the genetics of vascular dementia. The identification of causal genes remains limited to monogenic forms of the disease, with findings for sporadic vascular dementia being less robust. However, progress in genetic research on associated phenotypes, such as cerebral small vessel disease, Alzheimer's disease, and stroke, have the potential to inform on the genetics of vascular dementia. We conclude by providing an overview of future developments in the field and how such work could impact patients and clinicians. CONCLUSION The genetic background of vascular dementia is well established for monogenic disorders, but remains relatively obscure for the sporadic form. More work is needed for providing robust findings that might eventually lead to clinical translation.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands. .,Department of Neurology, Erasmus MC, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Anna Bersano
- Cerebrovascular Unit IRCCS Foundation Neurological Institute C. Besta, Milan, Italy
| | - Raquel Manso-Calderón
- Department of Neurology, University Hospital of Salamanca, Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca-CSIC-SACYL, Salamanca, Spain
| | - Jian-Ping Jia
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Helena Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Lefkos Middleton
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Hieab H H Adams
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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23
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Di Donato I, Bianchi S, De Stefano N, Dichgans M, Dotti MT, Duering M, Jouvent E, Korczyn AD, Lesnik-Oberstein SAJ, Malandrini A, Markus HS, Pantoni L, Penco S, Rufa A, Sinanović O, Stojanov D, Federico A. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) as a model of small vessel disease: update on clinical, diagnostic, and management aspects. BMC Med 2017; 15:41. [PMID: 28231783 PMCID: PMC5324276 DOI: 10.1186/s12916-017-0778-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/03/2017] [Indexed: 12/11/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common and best known monogenic small vessel disease. Here, we review the clinical, neuroimaging, neuropathological, genetic, and therapeutic aspects based on the most relevant articles published between 1994 and 2016 and on the personal experience of the authors, all directly involved in CADASIL research and care. We conclude with some suggestions that may help in the clinical practice and management of these patients.
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Affiliation(s)
- Ilaria Di Donato
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Silvia Bianchi
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Marco Duering
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Eric Jouvent
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205, Paris, France.,Department of Neurology, AP-HP, Lariboisière Hospital, F-75475, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité, Paris, France
| | - Amos D Korczyn
- Department of Neurology, Tel Aviv University, Ramat Aviv, 69978, Israel
| | - Saskia A J Lesnik-Oberstein
- Department of Clinical Genetics, K5-R Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Alessandro Malandrini
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Leonardo Pantoni
- NEUROFARBA Department, Neuroscience section, Largo Brambilla 3, 50134, Florence, Italy
| | - Silvana Penco
- Medical Genetic Unit, Department of Laboratory Medicine, Niguarda Hospital, Milan, Italy
| | - Alessandra Rufa
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Osman Sinanović
- Department of Neurology, University Clinical Center Tuzla, School of Medicine University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina
| | - Dragan Stojanov
- Faculty of Medicine, University of Nis, Bul. Dr. Zorana Djindjica 81, Nis, 18000, Serbia
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy.
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24
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Abstract
Any damage to the brain may affect cognition. However, although the effects of vascular changes have been known for years, involvement of such changes is becoming increasingly better recognized. In particular the effects of comorbid vascular disease to primary neurodegenerative processes adds to the complexity of the issue. An attempt to clarify the problems needed specific attention to different points, which led to Consensus Reports on several of them.
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Affiliation(s)
- Amos D Korczyn
- Department of Neurology, Tel Aviv University, Ramat Aviv, 69978, Israel.
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