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Gregory S, Buller‐Peralta I, Bridgeman K, Góngora VDLC, Dounavi M, Low A, Ntailianis G, O'Brien J, Parra MA, Ritchie CW, Ritchie K, Shannon OM, Stevenson EJ, Muniz‐Terrera G. The Mediterranean diet is not associated with neuroimaging or cognition in middle-aged adults: a cross-sectional analysis of the PREVENT dementia programme. Eur J Neurol 2024; 31:e16345. [PMID: 38794967 PMCID: PMC11236004 DOI: 10.1111/ene.16345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/02/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND AND PURPOSE The Mediterranean diet (MedDiet) has been associated with reduced dementia incidence in several studies. It is important to understand if diet is associated with brain health in midlife, when Alzheimer's disease and related dementias are known to begin. METHODS This study used data from the PREVENT dementia programme. Three MedDiet scores were created (the Pyramid, Mediterranean Diet Adherence Screener [MEDAS] and MEDAS continuous) from a self-reported food frequency questionnaire. Primary outcomes were hippocampal volume and cube-transformed white matter hyperintensity volume. Secondary outcomes included cornu ammonis 1 and subiculum hippocampal subfield volumes, cortical thickness and measures of cognition. Sex-stratified analyses were run to explore differential associations between diet and brain health by sex. An exploratory path analysis was conducted to study if any associations between diet and brain health were mediated by cardiovascular risk factors for dementia. RESULTS In all, 504 participants were included in this analysis, with a mean Pyramid score of 8.10 (SD 1.56). There were no significant associations between any MedDiet scoring method and any of the primary or secondary outcomes. There were no differences by sex in any analyses and no significant mediation between the Pyramid score and global cognition by cardiovascular risk factors. CONCLUSIONS Overall, this study did not find evidence for an association between the MedDiet and either neuroimaging or cognition in a midlife population study. Future work should investigate associations between the MedDiet and Alzheimer's disease and related dementias biomarkers as well as functional neuroimaging in a midlife population.
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Affiliation(s)
- Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Scottish Brain SciencesEdinburghUK
| | - Ingrid Buller‐Peralta
- Edinburgh Dementia Prevention, Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Katie Bridgeman
- Edinburgh Dementia Prevention, Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Vanessa De La Cruz Góngora
- Global Brain Health Institute, Institute of NeuroscienceTrinity College DublinDublinIreland
- Centre for Evaluation and Survey ResearchNational Institute of Public HealthCuernavacaMexico
| | - Maria‐Eleni Dounavi
- Department of Psychiatry, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Audrey Low
- Department of Psychiatry, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Georgios Ntailianis
- Edinburgh Dementia Prevention, Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - John O'Brien
- Department of Psychiatry, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Mario A. Parra
- Department of Psychological Sciences and HealthUniversity of StrathclydeGlasgowUK
| | - Craig W. Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Scottish Brain SciencesEdinburghUK
- Mackenzie InstituteUniversity of St AndrewsSt AndrewsUK
| | - Karen Ritchie
- INM, Université de Montpellier, INSERMMontpellierFrance
| | - Oliver M. Shannon
- Human Nutrition and Exercise Research Centre, Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Emma J. Stevenson
- Human Nutrition and Exercise Research Centre, Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Graciela Muniz‐Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Ohio University Heritage College of Osteopathic MedicineOhio UniversityAthensOhioUSA
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Ritchie CW, Bridgeman K, Gregory S, O’Brien JT, Danso SO, Dounavi ME, Carriere I, Driscoll D, Hillary R, Koychev I, Lawlor B, Naci L, Su L, Low A, Mak E, Malhotra P, Manson J, Marioni R, Murphy L, Ntailianis G, Stewart W, Muniz-Terrera G, Ritchie K. The PREVENT dementia programme: baseline demographic, lifestyle, imaging and cognitive data from a midlife cohort study investigating risk factors for dementia. Brain Commun 2024; 6:fcae189. [PMID: 38863576 PMCID: PMC11166176 DOI: 10.1093/braincomms/fcae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 03/27/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024] Open
Abstract
PREVENT is a multi-centre prospective cohort study in the UK and Ireland that aims to examine midlife risk factors for dementia and identify and describe the earliest indices of disease development. The PREVENT dementia programme is one of the original epidemiological initiatives targeting midlife as a critical window for intervention in neurodegenerative conditions. This paper provides an overview of the study protocol and presents the first summary results from the initial baseline data to describe the cohort. Participants in the PREVENT cohort provide demographic data, biological samples (blood, saliva, urine and optional cerebrospinal fluid), lifestyle and psychological questionnaires, undergo a comprehensive cognitive test battery and are imaged using multi-modal 3-T MRI scanning, with both structural and functional sequences. The PREVENT cohort governance structure is described, which includes a steering committee, a scientific advisory board and core patient and public involvement groups. A number of sub-studies that supplement the main PREVENT cohort are also described. The PREVENT cohort baseline data include 700 participants recruited between 2014 and 2020 across five sites in the UK and Ireland (Cambridge, Dublin, Edinburgh, London and Oxford). At baseline, participants had a mean age of 51.2 years (range 40-59, SD ± 5.47), with the majority female (n = 433, 61.9%). There was a near equal distribution of participants with and without a parental history of dementia (51.4% versus 48.6%) and a relatively high prevalence of APOEɛ4 carriers (n = 264, 38.0%). Participants were highly educated (16.7 ± 3.44 years of education), were mainly of European Ancestry (n = 672, 95.9%) and were cognitively healthy as measured by the Addenbrookes Cognitive Examination-III (total score 95.6 ± 4.06). Mean white matter hyperintensity volume at recruitment was 2.26 ± 2.77 ml (median = 1.39 ml), with hippocampal volume being 8.15 ± 0.79 ml. There was good representation of known dementia risk factors in the cohort. The PREVENT cohort offers a novel data set to explore midlife risk factors and early signs of neurodegenerative disease. Data are available open access at no cost via the Alzheimer's Disease Data Initiative platform and Dementia Platforms UK platform pending approval of the data access request from the PREVENT steering group committee.
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Affiliation(s)
- Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Scottish Brain Sciences, Edinburgh, EH12 9DQ, UK
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK
| | - Katie Bridgeman
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Scottish Brain Sciences, Edinburgh, EH12 9DQ, UK
| | - John T O’Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Samuel O Danso
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
| | | | | | - Robert Hillary
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Lorina Naci
- Global Brain Health Institute, Trinity College Dublin, Dublin 2, Ireland
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, D02 PX31, Ireland
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
- Department of Neuroscience, University of Sheffield, Sheffield, S10 2HQ, UK
| | - Audrey Low
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Paresh Malhotra
- Imperial College London, UK Dementia Research Institute Care Research and Technology Centre, London, W12 0BZ, UK
- Brain Sciences, Imperial College London, London, W12 0NN, UK
- Clinical Neurosciences, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
| | - Jean Manson
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK
| | - Riccardo Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Lee Murphy
- Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Georgios Ntailianis
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QB, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Ohio University Heritage College of Osteopathic Medicine, Ohio University, Ohio, OH 45701, USA
| | - Karen Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- INM, Université de Montpellier, INSERM, Montpellier, 34091, France
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3
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Buller-Peralta I, Gregory S, Low A, Dounavi ME, Bridgeman K, Ntailianis G, Lawlor B, Naci L, Koychev I, Malhotra P, O'Brien JT, Ritchie CW, Muniz-Terrera G. Comprehensive allostatic load risk index is associated with increased frontal and left parietal white matter hyperintensities in mid-life cognitively healthy adults. Sci Rep 2024; 14:573. [PMID: 38177228 PMCID: PMC10766612 DOI: 10.1038/s41598-023-49656-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
To date, there is a considerable heterogeneity of methods to score Allostatic Load (AL). Here we propose a comprehensive algorithm (ALCS) that integrates commonly used approaches to generate AL risk categories and assess associations to brain structure deterioration. In a cohort of cognitively normal mid-life adults (n = 620, age 51.3 ± 5.48 years), we developed a comprehensive composite for AL scoring incorporating gender and age differences, high quartile approach, clinical reference values, and current medications, to then generate AL risk categories. Compared to the empirical approach (ALES), ALCS showed better model fit criteria and a strong association with age and sex. ALSC categories were regressed against brain and white matter hyperintensity (WMH) volumes. Higher AL risk categories were associated with increased total, periventricular, frontal, and left parietal WMH volumes, also showing better fit compared to ALES. When cardiovascular biomarkers were removed from the ALSC algorithm, only left-frontal WMHV remained associated with AL, revealing a strong vascular burden influencing the index. Our results agree with previous evidence and suggest that sustained stress exposure enhances brain deterioration in mid-life adults. Showing better fit than ALES, our comprehensive algorithm can provide a more accurate AL estimation to explore how stress exposure enhances age-related health decline.
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Affiliation(s)
- Ingrid Buller-Peralta
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatients Department Level 2 Western General Hospital, The University of Edinburgh, Crewe Rd S, Edinburgh, EH4 2XU, UK.
| | - Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatients Department Level 2 Western General Hospital, The University of Edinburgh, Crewe Rd S, Edinburgh, EH4 2XU, UK
| | - Audrey Low
- Department of Psychiatry, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Level E4, Box 189, Cambridge, CB2 0QQ, UK
| | - Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Level E4, Box 189, Cambridge, CB2 0QQ, UK
| | - Katie Bridgeman
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatients Department Level 2 Western General Hospital, The University of Edinburgh, Crewe Rd S, Edinburgh, EH4 2XU, UK
| | - Georgios Ntailianis
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatients Department Level 2 Western General Hospital, The University of Edinburgh, Crewe Rd S, Edinburgh, EH4 2XU, UK
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, Dublin 2, Ireland
- Global Brain Health Institute, Trinity College Dublin, GBHI Office Room 0.60, Lloyd Building Trinity College Dublin, Dublin 2, Ireland
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, Dublin 2, Ireland
- Global Brain Health Institute, Trinity College Dublin, GBHI Office Room 0.60, Lloyd Building Trinity College Dublin, Dublin 2, Ireland
| | - Ivan Koychev
- Department of Psychiatry, Warneford Hospital, Oxford University, Warneford Ln, Headington, Oxford, OX3 7JX, UK
| | - Paresh Malhotra
- Department of Brain Sciences, Imperial College London, Burlington Danes, The Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Level E4, Box 189, Cambridge, CB2 0QQ, UK
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatients Department Level 2 Western General Hospital, The University of Edinburgh, Crewe Rd S, Edinburgh, EH4 2XU, UK
- Scottish Brain Sciences, Gyleview House, 3 Redheughs Rigg, South Gyle, Edinburgh, EH12 9DQ, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatients Department Level 2 Western General Hospital, The University of Edinburgh, Crewe Rd S, Edinburgh, EH4 2XU, UK
- Ohio University Heritage College of Osteopathic Medicine, 191 W Union St, Athens, OH, 45701, USA
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4
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Low A, Prats-Sedano MA, McKiernan E, Carter SF, Stefaniak JD, Nannoni S, Su L, Dounavi ME, Muniz-Terrera G, Ritchie K, Lawlor B, Naci L, Malhotra P, Mackay C, Koychev I, Ritchie CW, Markus HS, O’Brien JT. Modifiable and non-modifiable risk factors of dementia on midlife cerebral small vessel disease in cognitively healthy middle-aged adults: the PREVENT-Dementia study. Alzheimers Res Ther 2022; 14:154. [PMID: 36224605 PMCID: PMC9554984 DOI: 10.1186/s13195-022-01095-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
Background Considerable overlap exists between the risk factors of dementia and cerebral small vessel disease (SVD). However, studies remain limited to older cohorts wherein pathologies of both dementia (e.g. amyloid) and SVD (e.g. white matter hyperintensities) already co-exist. In younger asymptomatic adults, we investigated differential associations and interactions of modifiable and non-modifiable inherited risk factors of (future) late-life dementia to (present-day) mid-life SVD. Methods Cognitively healthy middle-aged adults (aged 40–59; mean 51.2 years) underwent 3T MRI (n = 630) as part of the PREVENT-Dementia study. To assess SVD, we quantified white matter hyperintensities, enlarged perivascular spaces, microbleeds, lacunes, and computed composite scores of SVD burden and subtypes of hypertensive arteriopathy and cerebral amyloid angiopathy (CAA). Non-modifiable (inherited) risk factors were APOE4 status and parental family history of dementia. Modifiable risk factors were derived from the 2020 Lancet Commission on dementia prevention (early/midlife: education, hypertension, obesity, alcohol, hearing impairment, head injuries). Confirmatory factor analysis (CFA) was used to evaluate the latent variables of SVD and risk factors. Structural equation modelling (SEM) of the full structural assessed associations of SVD with risk factors and APOE4*risk interaction. Results In SEM, the latent variable of global SVD related to the latent variable of modifiable midlife risk SVD (β = 0.80, p = .009) but not non-modifiable inherited risk factors of APOE4 or family history of dementia. Interaction analysis demonstrated that the effect of modifiable risk on SVD was amplified in APOE4 non-carriers (β = − 0.31, p = .009), rather than carriers. These associations and interaction effects were observed in relation to the SVD subtype of hypertensive arteriopathy, rather than CAA. Sensitivity analyses using separate general linear models validated SEM results. Conclusions Established modifiable risk factors of future (late-life) dementia related to present-day (mid-life) SVD, suggesting that early lifestyle modifications could potentially reduce rates of vascular cognitive impairment attributed to SVD, a major ‘silent’ contributor to global dementia cases. This association was amplified in APOE4 non-carriers, suggesting that lifestyle modifications could be effective even in those with genetic predisposition to dementia. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-022-01095-4.
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Affiliation(s)
- Audrey Low
- grid.5335.00000000121885934Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, Cambridgeshire CB2 0SP UK
| | - Maria A. Prats-Sedano
- grid.5335.00000000121885934Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, Cambridgeshire CB2 0SP UK
| | - Elizabeth McKiernan
- grid.5335.00000000121885934Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, Cambridgeshire CB2 0SP UK
| | - Stephen F. Carter
- grid.5335.00000000121885934Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, Cambridgeshire CB2 0SP UK
| | - James D. Stefaniak
- grid.5335.00000000121885934Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, Cambridgeshire CB2 0SP UK ,grid.5335.00000000121885934Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Stefania Nannoni
- grid.5335.00000000121885934Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Li Su
- grid.5335.00000000121885934Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, Cambridgeshire CB2 0SP UK ,grid.11835.3e0000 0004 1936 9262Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Maria-Eleni Dounavi
- grid.5335.00000000121885934Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, Cambridgeshire CB2 0SP UK
| | - Graciela Muniz-Terrera
- grid.4305.20000 0004 1936 7988Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Karen Ritchie
- grid.4305.20000 0004 1936 7988Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK ,grid.457377.5INSERM, Montpellier, France
| | - Brian Lawlor
- grid.8217.c0000 0004 1936 9705Institute of Neuroscience, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Lorina Naci
- grid.8217.c0000 0004 1936 9705Institute of Neuroscience, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Paresh Malhotra
- grid.417895.60000 0001 0693 2181Division of Brain Science, Imperial College Healthcare NHS Trust, London, UK
| | - Clare Mackay
- grid.4991.50000 0004 1936 8948Department of Psychiatry, Oxford University, Oxford, UK
| | - Ivan Koychev
- grid.4991.50000 0004 1936 8948Department of Psychiatry, Oxford University, Oxford, UK
| | - Craig W. Ritchie
- grid.4305.20000 0004 1936 7988Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Hugh S. Markus
- grid.5335.00000000121885934Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John T. O’Brien
- grid.5335.00000000121885934Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, Cambridgeshire CB2 0SP UK ,grid.450563.10000 0004 0412 9303Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Dounavi ME, Low A, Muniz-Terrera G, Ritchie K, Ritchie CW, Su L, Markus HS, O’Brien JT. Fluid-attenuated inversion recovery magnetic resonance imaging textural features as sensitive markers of white matter damage in midlife adults. Brain Commun 2022; 4:fcac116. [PMID: 35611309 PMCID: PMC9123845 DOI: 10.1093/braincomms/fcac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/28/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
White matter hyperintensities are common radiological findings in ageing and a typical manifestation of cerebral small vessel disease. White matter hyperintensity burden is evaluated by quantifying their volume; however, subtle changes in the white matter may not be captured by white matter hyperintensity volumetry. In this cross-sectional study, we investigated whether magnetic resonance imaging texture of both white matter hyperintensities and normal appearing white matter was associated with reaction time, white matter hyperintensity volume and dementia risk in a midlife cognitively normal population. Data from 183 cognitively healthy midlife adults from the PREVENT-Dementia study (mean age 51.9 ± 5.4; 70% females) were analysed. White matter hyperintensities were segmented from 3 Tesla fluid-attenuated inversion recovery scans using a semi-automated approach. The fluid-attenuated inversion recovery images were bias field corrected and textural features (intensity mean and standard deviation, contrast, energy, entropy, homogeneity) were calculated in white matter hyperintensities and normal appearing white matter based on generated textural maps. Textural features were analysed for associations with white matter hyperintensity volume, reaction time and the Cardiovascular Risk Factors, Aging and Dementia risk score using linear regression models adjusting for age and sex. The extent of normal appearing white matter surrounding white matter hyperintensities demonstrating similar textural associations to white matter hyperintensities was further investigated by defining layers surrounding white matter hyperintensities at increments of 0.86 mm thickness. Lower mean intensity within white matter hyperintensities was a significant predictor of longer reaction time (t = −3.77, P < 0.01). White matter hyperintensity volume was predicted by textural features within white matter hyperintensities and normal appearing white matter, albeit in opposite directions. A white matter area extending 2.5 – 3.5 mm further from the white matter hyperintensities demonstrated similar associations. White matter hyperintensity volume was not related to reaction time, although interaction analysis revealed that participants with high white matter hyperintensity burden and less homogeneous white matter hyperintensity texture demonstrated slower reaction time. Higher Cardiovascular Risk Factors, Aging, and Dementia score was associated with a heterogeneous normal appearing white matter intensity pattern. Overall, greater homogeneity within white matter hyperintensities and a more heterogeneous normal appearing white matter intensity profile were connected to a higher white matter hyperintensity burden, while heterogeneous intensity was related to prolonged reaction time (white matter hyperintensities of larger volume) and dementia risk (normal appearing white matter). Our results suggest that the quantified textural measures extracted from widely used clinical scans, might capture underlying microstructural damage and might be more sensitive to early pathological changes compared to white matter hyperintensity volumetry.
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Affiliation(s)
- Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Audrey Low
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, United Kingdom
| | | | - Karen Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, United Kingdom
- INM, Univ Montpellier, INSERM, Montpellier, France
| | - Craig W. Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, United Kingdom
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, United Kingdom
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Hugh S. Markus
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, United Kingdom
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Low A, Prats-Sedano MA, Stefaniak JD, McKiernan EF, Carter SF, Douvani ME, Mak E, Su L, Stupart O, Muniz G, Ritchie K, Ritchie CW, Markus HS, O'Brien JT. CAIDE dementia risk score relates to severity and progression of cerebral small vessel disease in healthy midlife adults: the PREVENT-Dementia study. J Neurol Neurosurg Psychiatry 2022; 93:481-490. [PMID: 35135868 PMCID: PMC9016254 DOI: 10.1136/jnnp-2021-327462] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Markers of cerebrovascular disease are common in dementia, and may be present before dementia onset. However, their clinical relevance in midlife adults at risk of future dementia remains unclear. We investigated whether the Cardiovascular Risk Factors, Ageing and Dementia (CAIDE) risk score was associated with markers of cerebral small vessel disease (SVD), and if it predicted future progression of SVD. We also determined its relationship to systemic inflammation, which has been additionally implicated in dementia and SVD. METHODS Cognitively healthy midlife participants were assessed at baseline (n=185) and 2-year follow-up (n=158). To assess SVD, we quantified white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS), microbleeds and lacunes. We derived composite scores of SVD burden, and subtypes of hypertensive arteriopathy and cerebral amyloid angiopathy. Inflammation was quantified using serum C-reactive protein (CRP) and fibrinogen. RESULTS At baseline, higher CAIDE scores were associated with all markers of SVD and inflammation. Longitudinally, CAIDE scores predicted greater total (p<0.001), periventricular (p<0.001) and deep (p=0.012) WMH progression, and increased CRP (p=0.017). Assessment of individual CAIDE components suggested that markers were driven by different risk factors (WMH/EPVS: age/hypertension, lacunes/deep microbleeds: hypertension/obesity). Interaction analyses demonstrated that higher CAIDE scores amplified the effect of age on SVD, and the effect of WMH on poorer memory. CONCLUSION Higher CAIDE scores, indicating greater risk of dementia, predicts future progression of both WMH and systemic inflammation. Findings highlight the CAIDE score's potential as both a prognostic and predictive marker in the context of cerebrovascular disease, identifying at-risk individuals who might benefit most from managing modifiable risk.
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Affiliation(s)
- Audrey Low
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maria A Prats-Sedano
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - James D Stefaniak
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Stephen F Carter
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maria-Eleni Douvani
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Olivia Stupart
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Graciela Muniz
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Karen Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
- INSERM, Montpellier, France
| | - Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Hugh S Markus
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - John Tiernan O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Schumacher J, Taylor JP, Hamilton CA, Firbank M, Donaghy PC, Roberts G, Allan L, Durcan R, Barnett N, O'Brien JT, Thomas AJ. Functional connectivity in mild cognitive impairment with Lewy bodies. J Neurol 2021; 268:4707-4720. [PMID: 33928432 PMCID: PMC8563567 DOI: 10.1007/s00415-021-10580-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/13/2022]
Abstract
Previous resting-state fMRI studies in dementia with Lewy bodies have described changes in functional connectivity in networks related to cognition, motor function, and attention as well as alterations in connectivity dynamics. However, whether these changes occur early in the course of the disease and are already evident at the stage of mild cognitive impairment is not clear. We studied resting-state fMRI data from 31 patients with mild cognitive impairment with Lewy bodies compared to 28 patients with mild cognitive impairment due to Alzheimer’s disease and 24 age-matched controls. We compared the groups with respect to within- and between-network functional connectivity. Additionally, we applied two different approaches to study dynamic functional connectivity (sliding-window analysis and leading eigenvector dynamic analysis). We did not find any significant changes in the mild cognitive impairment groups compared to controls and no differences between the two mild cognitive impairment groups, using static as well as dynamic connectivity measures. While patients with mild cognitive impairment with Lewy bodies already show clear functional abnormalities on EEG measures, the fMRI analyses presented here do not appear to be sensitive enough to detect such early and subtle changes in brain function in these patients.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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Firbank MJ, Durcan R, O'Brien JT, Allan LM, Barker S, Ciafone J, Donaghy PC, Hamilton CA, Lawley S, Roberts G, Taylor JP, Thomas AJ. Hippocampal and insula volume in mild cognitive impairment with Lewy bodies. Parkinsonism Relat Disord 2021; 86:27-33. [PMID: 33823470 DOI: 10.1016/j.parkreldis.2021.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Diagnostic criteria for prodromal dementia with Lewy bodies have recently been published. These include the use of imaging biomarkers to distinguish mild cognitive impairment with Lewy bodies (MCI-LB) from MCI due to other causes. Two potential biomarkers listed, though not formally included in the diagnostic criteria, due to insufficient evidence, are relatively preserved hippocampi, and atrophy of the insula cortex on structural brain imaging. METHODS In this report, we sought to investigate these imaging biomarkers in 105 research subjects, including well characterised groups of patients with MCI-LB (n = 38), MCI with no core features of Lewy body disease (MCI-AD; n = 36) and healthy controls (N = 31). Hippocampal and insula volumes were determined from T1 weighted structural MRI scans, using grey matter segmentation performed with SPM software. RESULTS Adjusting for age, sex and intracranial volume, there were no differences in hippocampal or insula volume between MCI-AD and MCI-LB, although in both conditions volumes were significantly reduced relative to controls. CONCLUSION Our results do not support the use of either hippocampal or insula volume to identify prodromal dementia with Lewy bodies.
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Affiliation(s)
- Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, UK.
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | | | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
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9
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Khan W, Khlif MS, Mito R, Dhollander T, Brodtmann A. Investigating the microstructural properties of normal-appearing white matter (NAWM) preceding conversion to white matter hyperintensities (WMHs) in stroke survivors. Neuroimage 2021; 232:117839. [PMID: 33577935 DOI: 10.1016/j.neuroimage.2021.117839] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
Using advanced diffusion MRI, we aimed to assess the microstructural properties of normal-appearing white matter (NAWM) preceding conversion to white matter hyperintensities (WMHs) using 3-tissue diffusion signal compositions in ischemic stroke. Data were obtained from the Cognition and Neocortical Volume After Stroke (CANVAS) study. Diffusion-weighted MR and high-resolution structural brain images were acquired 3- (baseline) and 12-months (follow-up) post-stroke. WMHs were automatically segmented and longitudinal assessment at 12-months was used to retrospectively delineate NAWM voxels at baseline converting to WMHs. NAWM voxels converting to WMHs were further dichotomized into either: "growing" WMHs if NAWM adhered to existing WMH voxels, or "isolated de-novo" WMHs if NAWM was unconnected to WMH voxels identified at baseline. Microstructural properties were assessed using 3-tissue diffusion signal compositions consisting of white matter-like (WM-like: TW), gray matter-like (GM-like: TG), and cerebrospinal fluid-like (CSF-like: TC) signal fractions. Our findings showed that NAWM converting to WMHs already exhibited similar changes in tissue compositions at baseline to WMHs with lower TW and increased TC (fluid-like, i.e. free-water) and TG compared to persistent NAWM. We also found that microstructural properties of persistent NAWM were related to overall WMH burden with greater free-water content in patients with high WMH load. These findings suggest that NAWM preceding conversion to WMHs are accompanied by greater fluid-like properties indicating increased tissue water content. Increased GM-like properties may indicate a more isotropic microstructure of tissue reflecting a degree of hindered diffusion in NAWM regions vulnerable to WMH development. These results support the usefulness of microstructural compositions as a sensitive marker of NAWM vulnerability to WMH pathogenesis.
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Affiliation(s)
- Wasim Khan
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, United Kingdom.
| | - Mohamed Salah Khlif
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
| | - Remika Mito
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
| | - Thijs Dhollander
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; Melbourne Dementia Research Centre, University of Melbourne, Victoria, Australia.
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10
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Low A, Su L, Stefaniak JD, Mak E, Dounavi ME, Muniz-Terrera G, Ritchie K, Ritchie CW, Markus HS, O'Brien JT. Inherited risk of dementia and the progression of cerebral small vessel disease and inflammatory markers in cognitively healthy midlife adults: the PREVENT-Dementia study. Neurobiol Aging 2021; 98:124-133. [PMID: 33264710 PMCID: PMC7895800 DOI: 10.1016/j.neurobiolaging.2020.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 02/05/2023]
Abstract
Cerebral small vessel disease (SVD) and inflammation are increasingly recognized as key contributors to Alzheimer's disease (AD), although the timing, trajectory, and relation between them early in the disease process is unclear. Therefore, to investigate very early-stage changes, we compared 158 healthy midlife adults with and without inherited AD predisposition (APOE4 carriership (38% positive), parental family history (FH) of dementia (54% positive)) on markers of SVD (white matter hyperintensities (WMH), cerebral microbleeds), and inflammation (C-reactive protein (CRP), fibrinogen), cross-sectionally and longitudinally over two years. While WMH severity was comparable between groups at baseline, longitudinal progression of WMH was greater in at-risk groups (APOE4+ and FH+). Topographically, APOE4 was associated exclusively with deep, but not periventricular, WMH progression after adjusting for FH. Conversely, APOE4 carriers displayed lower CRP levels than noncarriers, but not fibrinogen. Furthermore, interaction analysis showed that FH moderated the effect of SVD and inflammation on reaction time, an early feature of SVD, but not episodic memory or executive function. Findings suggest that vascular and inflammatory changes could occur decades before dementia onset, and may be of relevance in predicting incipient clinical progression.
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Affiliation(s)
- Audrey Low
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - James D Stefaniak
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Karen Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK; INSERM, Montpellier, France
| | - Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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11
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Mak E, Dounavi ME, Low A, Carter SF, McKiernan E, Williams GB, Jones PS, Carriere I, Muniz GT, Ritchie K, Ritchie C, Su L, O'Brien JT. Proximity to dementia onset and multi-modal neuroimaging changes: The prevent-dementia study. Neuroimage 2021; 229:117749. [PMID: 33454416 DOI: 10.1016/j.neuroimage.2021.117749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND First-degree relatives of people with dementia (FH+) are at increased risk of developing Alzheimer's disease (AD). Here, we investigate "estimated years to onset of dementia" (EYO) as a surrogate marker of preclinical disease progression and assess its associations with multi-modal neuroimaging biomarkers. METHODS 89 FH+ participants in the PREVENT-Dementia study underwent longitudinal MR imaging over 2 years. EYO was calculated as the difference between the parental age of dementia diagnosis and the current age of the participant (mean EYO = 23.9 years). MPRAGE, ASL and DWI data were processed using Freesurfer, FSL-BASIL and DTI-TK. White matter lesion maps were segmented from FLAIR scans. The SPM Sandwich Estimator Toolbox was used to test for the main effects of EYO and interactions between EYO, Time, and APOE-ε4+. Threshold free cluster enhancement and family wise error rate correction (TFCE FWER) was performed on voxelwise statistical maps. RESULTS There were no significant effects of EYO on regional grey matter atrophy or white matter hyperintensities. However, a shorter EYO was associated with lower white matter Fractional Anisotropy and elevated Mean/Radial Diffusivity, particularly in the corpus callosum (TFCEFWERp < 0.05). The influence of EYO on white matter deficits were significantly stronger compared to that of normal ageing. APOE-ε4 carriers exhibited hyperperfusion with nearer proximity to estimated onset in temporo-parietal regions. There were no interactions between EYO and time, suggesting that EYO was not associated with accelerated imaging changes in this sample. CONCLUSIONS Amongst cognitively normal midlife adults with a family history of dementia, a shorter hypothetical proximity to dementia onset may be associated with incipient brain abnormalities, characterised by white matter disruptions and perfusion abnormalities, particularly amongst APOE-ε4 carriers. Our findings also confer biological validity to the construct of EYO as a potential stage marker of preclinical progression in the context of sporadic dementia. Further clinical follow-up of our longitudinal sample would provide critical validation of these findings.
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Affiliation(s)
- Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK.
| | - Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Audrey Low
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Stephen F Carter
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Elizabeth McKiernan
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Guy B Williams
- Department of Clinical Neurosciences and Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences and Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Isabelle Carriere
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | | | - Karen Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK; INSERM and University of Montpellier, Montpellier, France
| | - Craig Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
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12
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Mito R, Dhollander T, Xia Y, Raffelt D, Salvado O, Churilov L, Rowe CC, Brodtmann A, Villemagne VL, Connelly A. In vivo microstructural heterogeneity of white matter lesions in healthy elderly and Alzheimer's disease participants using tissue compositional analysis of diffusion MRI data. Neuroimage Clin 2020; 28:102479. [PMID: 33395971 PMCID: PMC7652769 DOI: 10.1016/j.nicl.2020.102479] [Citation(s) in RCA: 8] [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] [Received: 05/01/2020] [Revised: 09/25/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022]
Abstract
White matter hyperintensities (WMH) are regions of high signal intensity typically identified on fluid attenuated inversion recovery (FLAIR). Although commonly observed in elderly individuals, they are more prevalent in Alzheimer's disease (AD) patients. Given that WMH appear relatively homogeneous on FLAIR, they are commonly partitioned into location- or distance-based classes when investigating their relevance to disease. Since pathology indicates that such lesions are often heterogeneous, probing their microstructure in vivo may provide greater insight than relying on such arbitrary classification schemes. In this study, we investigated WMH in vivo using an advanced diffusion MRI method known as single-shell 3-tissue constrained spherical deconvolution (SS3T-CSD), which models white matter microstructure while accounting for grey matter and CSF compartments. Diffusion MRI data and FLAIR images were obtained from AD (n = 48) and healthy elderly control (n = 94) subjects. WMH were automatically segmented, and classified: (1) as either periventricular or deep; or (2) into three distance-based contours from the ventricles. The 3-tissue profile of WMH enabled their characterisation in terms of white matter-, grey matter-, and fluid-like characteristics of the diffusion signal. Our SS3T-CSD findings revealed substantial heterogeneity in the 3-tissue profile of WMH, both within lesions and across the various classes. Moreover, this heterogeneity information indicated that the use of different commonly used WMH classification schemes can result in different disease-based conclusions. We conclude that future studies of WMH in AD would benefit from inclusion of microstructural information when characterising lesions, which we demonstrate can be performed in vivo using SS3T-CSD.
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Affiliation(s)
- Remika Mito
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Thijs Dhollander
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia; Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ying Xia
- CSIRO, Health & Biosecurity, The Australian eHealth Research Centre, Brisbane, Queensland, Australia
| | - David Raffelt
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Olivier Salvado
- CSIRO, Health & Biosecurity, The Australian eHealth Research Centre, Brisbane, Queensland, Australia; CSIRO Data61, Sydney, New South Wales, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia
| | - Christopher C Rowe
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia; Department of Molecular Imaging & Therapy, Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia; Eastern Clinical Research Unit, Monash University, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Victor L Villemagne
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia; Department of Molecular Imaging & Therapy, Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Alan Connelly
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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13
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Firbank MJ, O'Brien JT, Durcan R, Allan LM, Barker S, Ciafone J, Donaghy PC, Hamilton CA, Lawley S, Lloyd J, Roberts G, Taylor JP, Thomas AJ. Mild cognitive impairment with Lewy bodies: blood perfusion with arterial spin labelling. J Neurol 2020; 268:1284-1294. [PMID: 33084940 PMCID: PMC7990749 DOI: 10.1007/s00415-020-10271-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 12/24/2022]
Abstract
Objective To use arterial spin labelling to investigate differences in perfusion in mild cognitive impairment with Lewy bodies (MCI-LB) compared to Alzheimer type MCI (MCI-AD) and healthy controls. Methods We obtained perfusion images on 32 MCI-LB, 30 MCI-AD and 28 healthy subjects of similar age. Perfusion relative to cerebellum was calculated, and we aimed to examine differences in relative perfusion between MCI-LB and the other groups. This included whole brain voxelwise comparisons, as well as using predefined region-of-interest ratios of medial occipital to medial temporal, and posterior cingulate to precuneus. Differences in occipital perfusion in eyes open vs eyes closed conditions were also examined. Results Compared to controls, the MCI-LB showed reduced perfusion in the precuneus, parietal, occipital and fusiform gyrus regions. In our predefined regions, the ratio of perfusion in occipital/medial temporal was significantly lower, and the posterior cingulate/precuneus ratio was significantly higher in MCI-LB compared to controls. Overall, the occipital perfusion was greater in the eyes open vs closed condition, but this did not differ between groups. Conclusion We found patterns of altered perfusion in MCI-LB which are similar to those seen in dementia with Lewy bodies, with reduction in posterior parietal and occipital regions, but relatively preserved posterior cingulate.
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Affiliation(s)
- Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise M Allan
- College of Medicine and Health, Exeter University, Exeter, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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14
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Low A, Ng KP, Chander RJ, Wong B, Kandiah N. Association of Asymmetrical White Matter Hyperintensities and Apolipoprotein E4 on Cognitive Impairment. J Alzheimers Dis 2020; 70:953-964. [PMID: 31306121 DOI: 10.3233/jad-190159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Asymmetrical patterns of cerebral damage have been widely observed in a range of neurodegenerative diseases, including Alzheimer's disease (AD). OBJECTIVE To elucidate the clinical associations of asymmetrical white matter hyperintensities (WMH) in mild cognitive impairment (MCI) and AD. METHODS Regional WMH asymmetry of 340 participants (90 healthy controls, 132 MCI, 118 AD) was calculated as the difference in normalized hemispheric WMH volume (WMH/ICV) adjusted for structural brain asymmetry of respective lobar regions and total WMH. WMH asymmetry was analyzed in relation to disease classification, cognition, and APOE4 status using ANCOVA and multiple regression analysis, controlling for gender, age, ethnicity, and correcting for multiple comparisons using Bonferroni correction. Moderation analysis examined interaction effects of APOE4 on associations between cognition and WMH asymmetry. RESULTS Greater left-dominant occipital WMH asymmetry was observed in AD, compared to healthy controls and MCI, and was associated with poorer global cognition, memory, language, and executive functions among cognitively impaired participants (MCI and AD). Cognitively impaired APOE4 carriers displayed greater left-dominant WMH asymmetry in the whole brain and frontal lobe, compared to non-carriers. Importantly, effects were independent of structural brain asymmetry, global cerebral atrophy, and overall WMH burden. Moderation analysis demonstrated associations between left-dominant WMH asymmetry and cognition in cognitively impaired APOE4 non-carriers, but not APOE4 carriers. CONCLUSION Leftward asymmetry of WMH may be more pathological in nature, compared to symmetrical WMH. Furthermore, the detrimental effects of WMH asymmetry was more relevant in APOE4-negative cognitive impairment, compared to APOE4-positive which may be driven primarily by AD pathology.
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Affiliation(s)
- Audrey Low
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Russell Jude Chander
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Benjamin Wong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS, Singapore, Singapore
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15
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Low A, Mak E, Malpetti M, Passamonti L, Nicastro N, Stefaniak JD, Savulich G, Chouliaras L, Su L, Rowe JB, Markus HS, O'Brien JT. In vivo neuroinflammation and cerebral small vessel disease in mild cognitive impairment and Alzheimer's disease. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-323894. [PMID: 32917821 PMCID: PMC7803899 DOI: 10.1136/jnnp-2020-323894] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/06/2020] [Accepted: 08/05/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Associations between cerebral small vessel disease (SVD) and inflammation have been largely examined using peripheral blood markers of inflammation, with few studies measuring inflammation within the brain. We investigated the cross-sectional relationship between SVD and in vivo neuroinflammation using [11C]PK11195 positron emission tomography (PET) imaging. METHODS Forty-two participants were recruited (according to NIA-AA guidelines, 14 healthy controls, 14 mild Alzheimer's disease, 14 amyloid-positive mild cognitive impairment). Neuroinflammation was assessed using [11C]PK11195 PET imaging, a marker of microglial activation. To quantify SVD, we assessed white matter hyperintensities (WMH), enlarged perivascular spaces, cerebral microbleeds and lacunes. Composite scores were calculated for global SVD burden, and SVD subtypes of hypertensive arteriopathy and cerebral amyloid angiopathy (CAA). General linear models examined associations between SVD and [11C]PK11195, adjusting for sex, age, education, cognition, scan interval, and corrected for multiple comparisons via false discovery rate (FDR). Dominance analysis directly compared the relative importance of hypertensive arteriopathy and CAA scores as predictors of [11C]PK11195. RESULTS Global [11C]PK11195 binding was associated with SVD markers, particularly in regions typical of hypertensive arteriopathy: deep microbleeds (β=0.63, F(1,35)=35.24, p<0.001), deep WMH (β=0.59, t=4.91, p<0.001). In dominance analysis, hypertensive arteriopathy score outperformed CAA in predicting [11C]PK11195 binding globally and in 28 out of 37 regions of interest, especially the medial temporal lobe (β=0.66-0.76, t=3.90-5.58, FDR-corrected p (pFDR)=<0.001-0.002) and orbitofrontal cortex (β=0.51-0.57, t=3.53-4.30, pFDR=0.001-0.004). CONCLUSION Microglial activation is associated with SVD, particularly with the hypertensive arteriopathy subtype of SVD. Although further research is needed to determine causality, our study suggests that targeting neuroinflammation might represent a novel therapeutic strategy for SVD.
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Affiliation(s)
- Audrey Low
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Nicolas Nicastro
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - James D Stefaniak
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Li Su
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Donaghy PC, Firbank M, Petrides G, Lloyd J, Barnett N, Olsen K, Thomas AJ, O'Brien JT. Diffusion imaging in dementia with Lewy bodies: Associations with amyloid burden, atrophy, vascular factors and clinical features. Parkinsonism Relat Disord 2020; 78:109-115. [PMID: 32814228 DOI: 10.1016/j.parkreldis.2020.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/03/2020] [Accepted: 07/25/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION White matter disruption in dementia has been linked to a variety of factors including vascular disease and cortical pathology. We aimed to examine the relationship between white matter changes on diffusion tensor imaging (DTI) in DLB and factors including vascular disease, structural atrophy and amyloid burden. METHODS Participants with DLB (n = 29), Alzheimer's disease (AD, n = 17) and healthy controls (n = 20) had clinical and neuropsychological assessments followed by structural and diffusion tensor 3T MRI and 18F-Florbetapir PET-CT imaging. Voxelwise statistical analysis of white matter fractional anisotropy (FA) and mean diffusivity (MD) was carried out using Tract-Based Spatial Statistics with family-wise error correction (p < 0.05). RESULTS DLB and AD groups demonstrated widespread increased MD and decreased FA when compared with controls. There were no differences between the DLB and AD groups. In DLB, increased MD and decreased FA correlated with decreased grey matter and hippocampal volumes as well as vascular disease. There was no correlation with cortical florbetapir SUVR. The relationship between DTI changes and grey matter/hippocampal volumes remained after including Cumulative Illness Rating Scale-Geriatric vascular score as a covariate. CONCLUSIONS Widespread disruption of white matter tracts is present in DLB and is associated with vascular disease, reduced hippocampal volume and reduced grey matter volume, but not with cortical amyloid deposition. The mechanism behind the correlation observed between hippocampal volume and white matter tract disruption should be investigated in future cohorts using tau imaging, as hippocampal atrophy has been shown to correlate with tau deposition in DLB.
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Affiliation(s)
- Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK.
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
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Tay J, Lisiecka-Ford DM, Hollocks MJ, Tuladhar AM, Barrick TR, Forster A, O'Sullivan MJ, Husain M, de Leeuw FE, Morris RG, Markus HS. Network neuroscience of apathy in cerebrovascular disease. Prog Neurobiol 2020; 188:101785. [PMID: 32151533 DOI: 10.1016/j.pneurobio.2020.101785] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 01/15/2023]
Abstract
Apathy is a reduction in motivated goal-directed behavior (GDB) that is prevalent in cerebrovascular disease, providing an important opportunity to study the mechanistic underpinnings of motivation in humans. Focal lesions, such as those seen in stroke, have been crucial in developing models of brain regions underlying motivated behavior, while studies of cerebral small vessel disease (SVD) have helped define the connections between brain regions supporting such behavior. However, current lesion-based models cannot fully explain the neurobiology of apathy in stroke and SVD. To address this, we propose a network-based model which conceptualizes apathy as the result of damage to GDB-related networks. A review of the current evidence suggests that cerebrovascular disease-related pathology can lead to network changes outside of initially damaged territories, which may propagate to regions that share structural or functional connections. The presentation and longitudinal trajectory of apathy in stroke and SVD may be the result of these network changes. Distinct subnetworks might support cognitive components of GDB, the disruption of which results in specific symptoms of apathy. This network-based model of apathy may open new approaches for investigating its underlying neurobiology, and presents novel opportunities for its diagnosis and treatment.
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Affiliation(s)
- Jonathan Tay
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | | | - Matthew J Hollocks
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Thomas R Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | - Michael J O'Sullivan
- University of Queensland Centre for Clinical Research, University of Queensland Australia, Brisbane, Australia
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences & Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Robin G Morris
- Department of Psychology, King's College London, London, UK
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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18
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Low A, Mak E, Stefaniak JD, Malpetti M, Nicastro N, Savulich G, Chouliaras L, Markus HS, Rowe JB, O’Brien JT. Peak Width of Skeletonized Mean Diffusivity as a Marker of Diffuse Cerebrovascular Damage. Front Neurosci 2020; 14:238. [PMID: 32265640 PMCID: PMC7096698 DOI: 10.3389/fnins.2020.00238] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The peak width of skeletonized mean diffusivity (PSMD) has been proposed as a fully automated imaging marker of relevance to cerebral small vessel disease (SVD). We assessed PSMD in relation to conventional SVD markers, global measures of neurodegeneration, and cognition. METHODS 145 participants underwent 3T brain MRI and cognitive assessment. 112 were patients with mild cognitive impairment, Alzheimer's disease, progressive supranuclear palsy, dementia with Lewy bodies, or frontotemporal dementia. PSMD, SVD burden [white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS), microbleeds, lacunes], average mean diffusivity (MD), gray matter (GM), white matter (WM), and total intracranial volume were quantified. Robust linear regression was conducted to examine associations between variables. Dominance analysis assessed the relative importance of markers in predicting various outcomes. Regional analyses examined spatial overlap between PSMD and WMH. RESULTS PSMD was associated with global and regional SVD measures, especially WMH and microbleeds. Dominance analysis demonstrated that among SVD markers, WMH was the strongest predictor of PSMD. Furthermore, PSMD was more closely associated to WMH than with GM and WM volumes. PSMD was associated with WMH across all regions, and correlations were not significantly stronger in corresponding regions (e.g., frontal PSMD and frontal WMH) compared to non-corresponding regions. PSMD outperformed all four conventional SVD markers and MD in predicting cognition, but was comparable to GM and WM volumes. DISCUSSION PSMD was robustly associated with established SVD markers. This new measure appears to be a marker of diffuse brain injury, largely due to vascular pathology, and may be a useful and convenient metric of overall cerebrovascular burden.
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Affiliation(s)
- Audrey Low
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - James D. Stefaniak
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Nicolas Nicastro
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Leonidas Chouliaras
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Hugh S. Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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19
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Donaghy PC, Firbank M, Mitra D, Petrides G, Lloyd J, Barnett N, Olsen K, Thomas AJ, O'Brien JT. Microbleeds in dementia with Lewy bodies. J Neurol 2020; 267:1491-1498. [PMID: 32016624 PMCID: PMC7184053 DOI: 10.1007/s00415-020-09736-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Microbleeds are associated with the development of dementia in older people and are common in Alzheimer's disease (AD). Their prevalence and clinical importance in dementia with Lewy bodies (DLB) is unclear. The objective of this study was to compare the rates of microbleeds in DLB with those in AD and healthy older people, and investigate associations between microbleeds and amyloid deposition, vascular risk and disease severity in DLB. METHODS DLB (n = 30), AD (n = 18) and control (n = 20) participants underwent clinical assessment at baseline and 1 year in this longitudinal observational study. 3T MRI (including T2* susceptibility weighted imaging) and florbetapir PET were carried out at baseline. Microbleeds were rated visually and a standardised uptake value ratio (SUVR) was calculated from florbetapir PET scans. RESULTS 40% of DLB subjects had microbleeds compared with 50% of AD and 15% of controls. Compared to DLB without microbleeds, those with microbleeds had higher systolic BP (156 ± 26 v. 135 ± 19 mmHg; p = 0.03), but did not have greater levels of vascular disease or amyloid deposition (SUVR 1.25 ± 0.24 v. 1.25 ± 0.22; p = 0.33). There was evidence of less severe dementia in DLB participants with microbleeds, but these differences may have been driven by a shorter disease duration in those with microbleeds. CONCLUSION The presence of microbleeds in DLB is associated with higher blood pressure, but not with other measures of vascular disease or amyloid deposition. The relationship between microbleeds and clinical presentation remains unclear.
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Affiliation(s)
- Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dipayan Mitra
- Neuroradiology Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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20
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Rachmadi MF, Valdés-Hernández MDC, Li H, Guerrero R, Meijboom R, Wiseman S, Waldman A, Zhang J, Rueckert D, Wardlaw J, Komura T. Limited One-time Sampling Irregularity Map (LOTS-IM) for Automatic Unsupervised Assessment of White Matter Hyperintensities and Multiple Sclerosis Lesions in Structural Brain Magnetic Resonance Images. Comput Med Imaging Graph 2019; 79:101685. [PMID: 31846826 DOI: 10.1016/j.compmedimag.2019.101685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/02/2019] [Accepted: 11/13/2019] [Indexed: 01/29/2023]
Abstract
We present the application of limited one-time sampling irregularity map (LOTS-IM): a fully automatic unsupervised approach to extract brain tissue irregularities in magnetic resonance images (MRI), for quantitatively assessing white matter hyperintensities (WMH) of presumed vascular origin, and multiple sclerosis (MS) lesions and their progression. LOTS-IM generates an irregularity map (IM) that represents all voxels as irregularity values with respect to the ones considered "normal". Unlike probability values, IM represents both regular and irregular regions in the brain based on the original MRI's texture information. We evaluated and compared the use of IM for WMH and MS lesions segmentation on T2-FLAIR MRI with the state-of-the-art unsupervised lesions' segmentation method, Lesion Growth Algorithm from the public toolbox Lesion Segmentation Toolbox (LST-LGA), with several well established conventional supervised machine learning schemes and with state-of-the-art supervised deep learning methods for WMH segmentation. In our experiments, LOTS-IM outperformed unsupervised method LST-LGA on WMH segmentation, both in performance and processing speed, thanks to the limited one-time sampling scheme and its implementation on GPU. Our method also outperformed supervised conventional machine learning algorithms (i.e., support vector machine (SVM) and random forest (RF)) and deep learning algorithms (i.e., deep Boltzmann machine (DBM) and convolutional encoder network (CEN)), while yielding comparable results to the convolutional neural network schemes that rank top of the algorithms developed up to date for this purpose (i.e., UResNet and UNet). LOTS-IM also performed well on MS lesions segmentation, performing similar to LST-LGA. On the other hand, the high sensitivity of IM on depicting signal change deems suitable for assessing MS progression, although care must be taken with signal changes not reflective of a true pathology.
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Affiliation(s)
- Muhammad Febrian Rachmadi
- School of Informatics, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | | | - Hongwei Li
- Computing, School of Science and Engineering, University of Dundee, Dundee, UK; Department of Informatics, Technical University of Munich, Germany
| | | | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stewart Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adam Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jianguo Zhang
- Computing, School of Science and Engineering, University of Dundee, Dundee, UK; Department of Computer Science and Engineering, Southern University of Science and Technology, China; Shenzhen Institute of Artificial Intelligence and Robotics for Society, China
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Taku Komura
- School of Informatics, University of Edinburgh, Edinburgh, UK
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21
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Hase Y, Polvikoski TM, Firbank MJ, Craggs LJL, Hawthorne E, Platten C, Stevenson W, Deramecourt V, Ballard C, Kenny RA, Perry RH, Ince P, Carare RO, Allan LM, Horsburgh K, Kalaria RN. Small vessel disease pathological changes in neurodegenerative and vascular dementias concomitant with autonomic dysfunction. Brain Pathol 2019; 30:191-202. [PMID: 31357238 DOI: 10.1111/bpa.12769] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/21/2019] [Indexed: 12/16/2022] Open
Abstract
We performed a clinicopathological study to assess the burden of small vessel disease (SVD) type of pathological changes in elderly demented subjects, who had clinical evidence of autonomic dysfunction, either carotid sinus hypersensitivity or orthostatic hypotension or both or had exhibited unexpected repeated falls. Clinical and neuropathological diagnoses in 112 demented subjects comprised dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), Alzheimer's disease (AD), Mixed dementia (mostly AD-DLB) and vascular dementia (VaD). Of these, 12 DLB subjects had no recorded unexpected falls in life and therefore no evidence of concomitant autonomic dysfunction. A further 17 subjects were assessed as aging controls without significant pathology or signs of autonomic dysfunction. We quantified brain vascular pathological changes and determined severities of neurodegenerative lesions including α-synuclein pathology. We found moderate-severe vascular changes and high-vascular pathology scores (P < 0.01) in all neurodegenerative dementias and as expected in VaD compared to similar age controls. Arteriolosclerosis, perivascular spacing and microinfarcts were frequent in the basal ganglia and frontal white matter (WM) across all dementias, whereas small infarcts (<5 mm) were restricted to VaD. In a sub-set of demented subjects, we found that vascular pathology scores were correlated with WM hyperintensity volumes determined by MRI in life (P < 0.02). Sclerotic index values were increased by ~50% in both the WM and neocortex in all dementias compared to similar age controls. We found no evidence for increased α-synuclein deposition in subjects with autonomic dysfunction. Our findings suggest greater SVD pathological changes occur in the elderly diagnosed with neurodegenerative dementias including DLB and who develop autonomic dysfunction. SVD changes may not necessarily manifest in clinically overt symptoms but they likely confound motor or cognitive dysfunction. We propose dysautonomia promotes chronic cerebral hypoperfusion to impact upon aging-related neurodegenerative disorders and characterize their end-stage clinical syndromes.
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Affiliation(s)
- Yoshiki Hase
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tuomo M Polvikoski
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael J Firbank
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lucinda J L Craggs
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emily Hawthorne
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charlotte Platten
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - William Stevenson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vincent Deramecourt
- Histology and Pathology Department, Lille University Hospital, University Lille Nord de France, Lille, France
| | - Clive Ballard
- School of Medicine, University of Exeter, Exeter, United Kingdom
| | - Rose Anne Kenny
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Robert H Perry
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul Ince
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Roxana O Carare
- Clinical and Experimental Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Louise M Allan
- School of Medicine, University of Exeter, Exeter, United Kingdom
| | - Karen Horsburgh
- Centre for Neuroregeneration, University of Edinburgh, Little France Crescent, Edinburgh, United Kingdom
| | - Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
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22
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Koundal S, Liu X, Sanggaard S, Mortensen K, Wardlaw J, Nedergaard M, Benveniste H, Lee H. Brain Morphometry and Longitudinal Relaxation Time of Spontaneously Hypertensive Rats (SHRs) in Early and Intermediate Stages of Hypertension Investigated by 3D VFA-SPGR MRI. Neuroscience 2019; 404:14-26. [PMID: 30690138 DOI: 10.1016/j.neuroscience.2019.01.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 02/03/2023]
Abstract
Cerebral small vessel disease(s) (SVD) results from pathological changes of the small blood vessels in the brain and is common in older people. The diagnostic features by which SVD manifests in brain includes white matter hyperintensities, lacunes, dilated perivascular spaces, microbleeds, and atrophy. In the present study, we use in vivo magnetic resonance imaging (MRI) to characterize brain morphometry and longitudinal relaxation time (T1) of spontaneously hypertensive rats (SHRs) to study the contribution of chronic hypertension to SVD relevant pathology. Male SHR and Wistar-Kyoto (WKY) rats underwent 3D variable flip angle spoiled gradient echo brain MRI at 9.4 T at early (seven weeks old) and established (19 weeks old) stages of hypertension. The derived proton density weighted and T1 images were utilized for morphometry and to characterize T1 properties in gray matter (GM), white matter (WM) and cerebrospinal fluid (CSF). Custom tissue probability maps were constructed for accurate computerized whole brain tissue segmentations and voxel-wise analyses. Characteristic morphological differences between the two strains included enlarged ventricles, smaller corpus callosum (CC) volumes and general 'thinning' of CC in SHR compared to WKY rats at both age groups. While we did not observe parenchymal T1 differences, the T1 of CSF was elevated in SHR compared to controls. Collectively these findings indicate that SHRs develop WM atrophy which is a clinically robust MRI biomarker associated with WM degeneration.
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Affiliation(s)
- Sunil Koundal
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States of America
| | - Xiaodan Liu
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States of America
| | - Simon Sanggaard
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States of America
| | - Kristian Mortensen
- Center for Translational Neuromedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joanna Wardlaw
- Center for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at The University of Edinburgh, The University of Edinburgh, Edinburgh, UK; Row Fogo Centre for Research into Ageing and the Brain, The University of Edinburgh, Edinburgh, UK
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Glia Disease and Therapeutics, Center for Translational Neuromedicine, University of Rochester Medical School, Rochester, NY, USA
| | - Helene Benveniste
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States of America
| | - Hedok Lee
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States of America.
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23
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Park M, Moon Y, Han SH, Kim HK, Moon WJ. Myelin loss in white matter hyperintensities and normal-appearing white matter of cognitively impaired patients: a quantitative synthetic magnetic resonance imaging study. Eur Radiol 2018; 29:4914-4921. [PMID: 30488109 DOI: 10.1007/s00330-018-5836-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/19/2018] [Accepted: 10/16/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES White matter hyperintensities (WMHs) are implicated in the etiology of dementia. The underlying pathology of WMHs involves myelin and axonal loss due to chronic ischemia. We investigated myelin loss in WMHs and normal-appearing white matter (NAWM) in patients with various degrees of cognitive impairment using quantitative synthetic magnetic resonance imaging (MRI). METHODS We studied 99 consecutive patients with cognitive complaints who underwent 3 T brain MRI between July 2016 and August 2017. Myelin partial volume maps were generated with synthetic MRI. Region-of-interest-based analysis was performed on these maps to compare the myelin partial volumes of NAWM and periventricular and deep WMHs. The effects of myelin partial volume of NAWMs on clinical cognitive function were evaluated using multivariate linear regression analysis. RESULTS WMHs were present in 30.3% of patients. Myelin partial volume in NAWM was lower in patients with WMHs than in those without (37.5 ± 2.7% vs. 39.9 ± 2.4%, p < 0.001). In patients with WMHs, myelin partial volume was highest in NAWMs (median [interquartile range], 37.2% [35.5-39.0%]), followed by deep WMHs (7.2% [3.2-10.5%]) and periventricular WMHs (2.1% [1.1-3.9%], p < 0.001). After adjusting for sex and education years, myelin partial volume in NAWMs was associated with the Clinical Dementia Rating Scale Sum of Box (β = -0.189 [95% CI, -0.380 to -0.012], p = 0.031). CONCLUSION Myelin loss occurs in both NAWM and WMHs of cognitively impaired patients. Synthetic MRI-based myelin quantification may be a useful imaging marker of cognitive dysfunction in patients with cognitive complaints. KEY POINTS • Quantitative synthetic MRI allows simultaneous acquisition of conventional MRI and myelin quantification without additional scanning time. • Normal-appearing and hyperintense white matter demonstrate myelin loss in cognitively impaired patients. • This myelin loss partially explains cognitive dysfunction in patients with cognitive complaints.
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Affiliation(s)
- Mina Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.,Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeonsil Moon
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Ho Kyun Kim
- Department of Radiology, School of Medicine, Daegu Catholic University, Gyeongsan, Gyeongsangbuk-do, South Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
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BOLD activation of the ventromedial prefrontal cortex in patients with late life depression and comparison participants. Int Psychogeriatr 2018; 30:629-634. [PMID: 28516827 DOI: 10.1017/s1041610217000461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTThe ventromedial prefrontal cortex's (vMPFC) role in regulating emotions in late life depression (LLD) remains unclarified. We assessed vMPFC activation in an emotional valence blood oxygenation level-dependent (BOLD) functional magnetic neuroimaging (fMRI) task and related the findings to extent of white matter hyperintensities (WMH). Sixteen participants with mild to moderate LLD were compared to 14 similar aged comparison participants. Participants in the scanner viewed words matched for length and arousal, indicated the perceived valence by pressing one of the three buttons i.e. "positive, negative, or neutral." WMH volume was greater in LLD participants than comparison participants. There were no differences in activations between groups to any valence contrast. Female LLD participants showed greater activation for negative versus positive and negative versus neutral words as compared to female comparison participants. Female LLD participants respond differently to emotionally laden words compared to comparison participants. WMH could play a role in etiopathology of emotional perception in female LLD participants.
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25
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Longitudinal diffusion tensor imaging changes in early Parkinson’s disease: ICICLE-PD study. J Neurol 2018; 265:1528-1539. [DOI: 10.1007/s00415-018-8873-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 02/03/2023]
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Riphagen JM, Gronenschild EHBM, Salat DH, Freeze WM, Ivanov D, Clerx L, Verhey FRJ, Aalten P, Jacobs HIL. Shades of white: diffusion properties of T1- and FLAIR-defined white matter signal abnormalities differ in stages from cognitively normal to dementia. Neurobiol Aging 2018; 68:48-58. [PMID: 29704648 DOI: 10.1016/j.neurobiolaging.2018.03.029] [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: 08/17/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
The underlying pathology of white matter signal abnormalities (WMSAs) is heterogeneous and may vary dependent on the magnetic resonance imaging contrast used to define them. We investigated differences in white matter diffusivity as an indicator for white matter integrity underlying WMSA based on T1-weighted and fluid-attenuated inversion recovery (FLAIR) imaging contrast. In addition, we investigated which white matter region of interest (ROI) could predict clinical diagnosis best using diffusion metrics. One hundred three older individuals with varying cognitive impairment levels were included and underwent neuroimaging. Diffusion metrics were extracted from WMSA areas based on T1 and FLAIR contrast and from their overlapping areas, the border surrounding the WMSA and the normal-appearing white matter (NAWM). Regional diffusivity differences were calculated with linear mixed effects models. Multinomial logistic regression determined which ROI diffusion values classified individuals best into clinically defined diagnostic groups. T1-based WMSA showed lower white matter integrity compared to FLAIR WMSA-defined regions. Diffusion values of NAWM predicted diagnostic group best compared to other ROI's. To conclude, T1- or FLAIR-defined WMSA provides distinct information on the underlying white matter integrity associated with cognitive decline. Importantly, not the "diseased" but the NAWM is a potentially sensitive indicator for cognitive brain health status.
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Affiliation(s)
- Joost M Riphagen
- Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Anesthesiology, Sankt-Willibrord Spital, Emmerich am Rhein, Germany; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Charlestown, MA, USA.
| | - Ed H B M Gronenschild
- Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - David H Salat
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Charlestown, MA, USA; Neuroimaging Research for Veterans Center, Boston VA, VA Healthcare System, Boston, MA, USA
| | - Whitney M Freeze
- Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dimo Ivanov
- Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Lies Clerx
- Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frans R J Verhey
- Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pauline Aalten
- Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Heidi I L Jacobs
- Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital/Harvard Medical School, Boston, MA
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Tan YJ, Ng ASL, Vipin A, Lim JKW, Chander RJ, Ji F, Qiu Y, Ting SKS, Hameed S, Lee TS, Zeng L, Kandiah N, Zhou J. Higher Peripheral TREM2 mRNA Levels Relate to Cognitive Deficits and Hippocampal Atrophy in Alzheimer's Disease and Amnestic Mild Cognitive Impairment. J Alzheimers Dis 2018; 58:413-423. [PMID: 28453482 DOI: 10.3233/jad-161277] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Variants in triggering receptor expressed on myeloid cells 2 (TREM2) are associated with increased Alzheimer's disease (AD) risk. Recent studies have reported inconsistent peripheral TREM2 mRNA expression levels and relationship with cognitive scores in AD and mild cognitive impairment (MCI). Additionally, no study has examined the association of peripheral TREM2 levels with neuroimaging measures in AD and MCI. OBJECTIVE To determine peripheral TREM2 mRNA levels in AD, amnestic MCI (aMCI) and healthy controls, and the association with cognitive performance and brain structural changes. METHODS We measured peripheral TREM2 mRNA levels in 80 AD, 30 aMCI, and 86 healthy controls using real time polymerase chain reaction. TREM2 levels were correlated with various cognitive performance and brain volumes, correcting for APOE4 status. RESULTS TREM2 mRNA levels were significantly higher in AD compared to controls and aMCI. Levels did not differ between aMCI and controls. Corrected for APOE4, higher TREM2 levels correlated with lower Mini-Mental State Examination, Montreal Cognitive Assessment (MoCA) and episodic memory scores, and lower total grey matter and right hippocampal volumes. Whole-brain voxel-based morphometry analysis found negative association between TREM2 mRNA levels and grey matter volumes in temporal, parietal and frontal regions. AD subjects with MoCA scores ≤20 had higher TREM2 levels correlating with smaller total grey matter, left hippocampal and right hippocampal volumes. CONCLUSION Peripheral TREM2 mRNA levels are higher in AD and are associated with AD-related cognitive deficits and hippocampal atrophy. Our findings suggest that TREM2 may be a potential non-invasive peripheral biomarker for AD diagnosis.
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Affiliation(s)
- Yi Jayne Tan
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore.,Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Adeline S L Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Ashwati Vipin
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
| | - Joseph K W Lim
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
| | - Russell J Chander
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Fang Ji
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
| | - Yingwei Qiu
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
| | - Simon K S Ting
- Department of Neurology, Singapore General Hospital, Singapore
| | - Shahul Hameed
- Department of Neurology, Singapore General Hospital, Singapore
| | - Tih-Shih Lee
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
| | - Li Zeng
- Department of Research, Neural Stem Cell Research Lab, National Neuroscience Institute, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore.,Clinical Imaging Research Centre, The Agency for Science, Technology and Research and National University of Singapore, Singapore
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Schreiner SJ, Kirchner T, Narkhede A, Wyss M, Van Bergen JMG, Steininger SC, Gietl A, Leh SE, Treyer V, Buck A, Pruessmann KP, Nitsch RM, Hock C, Henning A, Brickman AM, Unschuld PG. Brain amyloid burden and cerebrovascular disease are synergistically associated with neurometabolism in cognitively unimpaired older adults. Neurobiol Aging 2017; 63:152-161. [PMID: 29310864 DOI: 10.1016/j.neurobiolaging.2017.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/16/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023]
Abstract
Alzheimer's disease (AD) is the most common cause of cognitive dysfunction in older adults. The pathological hallmarks of AD such as beta amyloid (Aβ) aggregation and neurometabolic change, as indicated by altered myo-inositol (mI) and N-acetylaspartate (NAA) levels, typically precede the onset of cognitive dysfunction by years. Furthermore, cerebrovascular disease occurs early in AD, but the interplay between vascular and neurometabolic brain change is largely unknown. Thirty cognitively normal older adults (age = 70 ± 5.6 years, Mini-Mental State Examination = 29.2 ± 1) received 11-C-Pittsburgh Compound B positron emission tomography for estimating Aβ-plaque density, 7 Tesla fluid-attenuated inversion recovery magnetic resonance imaging for quantifying white matter hyperintensity volume as a marker of small vessel cerebrovascular disease and high-resolution magnetic resonance spectroscopic imaging at 7 Tesla, based on free induction decay acquisition localized by outer volume suppression to investigate tissue-specific neurometabolism in the posterior cingulate and precuneus. Aβ (β = 0.45, p = 0.018) and white matter hyperintensities (β = 0.40, p = 0.046) were independently and interactively (β = -0.49, p = 0.026) associated with a higher ratio of mI over NAA (mI/NAA) in the posterior cingulate and precuneus gray matter but not in the white matter. Our data suggest that cerebrovascular disease and Aβ burden are synergistically associated with AD-related gray matter neurometabolism in older adults.
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Affiliation(s)
- Simon J Schreiner
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland; Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Thomas Kirchner
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Atul Narkhede
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, NY
| | - Michael Wyss
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Jiri M G Van Bergen
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland; Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Stephanie C Steininger
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland; Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Anton Gietl
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland; Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Sandra E Leh
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland; Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Valerie Treyer
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Alfred Buck
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Klaas P Pruessmann
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Roger M Nitsch
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland; Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph Hock
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland; Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Anke Henning
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Max Planck Institute for Biological Cybernetics, Tubingen, Germany
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, NY.
| | - Paul G Unschuld
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland; Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
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29
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Stefaniak JD, Su L, Mak E, Sheikh-Bahaei N, Wells K, Ritchie K, Waldman A, Ritchie CW, O'Brien JT. Cerebral small vessel disease in middle age and genetic predisposition to late-onset Alzheimer's disease. Alzheimers Dement 2017; 14:253-258. [PMID: 29156222 DOI: 10.1016/j.jalz.2017.08.017] [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: 03/30/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Cerebral small vessel disease (CSVD) is associated with late-onset Alzheimer's disease (LOAD) and might contribute to the relationship between apolipoprotein E ε4 (APOE ε4) and LOAD, in older people. However, it is unclear whether CSVD begins in middle age in individuals genetically predisposed to LOAD. METHODS We assessed the relationship between radiological markers of CSVD, white matter hyperintensities and microbleeds, and genetic predisposition to LOAD in a cross-sectional analysis of cognitively normal subjects aged 40-59 years recruited from the PREVENT Dementia study. RESULTS Microbleed prevalence was 14.5%, and mean ± standard deviation white matter hyperintensity percentage of total brain volume was 0.41 ± 0.28%. There was no significant association between APOE ε4 carrier status or history of parental dementia and white matter hyperintensity volume (P = .713, .912 respectively) or microbleeds (P = .082, .562 respectively) on multiple regression. DISCUSSION Genetic predisposition to LOAD, through APOE genotype or AD family history, is not associated with CSVD in middle age.
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Affiliation(s)
- James D Stefaniak
- Manchester Academic Health Sciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Li Su
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK; China-UK Centre for Cognition and Ageing Research, Faculty of Psychology, Southwest University, Chongqing, China
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Nasim Sheikh-Bahaei
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Katie Wells
- The Centre for Mental Health, Imperial College, London, UK
| | - Karen Ritchie
- INSERM Unit 1061 Neuropsychiatry, Montpellier, France; University of Montpellier, Montpellier, France; Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adam Waldman
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Craig W Ritchie
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
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30
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Ong M, Foo H, Chander RJ, Wen MC, Au WL, Sitoh YY, Tan L, Kandiah N. Influence of diabetes mellitus on longitudinal atrophy and cognition in Parkinson's disease. J Neurol Sci 2017; 377:122-126. [DOI: 10.1016/j.jns.2017.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/22/2017] [Accepted: 04/10/2017] [Indexed: 11/30/2022]
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31
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Zhong G, Lou M. Multimodal imaging findings in normal-appearing white matter of leucoaraiosis: a review. Stroke Vasc Neurol 2016; 1:59-63. [PMID: 28959465 PMCID: PMC5435207 DOI: 10.1136/svn-2016-000021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/23/2016] [Accepted: 04/26/2016] [Indexed: 01/16/2023] Open
Abstract
Leucoaraiosis (LA), also referred to as white matter hyperintensities (WMHs), are usually seen as patchy or confluent hyperintense areas on T2-weighted or fluid-attenuated inversion recovery MRI in the elderly. It is often asymptomatic in its early stages, yet its persistent evolution to more advanced stages may lead to substantial neurological dysfunction including dementia, stroke and death. Despite its clinical significance, the pathogenic mechanisms underlying LA development are uncertain. In patients with LA, the pathophysiological changes in white matter (WM) are suggested to be continuous from WMHs to its neighbourhood ‘normal-appearing white matter (NAWM)’ on conventional MRI sequences. Multimodal imaging studies revealed that the so-called ‘NAWM’ was actually abnormal with regard to underlying haemodynamic and microstructural changes. On the basis of positron emission tomography CT, xenon-CT, perfusion MRI, etc, the cerebral blood flow of NAWM was found to be significantly reduced in patients with LA, compared with healthy controls. Meanwhile, the integrity of microstructures and blood–brain barrier in NAWM was also demonstrated to be impaired with diffusion tensor imaging and dynamic contrast-enhanced MRI studies, respectively. In addition,the integrity of NAWM correlated much stronger with cognitive performance than did WMHs load. It is reasonable to assume that the subtle injury of NAWM would be more reversible than WMHs themselves. Therefore, multimodal imaging modalities could be appropriately applied to future interventional studies targeting at early pathophysiological changes of NAWM. In this paper, we summarise current knowledge about NAWM of LA mainly acquired from multimodal imaging studies in vivo, and attempt to give options for future work.
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Affiliation(s)
- Genlong Zhong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhenjiang, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhenjiang, China
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32
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Akinyemi RO, Firbank M, Ogbole GI, Allan LM, Owolabi MO, Akinyemi JO, Yusuf BP, Ogunseyinde O, Ogunniyi A, Kalaria RN. Medial temporal lobe atrophy, white matter hyperintensities and cognitive impairment among Nigerian African stroke survivors. BMC Res Notes 2015; 8:625. [PMID: 26519155 PMCID: PMC4628353 DOI: 10.1186/s13104-015-1552-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuroimaging features associated with vascular cognitive impairment have not been examined in sub-Saharan Africans. We determined magnetic resonance imaging (MRI) features associated with cognitive impairment in a sample of Nigerian stroke survivors. METHODS Stroke survivors underwent brain MRI with standardized assessment of brain volumes and visual rating of medial temporal lobe atrophy (MTA), and white matter hyperintensities (WMH) at 3 months post-stroke. Demographic, clinical and psychometric assessments of global cognitive function, executive function, mental speed and memory were related to changes in structural MRI. RESULTS In our pilot sample of 58 stroke survivors (60.1 ± 10.7 years old) MTA correlated significantly with age (r = 0.525), WMH (r = 0.461), memory (r = -0.702), executive function (r = -0.369) and general cognitive performance (r = -0.378). On univariate analysis, age >60 years (p = 0.016), low educational attainment (p < 0.001 to p < 0.003), total brain volume (p < 0.024 and p < 0.025) and MTA (p < 0.003 to p < 0.007) but not total WMH (p < 0.073, p = 0.610) were associated with cognitive outcome. In a two-step multivariate regression analysis, MTA (p < 0.035 and p < 0.016) and low educational attainment (p < 0.012 and p < 0.019) were sustained as independent statistical predictors of cognitive outcome. CONCLUSIONS Medial temporal lobe atrophy was a significant neuroimaging predictor of early post-stroke cognitive dysfunction in the Nigerian African stroke survivors. These observations have implications for a vascular basis of MTA in older stroke survivors among sub-Saharan Africans.
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Affiliation(s)
- Rufus O Akinyemi
- Division of Neurology, Department of Medicine, Federal Medical Centre Abeokuta, Abeokuta, Nigeria. .,Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
| | - Michael Firbank
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
| | - Godwin I Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria.
| | - Louise M Allan
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
| | | | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria.
| | | | | | | | - Raj N Kalaria
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
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33
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Bohr I, McDonald C, He J, Kerr S, Newton JL, Blamire AM. Brain oxygenation responses to an autonomic challenge: a quantitative fMRI investigation of the Valsalva manoeuvre. AGE (DORDRECHT, NETHERLANDS) 2015; 37:91. [PMID: 26318855 PMCID: PMC5005835 DOI: 10.1007/s11357-015-9833-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/20/2015] [Indexed: 06/04/2023]
Abstract
In late age, the autonomic nervous system (ANS) has diminished ability to maintain physiological homeostasis in the brain in response to challenges such as to systemic blood pressure changes caused by standing. We devised an fMRI experiment aiming to map the cerebral effects of an ANS challenge (Valsalva manoeuvre (VM)). We used dual-echo fMRI to measure the effective transverse relaxation rate (R2*, which is inversely proportional to brain tissue oxygenation levels) in 45 elderly subjects (median age 80 years old, total range 75-89) during performance of the VM. In addition, we collected fluid-attenuated inversion recovery (FLAIR) data from which we quantified white matter hyperintensity (WMH) volumes. We conducted voxelwise analysis of the dynamic changes in R2* during the VM to determine the distribution of oxygenation changes due to the autonomic stressor. In white matter, we observed significant decreases in oxygenation levels. These effects were predominantly located in posterior white matter and to a lesser degree in the right anterior brain, both concentrated around the border zones (watersheds) between cerebral perfusion territories. These areas are known to be particularly vulnerable to hypoxia and are prone to formation of white matter hyperintensities. Although we observed overlap between localisation of WMH and triggered deoxygenation on the group level, we did not find significant association between these independent variables using subjectwise statistics. This could suggest other than recurrent transient hypoxia mechanisms causing/contributing to the formation of WMH.
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Affiliation(s)
- Iwo Bohr
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK,
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Wharton SB, Simpson JE, Brayne C, Ince PG. Age-associated white matter lesions: the MRC Cognitive Function and Ageing Study. Brain Pathol 2015; 25:35-43. [PMID: 25521175 DOI: 10.1111/bpa.12219] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/08/2014] [Indexed: 12/11/2022] Open
Abstract
Cerebral white matter lesions (WML) are common in the aging brain and are associated with dementia and depression. They are associated with vascular risk factors and small vessel disease, suggesting an ischemic origin, but recent pathology studies suggest a more complex pathogenesis. Studies using samples from the population-representative Medical Research Council Cognitive Function and Ageing Study neuropathology cohort used post-mortem magnetic resonance imaging to identify WML for further study. Expression of hypoxia-related molecules and other injury and protective cellular pathways in candidate immunohistochemical and gene expression microarray studies support a role for hypoxia/ischemia. However, these approaches also suggest that immune activation, blood-brain barrier dysfunction, altered cell metabolic pathways and glial cell injury contribute to pathogenesis. These abnormalities are not confined to WML, but are also found in apparently normal white matter in brains with lesions, suggesting a field effect of white matter abnormality within which lesions arise. WML are an active pathology with a complex pathogenesis that may potentially offer a number of primary and secondary intervention targets.
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Affiliation(s)
- Stephen B Wharton
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
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35
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Wardlaw JM, Valdés Hernández MC, Muñoz-Maniega S. What are white matter hyperintensities made of? Relevance to vascular cognitive impairment. J Am Heart Assoc 2015; 4:001140. [PMID: 26104658 PMCID: PMC4599520 DOI: 10.1161/jaha.114.001140] [Citation(s) in RCA: 521] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Joanna M Wardlaw
- Division of Neuroimaging Sciences and Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (J.M.W., M.C.V.H., S.M.M.)
| | - Maria C Valdés Hernández
- Division of Neuroimaging Sciences and Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (J.M.W., M.C.V.H., S.M.M.)
| | - Susana Muñoz-Maniega
- Division of Neuroimaging Sciences and Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (J.M.W., M.C.V.H., S.M.M.)
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Mak E, Su L, Williams GB, O'Brien JT. Neuroimaging correlates of cognitive impairment and dementia in Parkinson's disease. Parkinsonism Relat Disord 2015; 21:862-70. [PMID: 26004683 DOI: 10.1016/j.parkreldis.2015.05.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/01/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Abstract
There has been a gradual shift in the definition of Parkinson's disease, from a movement disorder to a neurodegenerative condition affecting multiple cognitive domains. Mild cognitive impairment (PD-MCI) is a frequent comorbidity in PD that is associated with progression to dementia (PDD) and debilitating consequences for patients and caregivers. At present, the pathophysiology underpinning cognitive impairment in PD is not established, although emerging evidence has suggested that multi-modal imaging biomarkers could be useful in the early diagnosis of PD-MCI and PDD, thereby identifying at-risk patients to enable treatment at the earliest stage possible. Structural MRI studies have revealed prominent grey matter atrophy and disruptions of white matter tracts in PDD, although findings in non-demented PD have been more variable. There is a need for further longitudinal studies to clarify the spatial and temporal progression of morphological changes in PD, as well as to assess their underlying involvement in the evolution of cognitive deficits. In this review, we discuss the aetiology and neuropsychological profiles of PD-MCI and PDD, summarize the putative imaging substrates in light of evidence from multi-modal neuroimaging studies, highlight limitations in the present literature, and suggest recommendations for future research.
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Affiliation(s)
- Elijah Mak
- Department of Psychiatry, University of Cambridge, UK.
| | - Li Su
- Department of Psychiatry, University of Cambridge, UK.
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37
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Classifying dementia using local binary patterns from different regions in magnetic resonance images. Int J Biomed Imaging 2015; 2015:572567. [PMID: 25873943 PMCID: PMC4385607 DOI: 10.1155/2015/572567] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 01/10/2023] Open
Abstract
Dementia is an evolving challenge in society, and no disease-modifying treatment exists. Diagnosis can be demanding and MR imaging may aid as a noninvasive method to increase prediction accuracy. We explored the use of 2D local binary pattern (LBP) extracted from FLAIR and T1 MR images of the brain combined with a Random Forest classifier in an attempt to discern patients with Alzheimer's disease (AD), Lewy body dementia (LBD), and normal controls (NC). Analysis was conducted in areas with white matter lesions (WML) and all of white matter (WM). Results from 10-fold nested cross validation are reported as mean accuracy, precision, and recall with standard deviation in brackets. The best result we achieved was in the two-class problem NC versus AD + LBD with total accuracy of 0.98 (0.04). In the three-class problem AD versus LBD versus NC and the two-class problem AD versus LBD, we achieved 0.87 (0.08) and 0.74 (0.16), respectively. The performance using 3DT1 images was notably better than when using FLAIR images. The results from the WM region gave similar results as in the WML region. Our study demonstrates that LBP texture analysis in brain MR images can be successfully used for computer based dementia diagnosis.
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Kandiah N, Zainal NH, Narasimhalu K, Chander RJ, Ng A, Mak E, Au WL, Sitoh YY, Nadkarni N, Tan LC. Hippocampal volume and white matter disease in the prediction of dementia in Parkinson's disease. Parkinsonism Relat Disord 2014; 20:1203-8. [DOI: 10.1016/j.parkreldis.2014.08.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/22/2014] [Accepted: 08/27/2014] [Indexed: 11/24/2022]
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Maniega SM, Valdés Hernández MC, Clayden JD, Royle NA, Murray C, Morris Z, Aribisala BS, Gow AJ, Starr JM, Bastin ME, Deary IJ, Wardlaw JM. White matter hyperintensities and normal-appearing white matter integrity in the aging brain. Neurobiol Aging 2014; 36:909-18. [PMID: 25457555 PMCID: PMC4321830 DOI: 10.1016/j.neurobiolaging.2014.07.048] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 07/10/2014] [Accepted: 07/16/2014] [Indexed: 11/08/2022]
Abstract
White matter hyperintensities (WMH) of presumed vascular origin are a common finding in brain magnetic resonance imaging of older individuals and contribute to cognitive and functional decline. It is unknown how WMH form, although white matter degeneration is characterized pathologically by demyelination, axonal loss, and rarefaction, often attributed to ischemia. Changes within normal-appearing white matter (NAWM) in subjects with WMH have also been reported but have not yet been fully characterized. Here, we describe the in vivo imaging signatures of both NAWM and WMH in a large group of community-dwelling older people of similar age using biomarkers derived from magnetic resonance imaging that collectively reflect white matter integrity, myelination, and brain water content. Fractional anisotropy (FA) and magnetization transfer ratio (MTR) were significantly lower, whereas mean diffusivity (MD) and longitudinal relaxation time (T1) were significantly higher, in WMH than NAWM (p < 0.0001), with MD providing the largest difference between NAWM and WMH. Receiver operating characteristic analysis on each biomarker showed that MD differentiated best between NAWM and WMH, identifying 94.6% of the lesions using a threshold of 0.747 × 10−9 m2s−1 (area under curve, 0.982; 95% CI, 0.975–0.989). Furthermore, the level of deterioration of NAWM was strongly associated with the severity of WMH, with MD and T1 increasing and FA and MTR decreasing in NAWM with increasing WMH score, a relationship that was sustained regardless of distance from the WMH. These multimodal imaging data indicate that WMH have reduced structural integrity compared with surrounding NAWM, and MD provides the best discriminator between the 2 tissue classes even within the mild range of WMH severity, whereas FA, MTR, and T1 only start reflecting significant changes in tissue microstructure as WMH become more severe.
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Affiliation(s)
- Susana Muñoz Maniega
- Brain Research Imaging Centre, Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network: A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK
| | - Maria C Valdés Hernández
- Brain Research Imaging Centre, Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network: A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK
| | | | - Natalie A Royle
- Brain Research Imaging Centre, Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network: A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK
| | - Catherine Murray
- Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Zoe Morris
- Brain Research Imaging Centre, Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network: A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
| | | | - Alan J Gow
- Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK; Department of Psychology, School of Life Sciences, Heriot-Watt University, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Brain Research Imaging Centre, Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network: A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK.
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Brain Research Imaging Centre, Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network: A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK
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Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, Lindley RI, O'Brien JT, Barkhof F, Benavente OR, Black SE, Brayne C, Breteler M, Chabriat H, DeCarli C, de Leeuw FE, Doubal F, Duering M, Fox NC, Greenberg S, Hachinski V, Kilimann I, Mok V, Oostenbrugge RV, Pantoni L, Speck O, Stephan BCM, Teipel S, Viswanathan A, Werring D, Chen C, Smith C, van Buchem M, Norrving B, Gorelick PB, Dichgans M. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12:822-38. [PMID: 23867200 PMCID: PMC3714437 DOI: 10.1016/s1474-4422(13)70124-8] [Citation(s) in RCA: 3607] [Impact Index Per Article: 327.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cerebral small vessel disease (SVD) is a common accompaniment of ageing. Features seen on neuroimaging include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. SVD can present as a stroke or cognitive decline, or can have few or no symptoms. SVD frequently coexists with neurodegenerative disease, and can exacerbate cognitive deficits, physical disabilities, and other symptoms of neurodegeneration. Terminology and definitions for imaging the features of SVD vary widely, which is also true for protocols for image acquisition and image analysis. This lack of consistency hampers progress in identifying the contribution of SVD to the pathophysiology and clinical features of common neurodegenerative diseases. We are an international working group from the Centres of Excellence in Neurodegeneration. We completed a structured process to develop definitions and imaging standards for markers and consequences of SVD. We aimed to achieve the following: first, to provide a common advisory about terms and definitions for features visible on MRI; second, to suggest minimum standards for image acquisition and analysis; third, to agree on standards for scientific reporting of changes related to SVD on neuroimaging; and fourth, to review emerging imaging methods for detection and quantification of preclinical manifestations of SVD. Our findings and recommendations apply to research studies, and can be used in the clinical setting to standardise image interpretation, acquisition, and reporting. This Position Paper summarises the main outcomes of this international effort to provide the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE).
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Affiliation(s)
- Joanna M Wardlaw
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Correspondence to: Prof Joanna M Wardlaw, Division of Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Eric E Smith
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary and Seaman Family MR Research Centre, Calgary, AL, Canada
| | - Geert J Biessels
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, UMC Utrecht, Utrecht, Netherlands
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Richard Frayne
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary and Seaman Family MR Research Centre, Calgary, AL, Canada
| | - Richard I Lindley
- University of Sydney and George Institute for Global Health, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, Netherlands
| | - Oscar R Benavente
- Department of Medicine, Division of Neurology, Brain Research Centre, University of British Columbia, Vancouver, BC, Canada
| | | | - Carol Brayne
- Cambridge Institute of Public Health, School of Clinical Medicine, Cambridge, UK
| | | | - Hugues Chabriat
- Service de Neurologie, Hopital Lariboisiere, INSERM, Université Denis Diderot, Paris, France
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Sacramento, CA, USA
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Fergus Doubal
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Marco Duering
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nick C Fox
- Department of Neurodegeneration, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Steven Greenberg
- Massachusetts General Hospital, Stroke Research Center, Boston, MA, USA
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE) Rostock and Greifswald, Rostock, Germany
| | - Vincent Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Robert van Oostenbrugge
- Department of Neurology, School of Mental Health and Neuroscience, and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Leonardo Pantoni
- Azienda Universitario Ospedaliera Careggi, Department of Neuroscience, Pharmacology and Child's Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Oliver Speck
- Department of Biomedical Magnetic Resonance, Faculty for Natural Sciences, Institute for Experimental Physics, Otto-von-Guericke UniversityMagdeburg, Magdeburg, Germany
| | | | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE) Rostock and Greifswald, Rostock, Germany
| | - Anand Viswanathan
- Massachusetts General Hospital, Stroke Research Center, Boston, MA, USA
| | - David Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Christopher Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Skåne University Hospital, Lund, Sweden
| | - Philip B Gorelick
- Saint Mary's Health Care, Hauenstein Neuroscience Center, Grand Rapids, MI, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Prof M Dichgans, Institute for Stroke and Dementia Research, Klinikum der Universität, Munich, Germany
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Kandiah N, Mak E, Ng A, Huang S, Au WL, Sitoh YY, Tan LCS. Cerebral white matter hyperintensity in Parkinson's disease: a major risk factor for mild cognitive impairment. Parkinsonism Relat Disord 2013; 19:680-3. [PMID: 23623194 DOI: 10.1016/j.parkreldis.2013.03.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/25/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) and dementia contribute to a poor quality of life among patients with PD. The influence of cerebral ischemia as a risk factor for MCI in PD has not been adequately investigated. To address this issue, we examined the influence of the volume and distribution of white matter hyperintensity (WMH) as a risk factor for MCI in early PD. METHODS Prospective study of patients with early idiopathic PD. All patients had baseline MRI-FLAIR, clinical assessment and detailed neuropsychological evaluation. Data on demographics, vascular risk factors, cognitive performance and WMH volumes were analyzed. RESULTS 91 patients; mean age 64.9 years, mean education of 10.5 years. 24 patients fulfilled the Movement Disorder Society criteria for MCI and were classified as PD-MCI while the rest were classified as PD with no cognitive impairment (PD-NCI). Patients with PD-MCI and PD-NCI did not differ in Hoehn & Yahr staging. PD-MCI patients had a higher prevalence of diabetes mellitus, hypertension and hyperlipidemia. PD-MCI patients had significantly greater volume of periventricular (6.04 ml vs. 2.66 ml, p = 0.001) and deep subcortical WMH (2.16 vs.1.44, p = 0.002). Regional WMH was significantly greater among PD-MCI in the frontal, parietal and occipital regions. Logistic regression analyses demonstrated WMH to be associated with PD-MCI independent of age, education, and vascular risk factors. Increasing WMH volume was associated with lower performance on executive function, memory and language. CONCLUSIONS WMH is an important risk factor for PD-MCI independent of vascular risk factors. PD patients with WMH should be regularly screened for MCI.
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Oppedal K, Aarsland D, Firbank MJ, Sonnesyn H, Tysnes OB, O'Brien JT, Beyer MK. White matter hyperintensities in mild lewy body dementia. Dement Geriatr Cogn Dis Extra 2012. [PMID: 23189084 PMCID: PMC3507264 DOI: 10.1159/000343480] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The objective of this study was to explore the load of white matter hyperintensities (WMH) in patients with Lewy body dementia (LBD) and compare to Alzheimer's disease (AD) and normal controls (NC). Methods Diagnosis of LBD and AD was made according to consensus criteria and cognitive tests were administered. MRI scans for 77 (61 AD and 16 LBD) patients and 37 healthy elderly control subjects were available for analysis. We segmented WMH from FLAIR images using an automatic thresholding technique and calculated the volume of WMH in several regions of the brain, using non-parametric tests to compare groups. Multivariate regression was applied. Results There were no significant differences in WMH between AD and LBD. We found a significant correlation between total and frontal WMH and Mini-Mental State Examination (MMSE) and verbal fluency scores in the AD group, but not in the LBD group. Conclusion The WMH load in LBD was similar to that of AD. A correlation between WMH load and cognition was found in the AD group, but not in the LBD group, suggesting that vascular disease contributes to cognitive impairment in AD but not LBD.
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Affiliation(s)
- K Oppedal
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway ; Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
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Relationship between cognition, magnetic resonance white matter hyperintensities, and cardiovascular autonomic changes in late-life depression. Am J Geriatr Psychiatry 2012; 20:691-9. [PMID: 22609766 DOI: 10.1097/jgp.0b013e31824c0435] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To explore the relationship between specific aspects of cognition, white matter hyperintensities (WMHs), and cardiovascular autonomic parameters in late-life depression (LLD). DESIGN Cross-sectional analysis. SETTING Secondary care psychiatry. PARTICIPANTS Forty-one individuals older than 60 years, with current or previous history of major depression, and 32 age-matched comparison subjects. MEASUREMENTS Cognition was assessed by a standardized computer battery of tasks (Cognitive Drug Research) that measured processing speed, attention, episodic memory, and working memory. Cardiovascular autonomic parameters were estimated by a noninvasive device that calculated blood pressure, heart rate variability, and baroreflex sensitivity (Task Force Monitor). Magnetic resonance imaging was performed on a 3-T magnetic resonance imaging system, and WMH volume was estimated using an automated validated method. RESULTS As expected, cognitive deficits in all tested domains were present in LLD subjects compared with comparison subjects. In the LLD group, processing speed was correlated with scores on memory and working memory tasks. Attentional deficits were correlated with total and periventricular WMH volume, and episodic memory was associated with heart rate variability. There were no associations between cognitive variables and traditional vascular risk factors or between cognitive variables and any of these parameters in the comparison subjects. CONCLUSIONS This study suggests that processing speed may be an important factor underlying deficits in LLD, but it also indicates that other factors, including those related to vascular disease, are important and thus provide further support for the vascular depression hypothesis.
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Colombo RRDC, Schaufelberger MS, Santos LC, Duran FLDS, Menezes PR, Scazufca M, Busatto GF, Zanetti MV. Voxelwise evaluation of white matter volumes in first-episode psychosis. Psychiatry Res 2012; 202:198-205. [PMID: 22804969 DOI: 10.1016/j.pscychresns.2011.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 07/22/2011] [Accepted: 09/07/2011] [Indexed: 10/28/2022]
Abstract
The occurrence of white matter (WM) abnormalities in psychotic disorders has been suggested by several studies investigating brain pathology and diffusion tensor measures, but evidence assessing regional WM morphometry is still scarce and conflicting. In the present study, 122 individuals with first-episode psychosis (FEP) (62 fulfilling criteria for schizophrenia/schizophreniform disorder, 26 psychotic bipolar I disorder, and 20 psychotic major depressive disorder) underwent magnetic resonance imaging, as well as 94 epidemiologically recruited controls. Images were processed with the Statistical Parametric Mapping (SPM2) package, and voxel-based morphometry was used to compare groups (t-test) and subgroups (ANOVA). Initially, no regional WM abnormalities were observed when both groups (overall FEP group versus controls) and subgroups (i.e., schizophrenia/schizophreniform, psychotic bipolar I disorder, psychotic depression, and controls) were compared. However, when the voxelwise analyses were repeated excluding subjects with comorbid substance abuse or dependence, the resulting statistical maps revealed a focal volumetric reduction in right frontal WM, corresponding to the right middle frontal gyral WM/third subcomponent of the superior longitudinal fasciculus, in subjects with schizophrenia/schizophreniform disorder (n=40) relative to controls (n=89). Our results suggest that schizophrenia/schizophreniform disorder is associated with right frontal WM volume decrease at an early course of the illness.
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Affiliation(s)
- Renata Rodrigues da Cunha Colombo
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Soennesyn H, Oppedal K, Greve OJ, Fritze F, Auestad BH, Nore SP, Beyer MK, Aarsland D. White matter hyperintensities and the course of depressive symptoms in elderly people with mild dementia. Dement Geriatr Cogn Dis Extra 2012; 2:97-111. [PMID: 22590471 PMCID: PMC3347877 DOI: 10.1159/000335497] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives To explore the relationship between white matter hyperintensities (WMH) and the prevalence and course of depressive symptoms in mild Alzheimer's disease (AD) and Lewy body dementia. Design: This is a prospective cohort study conducted in secondary care outpatient clinics in western Norway. Subjects: The study population consisted of 77 elderly people with mild dementia diagnosed according to standardised criteria. Methods Structured clinical interviews and physical, neurological, psychiatric, and neuropsychological examinations were performed and routine blood tests were taken. Depression was assessed using the depression subitem of the Neuropsychiatric Inventory and the Montgomery-Åsberg Depression Rating Scale (MADRS). A standardised protocol for magnetic resonance imaging scan was used, and the volumes of WMH were quantified using an automated method, followed by manual editing. Results The volumes of total and frontal deep WMH were significantly and positively correlated with baseline severity of depressive symptoms, and depressed patients had significantly higher volumes of total and frontal deep WMH than non-depressed patients. Higher volumes of WMH were also associated with having a high MADRS score and incident and persistent depression at follow-up. After adjustment for potential confounders, frontal deep WMH, in addition to prior depression and non-AD dementia, were still significantly associated with baseline depressive symptoms (p = 0.015, OR 3.703, 95% CI 1.294–10.593). Similar results emerged for total WMH. Conclusion In elderly people with mild dementia, volumes of WMH, in particular frontal deep WMH, were positively correlated with baseline severity of depressive symptoms, and seemed to be associated with persistent and incident depression at follow-up. Further studies of the mechanisms that determine the course of depression in mild dementia are needed.
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Firbank MJ, Allan LM, Burton EJ, Barber R, O'Brien JT, Kalaria RN. Neuroimaging predictors of death and dementia in a cohort of older stroke survivors. J Neurol Neurosurg Psychiatry 2012; 83:263-7. [PMID: 22114300 PMCID: PMC3289833 DOI: 10.1136/jnnp-2011-300873] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stroke is a risk factor for subsequent death and dementia. Being able to identify subjects at particular risk would be beneficial to inform treatment and patient management. METHODS SUBJECTS aged over 75 years with incident stroke were recruited. Subjects had a cognitive assessment at 3 months post stroke to exclude dementia, and had an MRI scan (n=106) at that time. Subjects were then followed longitudinally for incident dementia and/or death. RESULTS Independent neuroimaging predictors of survival to dementia were medial temporal atrophy (MTA; p=0.013) and the presence of thalamic infarcts (p=0.002). After inclusion of cognitive score in the model, the significance of MTA (p=0.049) and thalamic infarcts (p=0.04) was reduced, with survival being best predicted by baseline cognitive score (p=0.004). The only independent significant predictor of survival to death was MTA. Apart from thalamic infarcts, the NINDS/AIREN neuroimaging criteria did not independently predict survival to death or dementia. CONCLUSIONS MTA was associated with shorter time to dementia, suggesting a role for Alzheimer pathology in the development of post stroke dementia.
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Affiliation(s)
- Michael J Firbank
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
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Narayan SK, Firbank MJ, Saxby BK, Stansby G, Hansrani M, O'Brien JT, Ford GA. Elevated plasma homocysteine is associated with increased brain atrophy rates in older subjects with mild hypertension. Dement Geriatr Cogn Disord 2011; 31:341-8. [PMID: 21597295 DOI: 10.1159/000328118] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2011] [Indexed: 11/19/2022] Open
Abstract
We determined using serial MR imaging whether raised plasma homocysteine levels are associated with increased brain atrophy, white matter lesion (WML) progression or incidence of silent brain infarcts (SBIs) in older hypertensive subjects. Brain atrophy rates (0.58 ± 0.48% per year, mean ± SD) were significantly correlated with homocysteine (β = 0.46, p = 0.001 homocysteine; β = 0.44, p = 0.007 homocysteine/folate/B12 models) but not with folate or B12 levels. Progression of WML (0.08 ± 0.16%) was not associated with homocysteine level (B = 0.01, p = 0.29). New SBIs were uncommon. In older hypertensive individuals, plasma homocysteine levels are associated with increased rates of whole-brain atrophy but not WML progression.
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Ihara M, Tomimoto H. Lessons from a mouse model characterizing features of vascular cognitive impairment with white matter changes. J Aging Res 2011; 2011:978761. [PMID: 22132331 PMCID: PMC3216359 DOI: 10.4061/2011/978761] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 07/26/2011] [Indexed: 01/13/2023] Open
Abstract
With the demographic shift in age in advanced countries inexorably set to progress in the 21st century, dementia will become one of the most important health problems worldwide. Vascular cognitive impairment is the second most common type of dementia after Alzheimer's disease and is frequently responsible for the cognitive decline of the elderly. It is characterized by cerebrovascular white matter changes; thus, in order to investigate the underlying mechanisms involved in white matter changes, a mouse model of chronic cerebral hypoperfusion has been developed, which involves the narrowing of the bilateral common carotid arteries with newly designed microcoils. The purpose of this paper is to provide a comprehensive summary of the achievements made with the model that shows good reproducibility of the white matter changes characterized by blood-brain barrier disruption, glial activation, oxidative stress, and oligodendrocyte loss following chronic cerebral hypoperfusion. Detailed characterization of this model may help to decipher the substrates associated with impaired memory and move toward a more integrated therapy of vascular cognitive impairment.
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Affiliation(s)
- Masafumi Ihara
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507, Japan
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Colloby SJ, Vasudev A, O'Brien JT, Firbank MJ, Parry SW, Thomas AJ. Relationship of orthostatic blood pressure to white matter hyperintensities and subcortical volumes in late-life depression. Br J Psychiatry 2011; 199:404-10. [PMID: 21903666 DOI: 10.1192/bjp.bp.110.090423] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Structural brain abnormalities are associated with late-life major depression, with numerous studies reporting increased white matter hyperintensities (WMH) and reduced cortical/subcortical grey matter volumes. There is strong evidence linking vascular disease to WMH, but limited evidence on its association with subcortical volumes. AIMS To investigate the relationship of orthostatic blood pressure changes to WMH and subcortical grey matter volumes in late-life depression. METHOD Thirty-eight people with depression and a similarly aged comparison group (n = 30) underwent fluid attenuated inversion recovery (FLAIR) and T(1)-weighted magnetic resonance imaging as well as systematic orthostatic blood pressure assessments. Volumetric estimates of WMH and subcortical grey matter were obtained for each participant and the relationship to blood pressure drop on active stand was examined. RESULTS An association between orthostatic systolic blood pressure drop and WMH volumes in temporal and parietal regions was found in the depression group (age-corrected partial correlation r' = 0.31-0.35, P<0.05). Subcortical volumes were not related to blood pressure changes or WMH volumes in either group. CONCLUSIONS We found evidence for an association between the degree of orthostatic systolic blood pressure drop and WMH volume in the depression group. Since blood pressure drops lead to WMH in animals our findings suggest systolic blood pressure drops may be a factor contributing to these lesions in late-life depression.
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Affiliation(s)
- Sean J Colloby
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Smart SD, Firbank MJ, O'Brien JT. Validation of automated white matter hyperintensity segmentation. J Aging Res 2011; 2011:391783. [PMID: 21904678 PMCID: PMC3167190 DOI: 10.4061/2011/391783] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 07/01/2011] [Accepted: 07/03/2011] [Indexed: 11/20/2022] Open
Abstract
Introduction. White matter hyperintensities (WMHs) are a common finding on MRI scans of older people and are associated with vascular disease. We compared 3 methods for automatically segmenting WMHs from MRI scans. Method. An operator manually segmented WMHs on MRI images from a 3T scanner. The scans were also segmented in a fully automated fashion by three different programmes. The voxel overlap between manual and automated segmentation was compared. Results. Between observer overlap ratio was 63%. Using our previously described in-house software, we had overlap of 62.2%. We investigated the use of a modified version of SPM segmentation; however, this was not successful, with only 14% overlap. Discussion. Using our previously reported software, we demonstrated good segmentation of WMHs in a fully automated fashion.
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Affiliation(s)
- Sean D Smart
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
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