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Naftali J, Barnea R, Leader A, Eliahou R, Pardo K, Tolkovsky A, Hasminski V, Raphaeli G, Bloch S, Shochat T, Saliba W, Auriel E. Association of Acute Incidental Cerebral Microinfarcts With Subsequent Ischemic Stroke in Patients With Cancer: A Population-Based Study. Neurology 2024; 103:e209655. [PMID: 38981073 DOI: 10.1212/wnl.0000000000209655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Incidental diffuse-weighted imaging (DWI)-positive subcortical and cortical lesions, or acute incidental cerebral microinfarcts (CMIs), are a common type of brain ischemia, which can be detected on magnetic resonance DWI for approximately 2 weeks after occurrence. Acute incidental CMI was found to be more common in patients with cancer. Whether acute incidental CMI predicts future ischemic stroke is still unknown. We aimed to examine the association between acute incidental CMI in patients with cancer and subsequent ischemic stroke or transient ischemic attack (TIA). METHODS This is a retrospective cohort study. We used Clalit Health Services records, representing over half of the Israeli population, to identify adults with lung, breast, pancreatic, or colon cancer who underwent brain MRI between January 2014 and April 2020. We included patients who underwent scan between 1 year before cancer diagnosis and 1 year after diagnosis. Primary outcome was ischemic stroke or TIA using International Classification of Diseases, Ninth Revision codes. Secondary outcomes were intracranial hemorrhage (ICH) and mortality. Records were followed from first MRI until primary outcome, death, or end of follow-up (January 2023). Cox proportional hazards models were used to calculate hazard ratio (HR) for patients with and without acute incidental CMI, as a time-dependent covariate. RESULTS The study cohort included 1,618 patients with cancer, among whom, 59 (3.6%) had acute incidental CMI on at least 1 brain MRI. The median (interquartile range) time from acute incidental CMI to stroke or TIA was 26 days (14-84). On multivariable analysis, patients with acute incidental CMI had a higher stroke or TIA risk (HR 2.97, 95% CI 1.08-8.18, p = 0.035) compared with their non-CMI counterparts. Acute incidental CMIs were also associated with mortality after multivariable analysis (HR 2.76, 95% CI 2.06-3.71, p < 0.001); no association with ICH was found. DISCUSSION Acute incidental CMI on brain MRI in patients with active cancer is associated with an increased risk of near-future ischemic stroke or TIA and mortality. This finding might suggest that randomly detected acute incidental CMI in patients with cancer may guide primary cerebrovascular risk prevention and etiologic workup.
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Affiliation(s)
- Jonathan Naftali
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Rani Barnea
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Avi Leader
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Ruth Eliahou
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Keshet Pardo
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Assaf Tolkovsky
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Vadim Hasminski
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Guy Raphaeli
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Sivan Bloch
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Tzippy Shochat
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Walid Saliba
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
| | - Eitan Auriel
- From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel
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Schiavolin S, Camarda G, Mazzucchelli A, Mariniello A, Marinoni G, Storti B, Canavero I, Bersano A, Leonardi M. Cognitive and psychological characteristics in patients with Cerebral Amyloid Angiopathy: a literature review. Neurol Sci 2024; 45:3031-3049. [PMID: 38388894 DOI: 10.1007/s10072-024-07399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
AIM To review the current data on cognitive and psychological characteristics of patients with CAA and on the instruments used for their evaluation. METHODS A systematic search was performed in Embase, Scopus and PubMed with terms related to "cerebral amyloid angiopathy", "neuropsychological measures" and "patient-reported outcome measures" from January 2001 to December 2021. RESULTS Out of 2851 records, 18 articles were selected. The cognitive evaluation was present in all of which, while the psychological one only in five articles. The MMSE (Mini Mental State Examination), TMT (Trail Making Test), fluency test, verbal learning test, digit span, digit symbol and Rey figure tests were the most used cognitive tests, while executive function, memory, processing speed, visuospatial function, attention and language were the most frequent impaired cognitive functions. Depression was the most considered psychological factor usually measured with BDI (Beck Depression Inventory) and GDS (Geriatric Depression Scale). CONCLUSIONS The results of this study might be used in clinical practice as a guide to choose cognitive and psychological instruments and integrate them in the clinical evaluation. The results might also be used in the research field for studies investigating the impact of cognitive and psychological variables on the disease course and for consensus studies aimed at define a standardized evaluation of these aspects.
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Affiliation(s)
- Silvia Schiavolin
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giorgia Camarda
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
| | - Alessia Mazzucchelli
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Arianna Mariniello
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giulia Marinoni
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Benedetta Storti
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Canavero
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Bersano
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
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Li P, Lu H, Shi X, Yan J, Zhou L, Yang J, Wang B, Zhao Y, Liu L, Zhu Y, Xu L, Yang X, Su X, Yang Y, Zhang T, Guo L, Liu X. Protective effects of human urinary kallidinogenase against corticospinal tract damage in acute ischemic stroke patients. Neuroreport 2024; 35:431-438. [PMID: 38526971 DOI: 10.1097/wnr.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
This study aimed to assess the effects of human urinary kallidinogenase (HUK) on motor function outcome and corticospinal tract recovery in patients with acute ischemic stroke (AIS). This study was a randomized, controlled, single-blinded trial. Eighty AIS patients were split into two groups: the HUK and control groups. The HUK group was administered HUK and standard treatment, while the control group received standard treatment only. At admission and discharge, the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and muscle strength were scored. The primary endpoint was the short-term outcomes of AIS patients under different treatments. The secondary endpoint was the degree of corticospinal tract fiber damage under different treatments. There was a significant improvement in the NIHSS Scale, BI and muscle strength scores in the HUK group compared with controls (Mann-Whitney U test; P < 0.05). Diffusion tensor tractography classification and intracranial arterial stenosis were independent predictors of short-term recovery by linear regression analysis. The changes in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) decline rate were significantly smaller in the HUK group than in the control group ( P < 0.05). Vascular endothelial growth factor (VEGF) increased significantly after HUK treatment ( P < 0.05), and the VEGF change was negatively correlated with changes in ADC. HUK is beneficial for the outcome in AIS patients especially in motor function recovery. It may have protective effects on the corticospinal tract which is reflected by the reduction in the FA and ADC decline rates and increased VEGF expression. The study was registered on ClinicalTrials.gov (unique identifier: NCT04102956).
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Affiliation(s)
- Peifang Li
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
- Department of Neurology, Handan Central Hospital, Handan
| | - Honglin Lu
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Xiaoman Shi
- Department of Pediatrics, Affiliated Hospital of Hebei University, Baoding
| | - Jiajia Yan
- Department of Neurology, Cangzhou Integrated Traditional Chinese and Western Medicine Hospital, Cangzhou
| | - Lixia Zhou
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Jipeng Yang
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Binbin Wang
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Yanying Zhao
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Luji Liu
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Yipu Zhu
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Lei Xu
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Xiaoli Yang
- Department of Neurology, Hebei University of Engineering School of Medicine, Handan
| | - Xudong Su
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Yi Yang
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Tong Zhang
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Li Guo
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
| | - Xiaoyun Liu
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang
- Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, China
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Naftali J, Barnea R, Eliahou R, Pardo K, Tolkovsky A, Adi M, Hasminski V, Saliba W, Bloch S, Raphaeli G, Leader A, Auriel E. Lung cancer is associated with acute ongoing cerebral ischemia: A population-based study. Int J Stroke 2024; 19:406-413. [PMID: 37978833 DOI: 10.1177/17474930231217670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Cerebral microinfarcts (CMIs) are the most common type of brain ischemia; however, they are extremely rare in the general population. CMIs can be detected by magnetic resonance diffusion-weighted imaging (MRI-DWI) only for a very short period of approximately 2 weeks after their formation and are associated with an increased stroke risk and cognitive impairment. We aimed to examine CMI detection rate in patients with lung cancer (LC), which is strongly associated with ischemic stroke risk relative to other cancer types. METHODS We used the Clalit Health Services record (representing more than 5 million patients) to identify adults with LC and breast, pancreatic, or colon cancer (non-lung cancer, NLC) who underwent brain magnetic resonance diffusion (MRI) scan within 5 years following cancer diagnosis. All brain MRI scans were reviewed, and CMIs were documented, as well as cardiovascular risk factors. RESULTS Our cohort contained a total of 2056 MRI scans of LC patients and 1598 of NLC patients. A total of 143 CMI were found in 73/2056 (3.5%) MRI scans of LC group compared to a total of 29 CMI in 22/1598 (1.4%) MRI scans of NLC (p < 0.01). Cancer type (e.g. LC vs NLC) was the only associated factor with CMI incidence on multivariate analysis. After calculating accumulated risk, we found an incidence of 2.5 CMI per year in LC patients and 0.5 in NLC. DISCUSSION CMIs are common findings in cancer patients, especially in LC patients and therefore might serve as a marker for occult brain ischemia, cognitive decline, and cancer-related stroke (CRS) risk.
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Affiliation(s)
- Jonathan Naftali
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ruth Eliahou
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
| | - Keshet Pardo
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Assaf Tolkovsky
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Meital Adi
- Department of Radiology, Kaplan Medical Center, Rehovot, Israel
| | - Vadim Hasminski
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Sivan Bloch
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Guy Raphaeli
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Avi Leader
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Wharton SB, Simpson JE, Ince PG, Richardson CD, Merrick R, Matthews FE, Brayne C. Insights into the pathological basis of dementia from population-based neuropathology studies. Neuropathol Appl Neurobiol 2023; 49:e12923. [PMID: 37462105 PMCID: PMC10946587 DOI: 10.1111/nan.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
The epidemiological neuropathology perspective of population and community-based studies allows unbiased assessment of the prevalence of various pathologies and their relationships to late-life dementia. In addition, this approach provides complementary insights to conventional case-control studies, which tend to be more representative of a younger clinical cohort. The Cognitive Function and Ageing Study (CFAS) is a longitudinal study of cognitive impairment and frailty in the general United Kingdom population. In this review, we provide an overview of the major findings from CFAS, alongside other studies, which have demonstrated a high prevalence of pathology in the ageing brain, particularly Alzheimer's disease neuropathological change and vascular pathology. Increasing burdens of these pathologies are the major correlates of dementia, especially neurofibrillary tangles, but there is substantial overlap in pathology between those with and without dementia, particularly at intermediate burdens of pathology and also at the oldest ages. Furthermore, additional pathologies such as limbic-predominant age-related TDP-43 encephalopathy, ageing-related tau astrogliopathy and primary age-related tauopathies contribute to late-life dementia. Findings from ageing population-representative studies have implications for the understanding of dementia pathology in the community. The high prevalence of pathology and variable relationship to dementia status has implications for disease definition and indicate a role for modulating factors on cognitive outcome. The complexity of late-life dementia, with mixed pathologies, indicates a need for a better understanding of these processes across the life-course to direct the best research for reducing risk in later life of avoidable clinical dementia syndromes.
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Affiliation(s)
- Stephen B. Wharton
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Julie E. Simpson
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Paul G. Ince
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | | | - Richard Merrick
- Cambridge Public Health, School of Clinical MedicineUniversity of CambridgeSheffieldUK
| | | | - Carol Brayne
- Cambridge Public Health, School of Clinical MedicineUniversity of CambridgeSheffieldUK
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Naftali J, Barnea R, Eliahou R, Tolkovsky A, Pardo K, Zukerman M, Soback N, Adi M, Leader A, Bloch S, Saliba W, Auriel E. Cerebral Microinfarcts Are Common in Undiagnosed Lung Cancer Patients: A Population-Based Study. Acta Neurol Scand 2023. [DOI: 10.1155/2023/9240247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Background. Cerebral microinfarcts (CMI) represent covert brain ischemia and were associated with stroke risk and cognitive impairment. Magnetic resonance imaging diffusion-weighted imaging (DWI) hyperintensities have been suggested to represent acute CMI. The relationship between malignancy and CMI is unknown. Aims. We aimed to examine whether CMI is more common in patients with undiagnosed lung cancer, and therefore might serve as a prediction marker for cognitive impairment or cancer-related stroke. Methods. We used the computerized database of Clalit Health Services (the largest healthcare provider in Israel) to identify adults diagnosed with lung cancer who had an MRI brain scan for any indication prior to cancer diagnosis. We analyzed DWI sequences, in order to evaluate CMI incidence in this population, and compared it to control groups of patients with other undiagnosed malignancies and patients without known cancer. Results. Altogether, we reviewed 1822 MRI brain scans, of which 497 scans were taken in patients with undiagnosed lung cancer, 543 scans of noncancer patients, and 793 scans of patients with other undiagnosed malignancies. In the lung cancer group, we found 24 CMI, compared with 4 in the noncancer group (
) and 8 in the other cancer group (
). Conclusions. CMI is common in undiagnosed lung cancer patients compare to other undiagnosed cancer types or noncancer patients. At the time of lung cancer diagnosis patients may be at risk for future stroke or cognitive decline.
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Affiliation(s)
- Jonathan Naftali
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ruth Eliahou
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
| | - Assaf Tolkovsky
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Keshet Pardo
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Michal Zukerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Noa Soback
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Meital Adi
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Kaplan Medical Center, Rehovot, Israel
| | - Avi Leader
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Sivan Bloch
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Lady Davis Carmel Medical Center, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Zanon Zotin MC, Schoemaker D, Raposo N, Perosa V, Bretzner M, Sveikata L, Li Q, van Veluw SJ, Horn MJ, Etherton MR, Charidimou A, Gurol ME, Greenberg SM, Duering M, dos Santos AC, Pontes-Neto OM, Viswanathan A. Peak width of skeletonized mean diffusivity in cerebral amyloid angiopathy: Spatial signature, cognitive, and neuroimaging associations. Front Neurosci 2022; 16:1051038. [PMID: 36440281 PMCID: PMC9693722 DOI: 10.3389/fnins.2022.1051038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Peak width of skeletonized mean diffusivity (PSMD) is a promising diffusion tensor imaging (DTI) marker that shows consistent and strong cognitive associations in the context of different cerebral small vessel diseases (cSVD). Purpose Investigate whether PSMD (1) is higher in patients with Cerebral Amyloid Angiopathy (CAA) than those with arteriolosclerosis; (2) can capture the anteroposterior distribution of CAA-related abnormalities; (3) shows similar neuroimaging and cognitive associations in comparison to other classical DTI markers, such as average mean diffusivity (MD) and fractional anisotropy (FA). Materials and methods We analyzed cross-sectional neuroimaging and neuropsychological data from 90 non-demented memory-clinic subjects from a single center. Based on MRI findings, we classified them into probable-CAA (those that fulfilled the modified Boston criteria), subjects with MRI markers of cSVD not attributable to CAA (presumed arteriolosclerosis; cSVD), and subjects without evidence of cSVD on MRI (non-cSVD). We compared total and lobe-specific (frontal and occipital) DTI metrics values across the groups. We used linear regression models to investigate how PSMD, MD, and FA correlate with conventional neuroimaging markers of cSVD and cognitive scores in CAA. Results PSMD was comparable in probable-CAA (median 4.06 × 10–4 mm2/s) and cSVD (4.07 × 10–4 mm2/s) patients, but higher than in non-cSVD (3.30 × 10–4 mm2/s; p < 0.001) subjects. Occipital-frontal PSMD gradients were higher in probable-CAA patients, and we observed a significant interaction between diagnosis and region on PSMD values [F(2, 87) = 3.887, p = 0.024]. PSMD was mainly associated with white matter hyperintensity volume, whereas MD and FA were also associated with other markers, especially with the burden of perivascular spaces. PSMD correlated with worse executive function (β = −0.581, p < 0.001) and processing speed (β = −0.463, p = 0.003), explaining more variance than other MRI markers. MD and FA were not associated with performance in any cognitive domain. Conclusion PSMD is a promising biomarker of cognitive impairment in CAA that outperforms other conventional and DTI-based neuroimaging markers. Although global PSMD is similarly increased in different forms of cSVD, PSMD’s spatial variations could potentially provide insights into the predominant type of underlying microvascular pathology.
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Affiliation(s)
- Maria Clara Zanon Zotin
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Center for Imaging Sciences and Medical Physics, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- *Correspondence: Maria Clara Zanon Zotin, ,
| | - Dorothee Schoemaker
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Nicolas Raposo
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | - Martin Bretzner
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neurosciences & Cognition, Lille, France
| | - Lukas Sveikata
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Qi Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Susanne J. van Veluw
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mitchell J. Horn
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mark R. Etherton
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Andreas Charidimou
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston University Medical Center, Boston, MA, United States
| | - M. Edip Gurol
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Steven M. Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Marco Duering
- Department of Biomedical Engineering, Medical Imaging Analysis Center (MIAC), University of Basel, Basel, Switzerland
| | - Antonio Carlos dos Santos
- Center for Imaging Sciences and Medical Physics, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Octavio M. Pontes-Neto
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Anand Viswanathan
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Yang J, Jing J, Chen S, Liu X, Tang Y, Pan C, Tang Z. Changes in Cerebral Blood Flow and Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage. Transl Stroke Res 2022; 13:686-706. [PMID: 35305264 DOI: 10.1007/s12975-022-00998-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
Abstract
Intracerebral hemorrhage (ICH) is a common subtype of stroke and places a great burden on the family and society with a high mortality and disability rate and a poor prognosis. Many findings from imaging and pathologic studies have suggested that cerebral ischemic lesions visualized on diffusion-weighted imaging (DWI) in patients with ICH are not rare and are generally considered to be associated with poor outcome, increased risk of recurrent (ischemic and hemorrhagic) stroke, cognitive impairment, and death. In this review, we describe the changes in cerebral blood flow (CBF) and DWI lesions after ICH and discuss the risk factors and possible mechanisms related to the occurrence of DWI lesions, such as cerebral microangiopathy, cerebral atherosclerosis, aggressive early blood pressure lowering, hyperglycemia, and inflammatory response. We also point out that a better understanding of cerebral DWI lesions will be a key step toward potential therapeutic interventions to improve long-term recovery for patients with ICH.
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Affiliation(s)
- Jingfei Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Jie Jing
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Xia Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Yingxin Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China.
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China.
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9
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Zhao H, Wen W, Cheng J, Jiang J, Kochan N, Niu H, Brodaty H, Sachdev P, Liu T. An accelerated degeneration of white matter microstructure and networks in the nondemented old-old. Cereb Cortex 2022; 33:4688-4698. [PMID: 36178117 DOI: 10.1093/cercor/bhac372] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/12/2022] Open
Abstract
The nondemented old-old over the age of 80 comprise a rapidly increasing population group; they can be regarded as exemplars of successful aging. However, our current understanding of successful aging in advanced age and its neural underpinnings is limited. In this study, we measured the microstructural and network-based topological properties of brain white matter using diffusion-weighted imaging scans of 419 community-dwelling nondemented older participants. The participants were further divided into 230 young-old (between 72 and 79, mean = 76.25 ± 2.00) and 219 old-old (between 80 and 92, mean = 83.98 ± 2.97). Results showed that white matter connectivity in microstructure and brain networks significantly declined with increased age and that the declined rates were faster in the old-old compared with young-old. Mediation models indicated that cognitive decline was in part through the age effect on the white matter connectivity in the old-old but not in the young-old. Machine learning predictive models further supported the crucial role of declines in white matter connectivity as a neural substrate of cognitive aging in the nondemented older population. Our findings shed new light on white matter connectivity in the nondemented aging brains and may contribute to uncovering the neural substrates of successful brain aging.
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Affiliation(s)
- Haichao Zhao
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of Psychiatry (CHeBA), University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jian Cheng
- School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of Psychiatry (CHeBA), University of New South Wales, Sydney, NSW, Australia
| | - Nicole Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry (CHeBA), University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Haijun Niu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry (CHeBA), University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry (CHeBA), University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Tao Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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10
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Freeze WM, Zanon Zotin MC, Scherlek AA, Perosa V, Auger CA, Warren AD, van der Weerd L, Schoemaker D, Horn MJ, Gurol ME, Gokcal E, Bacskai BJ, Viswanathan A, Greenberg SM, Reijmer YD, van Veluw SJ. Corpus callosum lesions are associated with worse cognitive performance in cerebral amyloid angiopathy. Brain Commun 2022; 4:fcac105. [PMID: 35611313 PMCID: PMC9123849 DOI: 10.1093/braincomms/fcac105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/20/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Abstract
The impact of vascular lesions on cognition is location dependent. Here, we assessed the contribution of small vessel disease lesions in the corpus callosum to vascular cognitive impairment in cerebral amyloid angiopathy, as a model for cerebral small vessel disease. Sixty-five patients with probable cerebral amyloid angiopathy underwent 3T magnetic resonance imaging, including a diffusion tensor imaging scan, and neuropsychological testing. Microstructural white-matter integrity was quantified by fractional anisotropy and mean diffusivity. Z-scores on individual neuropsychological tests were averaged into five cognitive domains: information processing speed, executive functioning, memory, language and visuospatial ability. Corpus callosum lesions were defined as haemorrhagic (microbleeds or larger bleeds) or ischaemic (microinfarcts, larger infarcts and diffuse fluid-attenuated inversion recovery hyperintensities). Associations between corpus callosum lesion presence, microstructural white-matter integrity and cognitive performance were examined with multiple regression models. The prevalence of corpus callosum lesions was confirmed in an independent cohort of memory clinic patients with and without cerebral amyloid angiopathy (n = 82). In parallel, we assessed corpus callosum lesions on ex vivo magnetic resonance imaging in cerebral amyloid angiopathy patients (n = 19) and controls (n = 5) and determined associated tissue abnormalities with histopathology. A total number of 21 corpus callosum lesions was found in 19/65 (29%) cerebral amyloid angiopathy patients. Corpus callosum lesion presence was associated with reduced microstructural white-matter integrity within the corpus callosum and in the whole-brain white matter. Patients with corpus callosum lesions performed significantly worse on all cognitive domains except language, compared with those without corpus callosum lesions after correcting for age, sex, education and time between magnetic resonance imaging and neuropsychological assessment. This association was independent of the presence of intracerebral haemorrhage, whole-brain fractional anisotropy and mean diffusivity, and white-matter hyperintensity volume and brain volume for the domains of information processing speed and executive functioning. In the memory clinic patient cohort, corpus callosum lesions were present in 14/54 (26%) patients with probable and 2/8 (25%) patients with possible cerebral amyloid angiopathy, and in 3/20 (15%) patients without cerebral amyloid angiopathy. In the ex vivo cohort, corpus callosum lesions were present in 10/19 (53%) patients and 2/5 (40%) controls. On histopathology, ischaemic corpus callosum lesions were associated with tissue loss and demyelination, which extended beyond the lesion core. Together, these data suggest that corpus callosum lesions are a frequent finding in cerebral amyloid angiopathy, and that they independently contribute to cognitive impairment through strategic microstructural disruption of white-matter tracts.
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Affiliation(s)
- Whitney M. Freeze
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neuropsychology and Psychiatry, Maastricht University, Maastricht, The Netherlands
| | - Maria Clara Zanon Zotin
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, USP, SP, Brazil
| | - Ashley A. Scherlek
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Valentina Perosa
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Corinne A. Auger
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Andrew D. Warren
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Louise van der Weerd
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Mitchell J. Horn
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - M. Edip Gurol
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Elif Gokcal
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Brian J. Bacskai
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Anand Viswanathan
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M. Greenberg
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Yael D. Reijmer
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Susanne J. van Veluw
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, MA 02129, USA
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11
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Poh L, Sim WL, Jo DG, Dinh QN, Drummond GR, Sobey CG, Chen CLH, Lai MKP, Fann DY, Arumugam TV. The role of inflammasomes in vascular cognitive impairment. Mol Neurodegener 2022; 17:4. [PMID: 35000611 PMCID: PMC8744307 DOI: 10.1186/s13024-021-00506-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/02/2021] [Indexed: 12/11/2022] Open
Abstract
There is an increasing prevalence of Vascular Cognitive Impairment (VCI) worldwide, and several studies have suggested that Chronic Cerebral Hypoperfusion (CCH) plays a critical role in disease onset and progression. However, there is a limited understanding of the underlying pathophysiology of VCI, especially in relation to CCH. Neuroinflammation is a significant contributor in the progression of VCI as increased systemic levels of the proinflammatory cytokine interleukin-1β (IL-1β) has been extensively reported in VCI patients. Recently it has been established that CCH can activate the inflammasome signaling pathways, involving NLRP3 and AIM2 inflammasomes that critically regulate IL-1β production. Given that neuroinflammation is an early event in VCI, it is important that we understand its molecular and cellular mechanisms to enable development of disease-modifying treatments to reduce the structural brain damage and cognitive deficits that are observed clinically in the elderly. Hence, this review aims to provide a comprehensive insight into the molecular and cellular mechanisms involved in the pathogenesis of CCH-induced inflammasome signaling in VCI.
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Affiliation(s)
- Luting Poh
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Liang Sim
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dong-Gyu Jo
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Quynh Nhu Dinh
- Centre for Cardiovascular Biology and Disease Research, Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, VIC Australia
| | - Grant R. Drummond
- Centre for Cardiovascular Biology and Disease Research, Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, VIC Australia
| | - Christopher G. Sobey
- Centre for Cardiovascular Biology and Disease Research, Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, VIC Australia
| | - Christopher Li-Hsian Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mitchell K. P. Lai
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David Y. Fann
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, National University Health System (NUHS), Singapore, Singapore
| | - Thiruma V. Arumugam
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
- Centre for Cardiovascular Biology and Disease Research, Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, VIC Australia
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12
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Luo X, Hong H, Wang S, Li K, Zeng Q, Hong L, Liu X, Li Z, Fu Y, Jiaerken Y, Xu X, Yu X, Huang P, Zhang M. Exploration of the Mechanism Underlying the Association of Incident Microinfarct and Motor Deficit: A Preliminary Functional MRI Study. J Alzheimers Dis 2021; 85:1545-1554. [PMID: 34958031 DOI: 10.3233/jad-215227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cerebral microinfarcts (CMIs) might cause measurable disruption to brain connections and are associated with cognitive decline, but the association between CMIs and motor impairment is still unclear. OBJECTIVE To assess the CMIs effect on motor function in vivo and explore the potential neuropathological mechanism based on graph-based network method. METHODS We identified 133 non-demented middle-aged and elderly participants who underwent MRI scanning, cognitive, and motor assessment. The short physical performance battery (SPPB) assessed motor function, including balance, walking speed, and chair stand. We grouped participants into 34 incident CMIs carriers and 99 non-CMIs carriers as controls, depending on diffusion-weighted imaging. Then we assessed the independent CMIs effects on motor function and explored neural mechanisms of CMIs on motor impairment via mapping of degree centrality (DC) and eigenvector centrality (EC). RESULTS CMIs carriers had worse motor function than non-carriers. Linear regression analyses showed that CMIs independently contributed to motor function. CMIs carriers had decreased EC in the precuneus, while increased DC and EC in the middle temporal gyrus and increased DC in the inferior frontal gyrus compared to controls (p < 0.05, corrected). Correlation analyses showed that EC of precuneus was related to SPPB (r = 0.25) and balance (r = 0.27); however, DC (r = -0.25) and EC (r = -0.25) of middle temporal gyrus was related with SPPB in all participants (p < 0.05, corrected). CONCLUSION CMIs represent an independent risk factor for motor dysfunction. The relationship between CMIs and motor function may be attributed to suppression of functional hub region and compensatory activation of motor-related regions.
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Affiliation(s)
- Xiao Luo
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Hong
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shuyue Wang
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kaicheng Li
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qingze Zeng
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Luwei Hong
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zheyu Li
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yanv Fu
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yeerfan Jiaerken
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - XiaoPei Xu
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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13
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Zou D, Zhu X. Acute intracerebral haemorrhage and diffusion-weighted imaging lesions: A meta-analysis. Int J Clin Pract 2021; 75:e14265. [PMID: 33887093 DOI: 10.1111/ijcp.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/14/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Diffusion-weighted imaging lesions in intracerebral haemorrhage are related to a higher risk of recurrent intracerebral haemorrhage, cognitive damage, and mortality. However, it has been reported that the relationship between the risk of diffusion-weighted imaging lesions and intracerebral haemorrhage subtype or the risk factors for diffusion-weighted imaging lesions is variable. This meta-analysis was performed to evaluate this relationship. METHODS A systematic literature search up-to August 2020 was performed and 12 studies included 2815 subjects at the baseline with intracerebral haemorrhage. They were reporting relationships between the diffusion-weighted imaging lesions and intracerebral haemorrhage subtype or investigated the risk factors for diffusion-weighted imaging lesions. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated to evaluate the prognostic role of diffusion-weighted imaging lesions and intracerebral haemorrhage subtype and investigated the risk factors for diffusion-weighted imaging lesions using the dichotomous and continuous method with a random or fixed-effect model. RESULTS Lobar intracerebral haemorrhage was not significantly related to a higher rate of diffusion-weighted imaging lesions (OR, 1.01; 95% CI, 0.75-1.36, P = .94) compared to the non-lobar intracerebral haemorrhage. Also, history of diabetes mellitus (OR, 1.15; 95% CI, 0.83-1.60, P = .39); history of smoking (OR, 0.95; 95% CI, 0.68-1.33, P = .76); history of hypercholesterolaemia (OR, 1.04; 95% CI, 0.73-1.48, P = .83) and history of ischaemic stroke (OR, 1.63; 95% CI, 0.57-4.66, P = .36) were not significantly related to higher rate of diffusion-weighted imaging lesions compared to no history of those factors. However, the history of hypertension was significantly related to a higher rate of diffusion-weighted imaging lesions (OR, 1.33; 95% CI, 1.04-1.70, P = .02) compared to no history of hypertension. Also, Subjects with diffusion-weighted imaging lesions had a greater decrease in systolic pressure in the acute phase of the intracerebral haemorrhage (OR, 10.23; 95% CI, 7.41-13.06, P < .001) compared to without diffusion-weighted imaging lesions. CONCLUSIONS Based on this meta-analysis, the history of hypertension may have an independent risk relationship with a higher rate of diffusion-weighted imaging lesions. Also, subjects with diffusion-weighted imaging lesions had a greater decrease in systolic pressure in the acute phase of the intracerebral haemorrhage compared to those without diffusion-weighted imaging lesions. This relationship forces us to recommend that identification of diffusion-weighted imaging lesions might add appreciated evidence to evaluate the progression of the underlying micro-angiopathy especially in subjects with a history of hypertension. Though further studies are needed to define the mechanisms by which these lesions may lead to cognitive damage and stroke reappearance.
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Affiliation(s)
- Dianjun Zou
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Xiaolong Zhu
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
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14
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Fotiadis P, Pasi M, Charidimou A, Warren AD, Schwab KM, Rosand J, van der Grond J, van Buchem MA, Viswanathan A, Gurol ME, Greenberg SM. Decreased Basal Ganglia Volume in Cerebral Amyloid Angiopathy. J Stroke 2021; 23:223-233. [PMID: 34102757 PMCID: PMC8189850 DOI: 10.5853/jos.2020.04280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose Cerebral amyloid angiopathy (CAA) is a common pathology of the leptomeningeal and cortical small vessels associated with hemorrhagic and non-hemorrhagic brain injury. Given previous evidence for CAA-related loss of cortical thickness and white matter volume, we hypothesized that CAA might also cause tissue loss in the basal ganglia.
Methods We compared basal ganglia volumes expressed as a percentage of total intracranial volume (pBGV) of non-demented patients with sporadic and hereditary CAA to age-matched healthy control (HC) and Alzheimer’s disease (AD) cohorts.
Results Patients with sporadic CAA had lower pBGV (n=80, 1.16%±0.14%) compared to HC (n=80, 1.30%±0.13%, P<0.0001) and AD patients (n=80, 1.23%±0.11%, P=0.001). Similarly, patients with hereditary CAA demonstrated lower pBGV (n=25, 1.26%±0.17%) compared to their matched HC (n=25, 1.36%±0.15%, P=0.036). Using a measurement of normalized basal ganglia width developed for analysis of clinical-grade magnetic resonance images, we found smaller basal ganglia width in patients with CAA-related lobar intracerebral hemorrhage (ICH; n=93, 12.35±1.47) compared to age-matched patients with hypertension-related deep ICH (n=93, 13.46±1.51, P<0.0001) or HC (n=93, 15.45±1.22, P<0.0001). Within the sporadic CAA research cohort, decreased basal ganglia volume was independently correlated with greater cortical gray matter atrophy (r=0.45, P<0.0001), increased basal ganglia fractional anisotropy (r=–0.36, P=0.001), and worse performance on language processing (r=0.35, P=0.003), but not with cognitive tests of executive function or processing speed.
Conclusions These findings suggest an independent effect of CAA on basal ganglia tissue loss, indicating a novel mechanism for CAA-related brain injury and neurologic dysfunction.
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Affiliation(s)
- Panagiotis Fotiadis
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marco Pasi
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Stroke Unit, Department of Neurology, University of Lille, INSERM U1171, CHU Lille, Lille, France
| | - Andreas Charidimou
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew D Warren
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M Schwab
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jonathan Rosand
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anand Viswanathan
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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15
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Hong H, Yu X, Zhang R, Jiaerken Y, Wang S, Luo X, Lou M, Huang P, Zhang M. Cortical degeneration detected by neurite orientation dispersion and density imaging in chronic lacunar infarcts. Quant Imaging Med Surg 2021; 11:2114-2124. [PMID: 33936992 DOI: 10.21037/qims-20-880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Although lacunar infarcts are focal lesions, they may also have more widespread effects. A reduction in cortical thickness in the remote cortex after lacunar infarcts has been detected by structural imaging; however, its underlying microstructural changes are yet to be elucidated. This study aimed to investigate the effects of lacunar infarcts on the microstructural abnormalities associated with cortical thickness reduction in the remote cortex. Methods Thirty-seven patients with chronic lacunar infarcts were included. Brain structural magnetic resonance images (MRIs) and diffusion tensor images were acquired. We constructed the white matter tracts connecting with the lacunar infarcts and identified the connected cortical area based on a standard brain atlas warped into the subject space. Cortical thickness and microstructural neurite orientation dispersion and density imaging (NODDI) metrics of the ipsilesional and contralesional cortices were compared, and correlations between cortical thickness and NODDI metrics were also investigated. Results We found decreased cortical thickness and reduced neurite orientation dispersion index (ODI) in the ipsilesional cortex (2.47 vs. 2.50 mm, P=0.008; 0.451 vs. 0.456, P=0.035, respectively). In patients with precentral gyrus involvement (n=23), we found that ODI in the ipsilesional cortex was correlated with cortical thickness (r=0.437, P=0.037), and ODI in the contralesional cortex was also correlated with contralesional cortical thickness (r=0.440, P=0.036). Conclusions NODDI metrics could reflect cortical microstructural changes following lacunar infarcts. The correlation between decreased ODI and reduced cortical thickness suggests that dendrites' loss might contribute to lacunar infarct-related cortical atrophy.
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Affiliation(s)
- Hui Hong
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ruiting Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yeerfan Jiaerken
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shuyue Wang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiao Luo
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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16
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Xu X, Ni Kan C, Li-Hsian Chen C, Hilal S. Long-term neurobehavioral correlates of brain cortical microinfarcts in a memory clinic cohort in Singapore. Int J Stroke 2021; 17:218-225. [PMID: 33724091 DOI: 10.1177/17474930211006294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cortical cerebral microinfarcts are a small vessel disease biomarker underlying cognitive impairment and dementia. However, it is unknown whether cortical cerebral microinfarcts are associated with neuropsychiatric disturbances, and whether its effects are independent of conventional small vessel disease markers. AIMS We investigated the associations of cortical cerebral microinfarcts burden with incidence and progression of neuropsychiatric subsyndromes in a memory clinic cohort of elderly in Singapore. METHODS In this prospective cohort, 496 subjects underwent detailed neuropsychological and clinical assessments, 3T brain MRI, and Neuropsychiatric Inventory assessment at baseline and two years later. Cortical cerebral microinfarcts and other small vessel disease markers, including white matter hyperintensities, lacunes, and microbleeds, were graded according to established criteria. Neuropsychiatric symptoms (NPS) were clustered into subsyndromes of hyperactivity, psychosis, affective, and apathy following prior findings. Functional decline was determined using the clinical dementia rating (CDR) scale. RESULTS The presence of multiple cortical cerebral microinfarcts (≥2) was associated with higher total NPS scores (β = 4.19, 95% CI = 2.81-5.58, p < 0.001), particularly hyperactivity (β = 2.01, 95% CI = 1.30-2.71, p < 0.01) and apathy (β = 1.42, 95% CI = 0.65-2.18, p < 0.01) at baseline. Between baseline and year-2, multiple cortical cerebral microinfarcts were associated with accelerated progression in total NPS scores (β = 0.29, 95% CI = 0.06-0.53, p = 0.015), driven by hyperactivity (β = 0.45, 95% CI = 0.17-0.72, p < 0.01). Subjects with multiple cortical cerebral microinfarcts also had a faster functional decline, as measured with the CDR-sum-of-boxes scores, when accompanied with progression (β = 0.31, 95% CI = 0.11-0.51, p < 0.01) or hyperactivity in total NPS (β = 0.34, 95% CI = 0.13-0.56, p < 0.01). CONCLUSION Cortical cerebral microinfarcts are associated with incidence and progression of geriatric neurobehavioral disturbances, independent of conventional small vessel disease markers. The impact of incident cortical cerebral microinfarcts on neurocognitive and neuropsychiatric trajectories warrants further investigations.
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Affiliation(s)
- Xin Xu
- The Second Affiliated Hospital and School of Public Health, 12377Zhejiang University School of Medicine, Zhejiang, China.,Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore
| | - Cheuk Ni Kan
- Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore
| | - Christopher Li-Hsian Chen
- Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore
| | - Saima Hilal
- Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, 37580National University of Singapore, Singapore and National University Health System, Singapore
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17
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The relation between acute intracerebral hemorrhage and diffusion-weighted imaging lesions: a meta-analysis. J Thromb Thrombolysis 2021; 52:962-970. [PMID: 33783661 DOI: 10.1007/s11239-021-02430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
Diffusion-weighted imaging lesions in intracerebral hemorrhage are related to a higher risk of recurrent intracerebral hemorrhage, cognitive damage, and mortality. However, it has been reported that the relationship between the risk of diffusion-weighted imaging lesions and intracerebral hemorrhage subtype or the possible risk factors for diffusion-weighted imaging lesions is variable. This meta-analysis was performed to evaluate this relationship. A systematic literature search up-to August 2020 was performed and 12 studies included 2815 subjects at the baseline with intracerebral hemorrhage. Odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs) was calculated to evaluate the prognostic role of diffusion-weighted imaging lesions and intracerebral hemorrhage subtype and investigated the possible risk factors for diffusion-weighted imaging lesions using the dichotomous and continuous methods with a random or fixed-effect model. Lobar intracerebral hemorrhage was not significantly related to a higher rate of diffusion-weighted imaging lesions (OR, 1.01; 95% CI, 0.75-1.36, p = 0.94) compared to the non-lobar intracerebral hemorrhage. Also, history of diabetes mellitus (OR, 1.15; 95% CI, 0.83-1.60, p = 0.39); history of smoking (OR, 0.95; 95% CI, 0.68-1.33, p = 0.76); history of hypercholesterolemia (OR, 1.04; 95% CI, 0.73-1.48, p = 0.83); and history of ischemic stroke (OR, 1.63; 95% CI, 0.57-4.66, p = 0.36) were not significantly related to higher rate of diffusion-weighted imaging lesions compared to no history of those factors. However, the history of hypertension was significantly related to a higher rate of diffusion-weighted imaging lesions (OR, 1.33; 95% CI, 1.04-1.70, p = 0.02) compared to no history of hypertension. Also, Subjects with diffusion-weighted imaging lesions had a greater decrease in systolic pressure in the acute phase of the intracerebral hemorrhage (MD, 10.23; 95% CI, 7.41-13.06, p < 0.001) compared to without diffusion-weighted imaging lesions. Based on this meta-analysis, the history of hypertension may have an independent risk relationship with a higher rate of diffusion-weighted imaging lesions. Also, subjects with diffusion-weighted imaging lesions had a greater decrease in systolic pressure in the acute phase of the intracerebral hemorrhage compared to those without diffusion-weighted imaging lesions. This relationship forces us to recommend that identification of diffusion-weighted imaging lesions might add appreciated evidence to evaluate the progression of the underlying micro-angiopathy especially in subjects with a history of hypertension. Though further studies are needed to define the mechanisms by which these lesions may lead to cognitive damage and stroke reappearance.
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18
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Saleh Y, Le Heron C, Petitet P, Veldsman M, Drew D, Plant O, Schulz U, Sen A, Rothwell PM, Manohar S, Husain M. Apathy in small vessel cerebrovascular disease is associated with deficits in effort-based decision making. Brain 2021; 144:1247-1262. [PMID: 33734344 PMCID: PMC8240747 DOI: 10.1093/brain/awab013] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 11/16/2022] Open
Abstract
Patients with small vessel cerebrovascular disease frequently suffer from apathy, a debilitating neuropsychiatric syndrome, the underlying mechanisms of which remain to be established. Here we investigated the hypothesis that apathy is associated with disrupted decision making in effort-based decision making, and that these alterations are associated with abnormalities in the white matter network connecting brain regions that underpin such decisions. Eighty-two patients with MRI evidence of small vessel disease were assessed using a behavioural paradigm as well as diffusion weighted MRI. The decision-making task involved accepting or rejecting monetary rewards in return for performing different levels of physical effort (hand grip force). Choice data and reaction times were integrated into a drift diffusion model that framed decisions to accept or reject offers as stochastic processes approaching a decision boundary with a particular drift rate. Tract-based spatial statistics were used to assess the relationship between white matter tract integrity and apathy, while accounting for depression. Overall, patients with apathy accepted significantly fewer offers on this decision-making task. Notably, while apathetic patients were less responsive to low rewards, they were also significantly averse to investing in high effort. Significant reductions in white matter integrity were observed to be specifically related to apathy, but not to depression. These included pathways connecting brain regions previously implicated in effort-based decision making in healthy people. The drift rate to decision parameter was significantly associated with both apathy and altered white matter tracts, suggesting that both brain and behavioural changes in apathy are associated with this single parameter. On the other hand, depression was associated with an increase in the decision boundary, consistent with an increase in the amount of evidence required prior to making a decision. These findings demonstrate altered effort-based decision making for reward in apathy, and also highlight dissociable mechanisms underlying apathy and depression in small vessel disease. They provide clear potential brain and behavioural targets for future therapeutic interventions, as well as modelling parameters that can be used to measure the effects of treatment at the behavioural level.
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Affiliation(s)
- Youssuf Saleh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - Campbell Le Heron
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,New Zealand Brain Research Institute, Christchurch 8011, New Zealand.,Department of Medicine, University of Otago, Christchurch 8011, New Zealand
| | - Pierre Petitet
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - Michele Veldsman
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - Daniel Drew
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - Olivia Plant
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - Ursula Schulz
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Dept Clinical Neurosciences, University of Oxford, UK
| | - Sanjay Manohar
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging, University of Oxford, UK
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19
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Ter Telgte A, Wiegertjes K, Gesierich B, Baskaran BS, Marques JP, Kuijf HJ, Norris DG, Tuladhar AM, Duering M, de Leeuw FE. Temporal Dynamics of Cortical Microinfarcts in Cerebral Small Vessel Disease. JAMA Neurol 2021; 77:643-647. [PMID: 32065609 DOI: 10.1001/jamaneurol.2019.5106] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Importance Neuropathology studies show a high prevalence of cortical microinfarcts (CMIs) in aging individuals, especially in patients with cerebrovascular disease and dementia. However, most, are invisible on T1- and T2-weighted magnetic resonance imaging (MRI), raising the question of how to explain this mismatch. Studies on small acute infarcts, detected on diffusion-weighted imaging (DWI), suggest that infarcts are largest in their acute phase and reduce in size thereafter. Therefore, we hypothesized that a subset of the CMI that are invisible on MRI can be detected on MRI in their acute phase. However, to our knowledge, a serial imaging study investigating the temporal dynamics of acute CMI (A-CMI) is lacking. Objective To determine the prevalence of chronic CMI (C-CMI) and the cumulative incidence and temporal dynamics of A-CMI in individuals with cerebral small vessel disease (SVD). Design, Setting, Participants and Exposures The RUN DMC-Intense study is a single-center hospital-based prospective cohort study on SVD performed between March 2016 and November 2017 and comprising 10 monthly 3-T MRI scans, including high-resolution DWI, 3-dimensional T1, 3-dimensional fluid-attenuated inversion recovery, and T2. One hundred six individuals from the previous longitudinal RUN DMC study were recruited based on the presence of progression of white matter hyperintensities on MRI between 2006 and 2015 and exclusion of causes of cerebral ischemia other than SVD. Fifty-four individuals (50.9%) participated. The median total follow-up duration was 39.5 weeks (interquartile range, 37.8-40.3). Statistical data analysis was performed between May and October 2019. Main Outcomes and Measures We determined the prevalence of C-CMI using the baseline T1, fluid-attenuated inversion recovery, and T2 scans. Monthly high-resolution DWI scans (n = 472) were screened to determine the cumulative incidence of A-CMI. The temporal dynamics of A-CMI were determined based on the MRI scans collected during the first follow-up visit after A-CMI onset and the last available follow-up visit. Results The median age of the cohort at baseline MRI was 69 years (interquartile range, 66-74 years) and 34 participants (63%) were men. The prevalence of C-CMI was 35% (95% CI, 0.24-0.49). Monthly DWI detected 21 A-CMI in 7 of 54 participants, resulting in a cumulative incidence of 13% (95% CI, 0.06-0.24). All A-CMI disappeared on follow-up MRI. Conclusions and Relevance Acute CMI never evolved into chronically MRI-detectable lesions. We suggest that these A-CMI underlie part of the submillimeter C-CMI encountered on neuropathological examination and thereby provide a source for the high CMI burden on neuropathology.
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Affiliation(s)
- Annemieke Ter Telgte
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kim Wiegertjes
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Benno Gesierich
- Institute for Stroke and Dementia Research (ISD), University Hospital LMU Munich, Munich, Germany
| | - Brendon Sri Baskaran
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - José P Marques
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marco Duering
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands.,Institute for Stroke and Dementia Research (ISD), University Hospital LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
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20
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Lee YH, Lee WJ, Chung SJ, Yoo HS, Jung JH, Baik K, Sohn YH, Seong JK, Lee PH. Microstructural Connectivity is More Related to Cognition than Conventional MRI in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:239-249. [PMID: 33074193 DOI: 10.3233/jpd-202312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The different effects of white matter hyperintensity (WMH) severity and WMH-associated microstructural connectivity on cognition in the early stages of Parkinson's disease (PD) have not been investigated. OBJECTIVE To investigate the differential effect of WMH severity and WMH-associated microstructural connectivity on cognition in early stages of PD. METHODS A total of 136 de novo PD patients were enrolled and divided into groups based on total WMH visual rating scores as follows: mild, moderate, and severe. Microstructural connectivity was measured using graph theoretical analysis according to WMH severity. Additionally, correlation coefficients between WMH-associated microstructural connectivity or WMH scores and cognitive performance were assessed. RESULTS Patients with severe WMHs demonstrated poorer performance in language function than those with moderate WMHs, and in frontal/executive and visual memory function than those with mild WMHs. Areas of microstructural connectivity were more extensive in patients with severe WMHs compared to those with mild and moderate WMHs, involving frontal and parieto-temporal regions. WMH-associated right fronto-temporo-parietal microstructural disintegration was correlated with cognitive dysfunction in attention, frontal/executive, and memory domains, whereas there was no correlation between WMH scores and any cognitive domains. CONCLUSION These data suggest that disruption of microstructural networks by WMHs, rather than WMH burden itself, contributed more to cognitive impairment in PD.
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Affiliation(s)
- Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Wha Jin Lee
- School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, South Korea.,Department of Artificial Intelligence, Korea University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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21
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Cerebral micro-infarcts; the hidden missing link to vascular cognitive decline. J Neurol Sci 2020; 420:117171. [PMID: 33268082 DOI: 10.1016/j.jns.2020.117171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
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22
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Kraushar D, Molad J, Hallevi H, Bornstein NM, Ben-Assayag E, Auriel E. Cerebral microinfarcts disruption of remote cortical thickness. J Neurol Sci 2020; 420:117170. [PMID: 33032831 DOI: 10.1016/j.jns.2020.117170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/13/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cerebral microinfarcts (CMI) are common lesions, carrying an important contribution to small-vessel-related cognitive impairment. CMIs were previously found to cause local microstructural damage and disruption of white matter integrity. This study examines CMIs influence on cortical thickness in remote brain areas. METHODS Six small silent diffuse weighted imaging (DWI) lesions corresponding to subacute CMI were identified among five patients who underwent baseline and follow-up MRI scans from the Tel-Aviv Acute Brain Stroke Cohort (TABASCO). Regions of interest (ROIs) corresponding to the site of the DWI lesions and of the non-lesioned contralateral hemisphere (control ROI) were co-registered. DTI tractography was additionally performed to reconstruct the white matter tracts containing the ROIs. The normalized cortical thickness was calculated for the DWI lesional tract as well as for the contralateral non-lesional tract, and the lesion-to-control cortical thickness ratio (CTR) was calculated. RESULTS Post-lesional scans, performed 25.1 ± 1.2 months after CMI detection, demonstrated reduced mean CTR within the ROI from 1.8 to 1.1 (p = 0.032). There was no difference between the CTR of the right hemisphere relative to those on the left hemisphere, or between the CTR change of the cortical and non-cortical CMI. DISCUSSION This study demonstrated the prolonged influence of CMI on cortical thickness in remote ROI. The total number of CMIs is difficult to determine, however it has been shown that detecting even a single CMI suggests the existence of hundreds to thousands lesions. Therefore, the cumulative impact of these widely distributed lesions on cerebral cortex may have a significant contribution to the development of vascular cognitive impairment.
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Affiliation(s)
- D Kraushar
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - J Molad
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - H Hallevi
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - N M Bornstein
- Department of Neurology, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - E Ben-Assayag
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - E Auriel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Neurology, Rabin Medical Center, Petah-Tikva, Israel.
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Liu JY, Zhou YJ, Zhai FF, Han F, Zhou LX, Ni J, Yao M, Zhang S, Jin Z, Cui L, Zhu YC. Cerebral Microbleeds Are Associated with Loss of White Matter Integrity. AJNR Am J Neuroradiol 2020; 41:1397-1404. [PMID: 32719091 DOI: 10.3174/ajnr.a6622] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/01/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have shown that diffusion tensor imaging suggests a diffuse loss of white matter integrity in people with white matter hyperintensities or lacunes. The purpose of this study was to investigate whether the presence of cerebral microbleeds and their distribution are related to the integrity of white matter microstructures. MATERIALS AND METHODS The study comprised 982 participants who underwent brain MR imaging to determine microbleed status. The cross-sectional relation between microbleeds and the microstructural integrity of the white matter was assessed by 2 statistical methods: a multilinear regression model based on the average DTI parameters of normal-appearing white matter and Tract-Based Spatial Statistics analysis, a tract-based voxelwise analysis. Fiber tractography was used to spatially describe the microstructural abnormalities along WM tracts containing a cerebral microbleed. RESULTS The presence of cerebral microbleeds was associated with lower mean fractional anisotropy and higher mean diffusivity, axial diffusivity, and radial diffusivity, and the association remained when cardiovascular risk factors and cerebral small-vessel disease markers were further adjusted. Tract-Based Spatial Statistics analysis indicated strictly lobar cerebral microbleeds associated with lower fractional anisotropy, higher mean diffusivity, and higher radial diffusivity in the internal capsule and corpus callosum after adjusting other cerebral small-vessel disease markers, while only a few voxels remained associated with deep cerebral microbleeds. Diffusion abnormalities gradients along WM tracts containing a cerebral microbleed were not found in fiber tractography analysis. CONCLUSIONS Cerebral microbleeds are associated with widely distributed changes in white matter, despite their focal appearance on SWI.
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Affiliation(s)
- J-Y Liu
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Y-J Zhou
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - F-F Zhai
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - F Han
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - L-X Zhou
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - J Ni
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - M Yao
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - S Zhang
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Z Jin
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - L Cui
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Y-C Zhu
- From the Departments of Neurology (J.-Y.L., Y.-J.Z., F.-F.Z., F.H., L.-X.Z., J.N., M.Y., L.C., Y.-C.Z.), Radiology (Z.J.), and Cardiology (S.Z.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
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Kamran S, Khan A, Salam A, Akhtar N, Petropoulos I, Ponirakis G, Babu B, George P, Shuaib A, Malik RA. Cornea: A Window to White Matter Changes in Stroke; Corneal Confocal Microscopy a Surrogate Marker for the Presence and Severity of White Matter Hyperintensities in Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104543. [PMID: 31902645 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/14/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The presence of white matter hyperintensities (WMH) on MRI imaging confers an increased risk of stroke, dementia, and death. Corneal confocal microscopy (CCM) can detect nerve injury non-invasively and may be a useful surrogate marker for WMH. The objective is to determine whether corneal nerve pathology identified using CCM is associated with the presence of WMH in patients with acute ischemic stroke. METHODS This is a cross-sectional study where 196 consecutive individuals with acute ischemic stroke were enrolled and underwent neurological examination, MRI brain imaging and CCM. Participants underwent blinded quantification of WMH and corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL). RESULTS The prevalence of hypertension [P = .013] was significantly higher and CNFD [P = .031] was significantly lower in patients with WMH compared to those without WMH. CNFD and CNFL were significantly lower in patients with DM without WMH [P = .008, P = .019] and in patients with DM and WMH [P = .042, P = .024] compared to patients without DM or WMH, respectively. In a multivariate model, a 1-unit decrease in the CNFD increased the risk of WMH by 6%, after adjusting for age, DM, gender, dyslipidemia, metabolic syndrome, smoking, and HbA1c. DM was associated with a decrease in all CCM parameters but was not a significant independent factor associated with WMH. CONCLUSIONS CCM demonstrates corneal nerve pathology, which is associated with the presence of WMH in participants with acute ischemic stroke. CCM may be a useful surrogate imaging marker for the presence and severity of WMHs.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.
| | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Abdul Salam
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Blessy Babu
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Pooja George
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
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25
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Gurol ME, Biessels GJ, Polimeni JR. Advanced Neuroimaging to Unravel Mechanisms of Cerebral Small Vessel Diseases. Stroke 2019; 51:29-37. [PMID: 31752614 DOI: 10.1161/strokeaha.119.024149] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- M Edip Gurol
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.E.G.)
| | - Geert J Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands (G.J.B.)
| | - Jonathan R Polimeni
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (J.R.P.).,Department of Radiology, Harvard Medical School, Boston, MA (J.R.P.).,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA (J.P.R.)
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26
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Wiegertjes K, Ter Telgte A, Oliveira PB, van Leijsen EMC, Bergkamp MI, van Uden IWM, Ghafoorian M, van der Holst HM, Norris DG, Platel B, Klijn CJM, Tuladhar AM, de Leeuw FE. The role of small diffusion-weighted imaging lesions in cerebral small vessel disease. Neurology 2019; 93:e1627-e1634. [PMID: 31530710 DOI: 10.1212/wnl.0000000000008364] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/22/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of asymptomatic diffusion-weighted imaging-positive (DWI+) lesions in individuals with cerebral small vessel disease (SVD) and identify their role in the origin of SVD markers on MRI. METHODS We included 503 individuals with SVD from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) study (mean age 65.6 years [SD 8.8], 56.5% male) with 1.5T MRI in 2006 and, if available, follow-up MRI in 2011 and 2015. We screened DWI scans (n = 1,152) for DWI+ lesions, assessed lesion evolution on follow-up fluid-attenuated inversion recovery, T1 and T2* images, and examined the association between DWI+ lesions and annual SVD progression (white matter hyperintensities [WMH], lacunes, microbleeds). RESULTS We found 50 DWI+ lesions in 39 individuals on 1,152 DWI (3.4%). Individuals with DWI+ lesions were older (p = 0.025), more frequently had a history of hypertension (p = 0.021), and had a larger burden of preexisting SVD MRI markers (WMH, lacunes, microbleeds: all p < 0.001) compared to individuals without DWI+ lesions. Of the 23 DWI+ lesions with available follow-up MRI, 14 (61%) evolved into a WMH, 8 (35%) resulted in a cavity, and 1 (4%) was no longer visible. Presence of DWI+ lesions was significantly associated with annual WMH volume increase and yearly incidence of lacunes and microbleeds (all p < 0.001). CONCLUSION Over 3% of individuals with SVD have DWI+ lesions. Although DWI+ lesions play a role in the progression of SVD, they may not fully explain progression of SVD markers on MRI, suggesting that other factors than acute ischemia are at play.
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Affiliation(s)
- Kim Wiegertjes
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Annemieke Ter Telgte
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Pedro B Oliveira
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Esther M C van Leijsen
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Mayra I Bergkamp
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Ingeborg W M van Uden
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Mohsen Ghafoorian
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Helena M van der Holst
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - David G Norris
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Bram Platel
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Catharina J M Klijn
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands.
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Xiong L, van Veluw SJ, Bounemia N, Charidimou A, Pasi M, Boulouis G, Reijmer YD, Giese AK, Davidsdottir S, Fotiadis P, Valenti R, Riley G, Schwab K, Gurol EM, Biffi A, Greenberg SM, Viswanathan A. Cerebral Cortical Microinfarcts on Magnetic Resonance Imaging and Their Association With Cognition in Cerebral Amyloid Angiopathy. Stroke 2019; 49:2330-2336. [PMID: 30355109 DOI: 10.1161/strokeaha.118.022280] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to explore the association between presence of cerebral cortical microinfarcts (CMIs) on magnetic resonance imaging and other small-vessel disease neuroimaging biomarkers in cerebral amyloid angiopathy (CAA) and to analyze the role of CMIs on individual cognitive domains and dementia conversion. Methods- Participants were recruited from an ongoing longitudinal research cohort of eligible CAA patients between March 2006 and October 2016. A total of 102 cases were included in the analysis that assessed the relationship of cortical CMIs to CAA neuroimaging markers. Ninety-five subjects had neuropsychological tests conducted within 1 month of magnetic resonance imaging scanning. Seventy-five nondemented CAA patients had cognitive evaluation data available during follow-up. Results- Among 102 patients enrolled, 40 patients had CMIs (39%) on magnetic resonance imaging. CMIs were uniformly distributed throughout the cortex without regional predilection ( P=0.971). The presence of CMIs was associated with lower total brain volume (odds ratio, 0.85; 95% CI, 0.74-0.98; P=0.025) and presence of cortical superficial siderosis (odds ratio, 2.66; 95% CI, 1.10-6.39; P=0.029). In 95 subjects with neuropsychological tests, presence of CMIs was associated with impaired executive function (β, -0.23; 95% CI, -0.44 to -0.02; P=0.036) and processing speed (β, -0.24; 95% CI, -0.45 to -0.04; P=0.020). Patients with CMIs had a higher cumulative dementia incidence compared with patients without CMIs ( P=0.043), whereas only baseline total brain volume (hazard ratio, 0.76; 95% CI, 0.62-0.92; P=0.006) independently predicted dementia conversion. Conclusions- Magnetic resonance imaging-detected CMIs in CAA correlated with greater overall disease burden. The presence of CMIs was associated with worse cognitive performance, whereas only total brain atrophy independently predicted dementia conversion.
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Affiliation(s)
- Li Xiong
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Susanne J van Veluw
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Narimene Bounemia
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Andreas Charidimou
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Marco Pasi
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Gregoire Boulouis
- Centre Hospitalier Sainte-Anne, Université Paris Descartes, France (G.B.)
| | - Yael D Reijmer
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (Y.D.R.)
| | - Anne-Katrin Giese
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Sigurros Davidsdottir
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (S.D.)
| | - Panagiotis Fotiadis
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Raffaella Valenti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Italy (R.V.)
| | - Grace Riley
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Kristin Schwab
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Edip M Gurol
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Alessandro Biffi
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Steven M Greenberg
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Anand Viswanathan
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
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Ter Telgte A, van Leijsen EMC, Wiegertjes K, Klijn CJM, Tuladhar AM, de Leeuw FE. Cerebral small vessel disease: from a focal to a global perspective. Nat Rev Neurol 2019; 14:387-398. [PMID: 29802354 DOI: 10.1038/s41582-018-0014-y] [Citation(s) in RCA: 300] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cerebral small vessel disease (SVD) is commonly observed on neuroimaging among elderly individuals and is recognized as a major vascular contributor to dementia, cognitive decline, gait impairment, mood disturbance and stroke. However, clinical symptoms are often highly inconsistent in nature and severity among patients with similar degrees of SVD on brain imaging. Here, we provide a new framework based on new advances in structural and functional neuroimaging that aims to explain the remarkable clinical variation in SVD. First, we discuss the heterogeneous pathology present in SVD lesions despite an identical appearance on imaging and the perilesional and remote effects of these lesions. We review effects of SVD on structural and functional connectivity in the brain, and we discuss how network disruption by SVD can lead to clinical deficits. We address reserve and compensatory mechanisms in SVD and discuss the part played by other age-related pathologies. Finally, we conclude that SVD should be considered a global rather than a focal disease, as the classically recognized focal lesions affect remote brain structures and structural and functional network connections. The large variability in clinical symptoms among patients with SVD can probably be understood by taking into account the heterogeneity of SVD lesions, the effects of SVD beyond the focal lesions, the contribution of neurodegenerative pathologies other than SVD, and the interaction with reserve mechanisms and compensatory mechanisms.
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Affiliation(s)
- Annemieke Ter Telgte
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Esther M C van Leijsen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands.
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Ferro D, Heinen R, de Brito Robalo B, Kuijf H, Biessels GJ, Reijmer Y. Cortical Microinfarcts and White Matter Connectivity in Memory Clinic Patients. Front Neurol 2019; 10:571. [PMID: 31231301 PMCID: PMC6560058 DOI: 10.3389/fneur.2019.00571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/15/2019] [Indexed: 02/04/2023] Open
Abstract
Background and purpose: Cerebral microinfarcts (CMIs) are associated with cognitive impairment and dementia. CMIs might affect cognitive performance through disruption of cerebral networks. We investigated in memory clinic patients whether cortical CMIs are clustered in specific brain regions and if presence of cortical CMIs is associated with reduced white matter (WM) connectivity in tracts projecting to these regions. Methods:164 memory clinic patients with vascular brain injury with a mean age of 72 ± 11 years (54% male) were included. All underwent 3 tesla MRI, including a diffusion MRI and cognitive testing. Cortical CMIs were rated according to established criteria and their spatial location was marked. Diffusion imaging-based tractography was used to reconstruct WM connections and voxel based analysis (VBA) to assess integrity of WM directly below the cortex. WM connectivity and integrity were compared between patients with and without cortical CMIs for the whole brain and regions with a high CMI burden. Results:30 patients (18%) had at least 1 cortical CMI [range 1–46]. More than 70% of the cortical CMIs were located in the superior frontal, middle frontal, and pre- and postcentral brain regions (covering 16% of the cortical surface). In these high CMI burden regions, presence of cortical CMIs was not associated with WM connectivity after correction for conventional neuroimaging markers of vascular injury. WM connectivity in the whole brain and WM voxels directly underneath the cortical surface did not differ between patients with and without cortical CMIs. Conclusion:Cortical CMIs displayed a strong local clustering in highly interconnected frontal, pre- and postcentral brain regions. Nevertheless, WM connections projecting to these regions were not disproportionally impaired in patients with compared to patients without cortical CMIs. Alternative mechanisms, such as focal disturbances in cortical structure and functioning, may better explain CMI associated cognitive impairment.
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Affiliation(s)
- Doeschka Ferro
- Brain Center, University Medical Center Utrecht, Department of Neurology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Rutger Heinen
- Brain Center, University Medical Center Utrecht, Department of Neurology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Bruno de Brito Robalo
- Brain Center, University Medical Center Utrecht, Department of Neurology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Hugo Kuijf
- Image Sciences Institute, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Geert Jan Biessels
- Brain Center, University Medical Center Utrecht, Department of Neurology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Yael Reijmer
- Brain Center, University Medical Center Utrecht, Department of Neurology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
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Regenhardt RW, Das AS, Ohtomo R, Lo EH, Ayata C, Gurol ME. Pathophysiology of Lacunar Stroke: History's Mysteries and Modern Interpretations. J Stroke Cerebrovasc Dis 2019; 28:2079-2097. [PMID: 31151839 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/13/2019] [Accepted: 05/04/2019] [Indexed: 01/13/2023] Open
Abstract
Since the term "lacune" was adopted in the 1800s to describe infarctions from cerebral small vessels, their underlying pathophysiological basis remained obscure until the 1960s when Charles Miller Fisher performed several autopsy studies of stroke patients. He observed that the vessels displayed segmental arteriolar disorganization that was associated with vessel enlargement, hemorrhage, and fibrinoid deposition. He coined the term "lipohyalinosis" to describe the microvascular mechanism that engenders small subcortical infarcts in the absence of a compelling embolic source. Since Fisher's early descriptions of lipohyalinosis and lacunar stroke (LS), there have been many advancements in the understanding of this disease process. Herein, we review lipohyalinosis as it relates to modern concepts of cerebral small vessel disease (cSVD). We discuss clinical classifications of LS as well as radiographic definitions based on modern neuroimaging techniques. We provide a broad and comprehensive overview of LS pathophysiology both at the vessel and parenchymal levels. We also comment on the role of biomarkers, the possibility of systemic disease processes, and advancements in the genetics of cSVD. Lastly, we assess preclinical models that can aid in studying LS disease pathogenesis. Enhanced understanding of this highly prevalent disease will allow for the identification of novel therapeutic targets capable of mitigating disease sequelae.
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Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryo Ohtomo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eng H Lo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cenk Ayata
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mahmut Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Honarpisheh P, McCullough LD. Sex as a biological variable in the pathology and pharmacology of neurodegenerative and neurovascular diseases. Br J Pharmacol 2019; 176:4173-4192. [PMID: 30950038 DOI: 10.1111/bph.14675] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 12/14/2022] Open
Abstract
The incidence of dementia, most commonly caused by cerebrovascular and neurodegenerative diseases, continues to grow as our population ages. Alzheimer disease (AD) and vascular cognitive impairment (VCI) are responsible for more than 80% of all cases of dementia. There are few effective, long-term treatments for AD and VCI-related conditions (e.g., stroke and cerebral amyloid angiopathy (CAA)). This review focuses on AD (as the most common "neurodegenerative" cause of dementia), CAA (as an "emerging" cause of dementia), and stroke (as the most common cause of "vascular" dementia). We will discuss the available literature on the pharmacological therapies that demonstrate sex differences, which refer to any combination of structural, chromosomal, gonadal, or hormonal differences between males and females. We will emphasize the importance of considering sex as a biological variable in the design of preclinical and clinical studies that investigate underlying pathologies or response to pharmacological interventions in dementia. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.
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Affiliation(s)
- Pedram Honarpisheh
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas
| | - Louise D McCullough
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas
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Ferro DA, van den Brink H, Exalto LG, Boomsma JM, Barkhof F, Prins ND, van der Flier WM, Biessels GJ. Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment. Neurology 2019; 92:e1558-e1566. [DOI: 10.1212/wnl.0000000000007250] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/24/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo determine the occurrence of acute cerebral microinfarcts (ACMIs) in memory clinic patients and relate their presence to vascular risk and cognitive profile, CSF and neuroimaging markers, and clinical outcome.MethodsThe TRACE-VCI study is a memory clinic cohort of patients with vascular brain injury on MRI (i.e., possible vascular cognitive impairment [VCI]). We included 783 patients (mean age 67.6 ± 8.5, 46% female) with available 3T diffusion-weighted imaging (DWI). ACMIs were defined as supratentorial DWI hyperintensities <5 mm with a corresponding hypo/isointense apparent diffusion coefficient signal and iso/hyperintense T2*-weighted signal.ResultsA total of 23 ACMIs were found in 16 of the 783 patients (2.0%). Patients with ACMIs did not differ in vascular risk or cognitive profile, but were more often diagnosed with vascular dementia (odds ratio [OR] 5.1; 95% confidence interval [CI] 1.4–18.9, p = 0.014). ACMI presence was associated with lower levels of β-amyloid (p < 0.004) and with vascular imaging markers (lacunar infarcts: OR 3.5, CI 1.3–9.6, p = 0.015; nonlacunar infarcts: OR 4.1, CI 1.4–12.5, p = 0.012; severe white matter hyperintensities: OR 4.8, CI 1.7–13.8, p = 0.004; microbleeds: OR 18.9, CI 2.5–144.0, p = 0.0001). After a median follow-up of 2.1 years, the risk of poor clinical outcome (composite of marked cognitive decline, major vascular event, death, and institutionalization) was increased among patients with ACMIs (hazard ratio 3.0; 1.4–6.0, p = 0.005).ConclusionIn patients with possible VCI, ACMI presence was associated with a high burden of cerebrovascular disease of both small and large vessel etiology and poor clinical outcome. ACMIs may thus be a novel marker of active vascular brain injury in these patients.
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van Veluw SJ, Reijmer YD, van der Kouwe AJ, Charidimou A, Riley GA, Leemans A, Bacskai BJ, Frosch MP, Viswanathan A, Greenberg SM. Histopathology of diffusion imaging abnormalities in cerebral amyloid angiopathy. Neurology 2019; 92:e933-e943. [PMID: 30700595 PMCID: PMC6404469 DOI: 10.1212/wnl.0000000000007005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/23/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We sought to determine the underlying mechanism for altered white matter diffusion tensor imaging (DTI) measures at the histopathologic level in patients with cerebral amyloid angiopathy (CAA). METHODS Formalin-fixed intact hemispheres from 9 CAA cases and 2 elderly controls were scanned at 3-tesla MRI, including a diffusion-weighted sequence. DTI measures (i.e., fractional anisotropy [FA] and mean diffusivity [MD]) and histopathology measures were obtained from 2 tracts: the anterior thalamic radiation and inferior longitudinal fasciculus. RESULTS FA was reduced in both tracts and MD was increased in cases with CAA compared to controls. Regional FA was significantly correlated with tissue rarefaction, myelin density, axonal density, and white matter microinfarcts. MD correlated significantly with tissue rarefaction, myelin density, and white matter microinfarcts, but not axonal density. FA and MD did not correlate with oligodendrocytes, astrocytes, or gliosis. Multivariate analysis revealed that tissue rarefaction (β = -0.32 ± 0.12, p = 0.009) and axonal density (β = 0.25 ± 0.12, p = 0.04) were both independently associated with FA, whereas myelin density was independently associated with MD (β = -0.32 ± 0.12, p = 0.013). Finally, we found an association between increased MD in the frontal white matter and CAA severity in the frontal cortex (p = 0.035). CONCLUSIONS These results suggest that overall tissue loss, and in particular axonal and myelin loss, are major components underlying CAA-related alterations in DTI properties observed in living patients. The findings allow for a more mechanistic interpretation of DTI parameters in small vessel disease and for mechanism-based selection of candidate treatments to prevent vascular cognitive impairment.
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Affiliation(s)
- Susanne J van Veluw
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown.
| | - Yael D Reijmer
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Andre J van der Kouwe
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Andreas Charidimou
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Grace A Riley
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Alexander Leemans
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Brian J Bacskai
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Matthew P Frosch
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Anand Viswanathan
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Steven M Greenberg
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
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Zhu LH, Zhang ZP, Wang FN, Cheng QH, Guo G. Diffusion kurtosis imaging of microstructural changes in brain tissue affected by acute ischemic stroke in different locations. Neural Regen Res 2019; 14:272-279. [PMID: 30531010 PMCID: PMC6301161 DOI: 10.4103/1673-5374.244791] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The location of an acute ischemic stroke is associated with its prognosis. The widely used Gaussian model-based parameter, apparent diffusion coefficient (ADC), cannot reveal microstructural changes in different locations or the degree of infarction. This prospective observational study was reviewed and approved by the Institutional Review Board of Xiamen Second Hospital, China (approval No. 2014002). Diffusion kurtosis imaging (DKI) was used to detect 199 lesions in 156 patients with acute ischemic stroke (61 males and 95 females), mean age 63.15 ± 12.34 years. A total of 199 lesions were located in the periventricular white matter (n = 52), corpus callosum (n = 14), cerebellum (n = 29), basal ganglia and thalamus (n = 21), brainstem (n = 21) and gray-white matter junctions (n = 62). Percentage changes of apparent diffusion coefficient (ΔADC) and DKI-derived indices (fractional anisotropy [ΔFA], mean diffusivity [ΔMD], axial diffusivity [ΔDa], radial diffusivity ΔDr, mean kurtosis [ΔMK], axial kurtosis [ΔKa], and radial kurtosis [ΔKr]) of each lesion were computed relative to the normal contralateral region. The results showed that (1) there was no significant difference in ΔADC, ΔMD, ΔDa or ΔDr among almost all locations. (2) There was significant difference in ΔMK among almost all locations (except basal ganglia and thalamus vs. brain stem; basal ganglia and thalamus vs. gray-white matter junctions; and brainstem vs. gray-white matter junctions. (3) The degree of change in diffusional kurtosis in descending order was as follows: corpus callosum > periventricular white matter > brainstem > gray-white matter junctions > basal ganglia and thalamus > cerebellum. In conclusion, DKI could reveal the differences in microstructure changes among various locations affected by acute ischemic stroke, and performed better than diffusivity among all groups.
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Affiliation(s)
- Liu-Hong Zhu
- Department of Radiology, Xiamen Second Hospital; Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian Province, China
| | | | - Fu-Nan Wang
- Department of Radiology, Xiamen Second Hospital, Xiamen, Fujian Province, China
| | - Qi-Hua Cheng
- Department of Radiology, Xiamen Second Hospital, Xiamen, Fujian Province, China
| | - Gang Guo
- Department of Radiology, Xiamen Second Hospital, Xiamen, Fujian Province, China
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Boulanger M, Schneckenburger R, Join-Lambert C, Werring DJ, Wilson D, Hodel J, Zuber M, Touzé E. Diffusion-Weighted Imaging Hyperintensities in Subtypes of Acute Intracerebral Hemorrhage: Meta-Analysis. Stroke 2019; 50:135-142. [PMID: 30580720 DOI: 10.1161/strokeaha.118.021407] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Diffusion-weighted imaging (DWI) hyperintensities in intracerebral hemorrhage (ICH) are associated with increased risk of recurrent ICH, cognitive impairment, and death, but whether these lesions are specific to a subtype of ICH remains uncertain. We investigated the association between DWI lesions and ICH subtype and explored the risk factors for DWI lesions. Methods- In a systematic review of ICH studies, we identified those reporting prevalence of DWI lesions. Two reviewers independently assessed study eligibility and risk of bias and collected data. We determined the pooled prevalence of DWI lesions within 90 days after ICH onset for cerebral amyloid angiopathy- and hypertensive angiopathy-related ICH using random-effects meta-analysis. We calculated odds ratios to compare prevalence of DWI lesions by ICH subtype and to assess risk factors for DWI lesions. Results- Eleven studies (1910 patients) were included. The pooled prevalence of DWI lesions was 18.9% (95% CI, 11.1-26.7) in cerebral amyloid angiopathy- and 21.0% (95% CI, 15.3-26.6) in hypertensive angiopathy-related ICH. There was no difference in the prevalence of DWI lesions between cerebral amyloid angiopathy- (64/292 [21.9%]) and hypertensive angiopathy-related ICH (79/370 [21.4%]; odds ratio, 1.25; 95% CI, 0.73-2.15) in the 5 studies reporting data on both ICH pathogeneses. In all ICH, presence of DWI lesions was associated with neuroimaging features of microangiopathy (leukoaraiosis extension, previous ICH, and presence, and number of microbleeds) but not with vascular risk factors or the use of antithrombotic therapies. Conclusions- Prevalence of DWI lesions in acute ICH averages 20%, with no difference between cerebral amyloid angiopathy- and hypertensive angiopathy-related ICH. Detection of DWI lesions may add valuable information to assess the progression of the underlying microangiopathy.
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Affiliation(s)
- Marion Boulanger
- From the Normandie University, UNICAEN, Inserm U1237, Caen, France (M.B., M.Z., E.T.)
- CHU Côte de Nacre, Neurology Department, Caen, France (M.B., R.S., E.T.)
| | | | - Claire Join-Lambert
- Neurology Department, Hôpital Saint Joseph, Université Paris Descartes, France (C.J.-L., M.Z.)
| | - David J Werring
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, Institute of Neurology, Queen Square, London, United Kingdom (D.J.W., D.W.)
| | - Duncan Wilson
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, Institute of Neurology, Queen Square, London, United Kingdom (D.J.W., D.W.)
| | - Jérome Hodel
- Neuroradiology Department, Hôpital Henri Mondor, Université Paris-Est Créteil, France (J.H.)
| | - Mathieu Zuber
- From the Normandie University, UNICAEN, Inserm U1237, Caen, France (M.B., M.Z., E.T.)
- Neurology Department, Hôpital Saint Joseph, Université Paris Descartes, France (C.J.-L., M.Z.)
| | - Emmanuel Touzé
- From the Normandie University, UNICAEN, Inserm U1237, Caen, France (M.B., M.Z., E.T.)
- CHU Côte de Nacre, Neurology Department, Caen, France (M.B., R.S., E.T.)
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Clinical and radiological determinants of transient symptoms associated with infarction (TSI). J Neurol Sci 2018; 390:195-199. [DOI: 10.1016/j.jns.2018.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/29/2018] [Accepted: 04/22/2018] [Indexed: 11/21/2022]
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37
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The Relationship between Cerebral White Matter Integrity and Cognitive Function in Mild Stroke with Basal Ganglia Region Infarcts. Sci Rep 2018; 8:8422. [PMID: 29849078 PMCID: PMC5976674 DOI: 10.1038/s41598-018-26316-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/04/2018] [Indexed: 12/11/2022] Open
Abstract
Mild stroke is a known risk factor for dementia. The relationship between cerebral white matter (WM) integrity and cognitive impairment (CI) in mild stroke patients with basal ganglia region infarcts is unknown. Total of 33 stroke patients and 19 age-matched controls underwent diffusion tensor imaging scans and a formal neuropsychological test battery. CI was defined as having a performance score 1.5 SD below the established norm. We compared the differences in Z-scores and Fraction Anisotropy (FA) values among controls, stroke with no CI (NCI) and stroke with CI groups. Multiple linear regressions were performed between FA values in affected regions and neuropsychological tests in stroke patients. The majority of stroke patients were in their 50s (56.90 ± 9.23 years). CI patients exhibited a significantly decreased Z score in visual delayed memory and remarkably decreased FA values in the right external capsule and right fornix (FWE-corrected) compared with NCI patients and controls. In stroke patients, the FA value in the right fornix was positively correlated with delayed visual memory. Mild stroke with basal ganglia region infarcts may be related to widespread abnormality of WM integrity. The lower WM integrity in the right fornix may be a marker of impaired delayed visual memory.
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Ter Telgte A, Wiegertjes K, Tuladhar AM, Noz MP, Marques JP, Gesierich B, Huebner M, Mutsaerts HJM, Elias-Smale SE, Beelen MJ, Ropele S, Kessels RP, Riksen NP, Klijn CJ, Norris DG, Duering M, de Leeuw FE. Investigating the origin and evolution of cerebral small vessel disease: The RUN DMC - InTENse study. Eur Stroke J 2018; 3:369-378. [PMID: 31236485 PMCID: PMC6571506 DOI: 10.1177/2396987318776088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/17/2018] [Indexed: 01/24/2023] Open
Abstract
Background Neuroimaging in older adults commonly reveals signs of cerebral small vessel
disease (SVD). SVD is believed to be caused by chronic hypoperfusion based
on animal models and longitudinal studies with inter-scan intervals of
years. Recent imaging evidence, however, suggests a role for acute
ischaemia, as indicated by incidental diffusion-weighted imaging lesions
(DWI+ lesions), in the origin of SVD. Furthermore, it becomes increasingly
recognised that focal SVD lesions likely affect the structure and function
of brain areas remote from the original SVD lesion. However, the temporal
dynamics of these events are largely unknown. Aims (1) To investigate the monthly incidence of DWI+ lesions in subjects with
SVD; (2) to assess to which extent these lesions explain progression of SVD
imaging markers; (3) to investigate their effects on cortical thickness,
structural and functional connectivity and cognitive and motor performance;
and (4) to investigate the potential role of the innate immune system in the
pathophysiology of SVD. Design/methods The RUN DMC – InTENse study is a longitudinal observational study among 54
non-demented RUN DMC survivors with mild to severe SVD and no other presumed
cause of ischaemia. We performed MRI assessments monthly during 10
consecutive months (totalling up to 10 scans per subject), complemented with
clinical, motor and cognitive examinations. Discussion Our study will provide a better understanding of the role of DWI+ lesions in
the pathophysiology of SVD and will further unravel the structural and
functional consequences and clinical importance of these lesions, with an
unprecedented temporal resolution. Understanding the role of acute,
potentially ischaemic, processes in SVD may provide new strategies for
therapies.
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Affiliation(s)
- Annemieke Ter Telgte
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marlies P Noz
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José P Marques
- Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Benno Gesierich
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | - Mathias Huebner
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | | | - Suzette E Elias-Smale
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marie-José Beelen
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Roy Pc Kessels
- Department of Medical Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels P Riksen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina Jm Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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Hartmann DA, Hyacinth HI, Liao FF, Shih AY. Does pathology of small venules contribute to cerebral microinfarcts and dementia? J Neurochem 2018; 144:517-526. [PMID: 28950410 PMCID: PMC5869083 DOI: 10.1111/jnc.14228] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 09/08/2017] [Accepted: 09/18/2017] [Indexed: 12/28/2022]
Abstract
Microinfarcts are small, but strikingly common, ischemic brain lesions in the aging human brain. There is mounting evidence that microinfarcts contribute to vascular cognitive impairment and dementia, but the origins of microinfarcts are unclear. Understanding the vascular pathologies that cause microinfarcts may yield strategies to prevent their occurrence and reduce their deleterious effects on brain function. Current thinking suggests that cortical microinfarcts arise from the occlusion of penetrating arterioles, which are responsible for delivering oxygenated blood to small volumes of tissue. Unexpectedly, pre-clinical studies have shown that the occlusion of penetrating venules, which drain deoxygenated blood from cortex, lead to microinfarcts that appear identical to those resulting from arteriole occlusion. Here we discuss the idea that cerebral venule pathology could be an overlooked source for brain microinfarcts in humans. This article is part of the Special Issue "Vascular Dementia". Cover Image for this Issue: doi: 10.1111/jnc.14167.
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Affiliation(s)
- David A. Hartmann
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Hyacinth I. Hyacinth
- Aflac Cancer and Blood Disorder Center, Children’s Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, USA
| | - Francesca-Fang Liao
- Department of Pharmacology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andy Y. Shih
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
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40
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Ueda Y, Satoh M, Tabei KI, Kida H, Ii Y, Asahi M, Maeda M, Sakuma H, Tomimoto H. Neuropsychological Features of Microbleeds and Cortical Microinfarct Detected by High Resolution Magnetic Resonance Imaging. J Alzheimers Dis 2018; 53:315-25. [PMID: 27163803 DOI: 10.3233/jad-151008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lobar microbleeds (MBs) and cortical microinfarct (CMI) are caused by cerebral amyloid angiopathy in the elderly and increase in number in Alzheimer's disease. OBJECTIVE The aim of this study is to elucidate the effects of lobar MBs and CMIs on cognitive function. METHODS The subjects were outpatients who visited the memory clinic of Mie University Hospital. Among 120 subjects, 109 patients fulfilled the inclusion criteria. We quantitatively estimated MBs and CMIs using double inversion recovery and 3D FLAIR images of 3T MRI. Neuropsychological assessments included intellectual, memory, constructional, and frontal lobe function. RESULTS Of the 109 patients, MBs and CMIs were observed in 68 (62%) and 17 (16%) subjects, respectively. Of the 68 patients with MBs, lobar MBs were found in 28, deep MBs in 8 and mixed MBs in 31. In each age group, the number of MBs increased in patients with CMI (CMI+ group) than those without CMI (CMI- group), and MBs and CMIs additively decreased MMSE scores. In psychological screens, the MBs+ group with more than 10 MBs showed significantly lower scores of category- and letter-WF than MB- group. The CMI+ group showed significantly worse scores than CMI- group in Japanese Raven's coloured progressive matrices, Trail Making Test-A, category- and letter-word fluency and copy and drawing of figures. CONCLUSION Lobar MBs and CMIs in the elderly frequently coexisted with each other and additively contributed to cognitive impairment, which is mainly predisposed to frontal lobe function.
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Affiliation(s)
- Yukito Ueda
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan
| | - Ken-Ichi Tabei
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan.,Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hirotaka Kida
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Masaru Asahi
- Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Masayuki Maeda
- Department of Radiology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan.,Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
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41
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Expression of RGMb in brain tissue of MCAO rats and its relationship with axonal regeneration. J Neurol Sci 2017; 383:79-86. [DOI: 10.1016/j.jns.2017.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 11/24/2022]
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42
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van Veluw SJ, Lauer A, Charidimou A, Bounemia N, Xiong L, Boulouis G, Fotiadis P, Ayres A, Gurol ME, Viswanathan A, Greenberg SM, Vernooij MW. Evolution of DWI lesions in cerebral amyloid angiopathy: Evidence for ischemia. Neurology 2017; 89:2136-2142. [PMID: 29070668 PMCID: PMC5696638 DOI: 10.1212/wnl.0000000000004668] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/15/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To address the pathophysiologic nature of small diffusion-weighted imaging (DWI) lesions in patients with cerebral amyloid angiopathy (CAA) who underwent serial MRI. Specifically, we tested (1) whether DWI lesions occurred preferentially in individuals with prior DWI lesions, (2) the cross-sectional association with chronic cortical cerebral microinfarcts (CMIs), and (3) the evolution of DWI lesions over time. METHODS Patients with probable CAA (n = 79) who underwent at least 2 MRI sessions were included. DWI lesions were assessed at each available time point. Lesion appearance and characteristics were assessed on available structural follow-up images. Presence and burden of other neuroimaging markers of small vessel disease (white matter hyperintensities, cerebral microbleeds, cortical superficial siderosis, and chronic cortical CMIs) were assessed as well. RESULTS Among 221 DWI scans (79 patients with 2 DWI scans; 40 with ≥3), 60 DWI lesions were found in 28 patients. Patients with DWI lesions at baseline were not more likely to have additional DWI lesions on follow-up compared to patients without DWI lesions at baseline. DWI lesions were associated with chronic cortical CMIs and cortical superficial siderosis, but not with other markers. For 39/60 DWI lesions, >1 MRI sequence was available at follow-up to determine lesion evolution. Twenty-four (62%) were demarcated as chronic lesions on follow-up MRI. Five appeared as cavitations, 18 as noncavitated infarcts, and 1 underwent hemorrhagic transformation. CONCLUSIONS Based on their neuroimaging signature as well as their association with chronic cortical CMIs, DWI lesions appear to have an ischemic origin and represent one part of the CMI spectrum.
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Affiliation(s)
- Susanne J van Veluw
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands.
| | - Arne Lauer
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Andreas Charidimou
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Narimene Bounemia
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Li Xiong
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Gregoire Boulouis
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Panagiotis Fotiadis
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Alison Ayres
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - M Edip Gurol
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Meike W Vernooij
- From the Hemorrhagic Stroke Research Program, Department of Neurology (S.J.v.V., A.L., A.C., N.B., L.X., G.B., P.F., A.A., M.E.G., A.V., S.M.G., M.W.V.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology and Nuclear Medicine (M.W.V.) and Epidemiology (M.W.V.), Erasmus MC, Rotterdam, the Netherlands
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Summers PM, Hartmann DA, Hui ES, Nie X, Deardorff RL, McKinnon ET, Helpern JA, Jensen JH, Shih AY. Functional deficits induced by cortical microinfarcts. J Cereb Blood Flow Metab 2017; 37:3599-3614. [PMID: 28090802 PMCID: PMC5669342 DOI: 10.1177/0271678x16685573] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical studies have revealed a strong link between increased burden of cerebral microinfarcts and risk for cognitive impairment. Since the sum of tissue damage incurred by microinfarcts is a miniscule percentage of total brain volume, we hypothesized that microinfarcts disrupt brain function beyond the injury site visible to histological or radiological examination. We tested this idea using a mouse model of microinfarcts, where single penetrating vessels that supply mouse cortex were occluded by targeted photothrombosis. We found that in vivo structural and diffusion MRI reliably reported the acute microinfarct core, based on spatial co-registrations with post-mortem stains of neuronal viability. Consistent with our hypothesis, c-Fos assays for neuronal activity and in vivo imaging of single vessel hemodynamics both reported functional deficits in viable peri-lesional tissues beyond the microinfarct core. We estimated that the volume of tissue with functional deficit in cortex was at least 12-fold greater than the volume of the microinfarct core. Impaired hemodynamic responses in peri-lesional tissues persisted at least 14 days, and were attributed to lasting deficits in neuronal circuitry or neurovascular coupling. These data show how individually miniscule microinfarcts could contribute to broader brain dysfunction during vascular cognitive impairment and dementia.
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Affiliation(s)
- Philipp M Summers
- 1 Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - David A Hartmann
- 1 Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Edward S Hui
- 2 Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | - Xingju Nie
- 3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Rachael L Deardorff
- 3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Emilie T McKinnon
- 3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph A Helpern
- 1 Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.,3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Jens H Jensen
- 3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Andy Y Shih
- 1 Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
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Banerjee G, Carare R, Cordonnier C, Greenberg SM, Schneider JA, Smith EE, Buchem MV, Grond JVD, Verbeek MM, Werring DJ. The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice. J Neurol Neurosurg Psychiatry 2017; 88:982-994. [PMID: 28844070 PMCID: PMC5740546 DOI: 10.1136/jnnp-2016-314697] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/26/2017] [Accepted: 05/18/2017] [Indexed: 12/29/2022]
Abstract
Cerebral amyloid angiopathy (CAA) has never been more relevant. The last 5 years have seen a rapid increase in publications and research in the field, with the development of new biomarkers for the disease, thanks to advances in MRI, amyloid positron emission tomography and cerebrospinal fluid biomarker analysis. The inadvertent development of CAA-like pathology in patients treated with amyloid-beta immunotherapy for Alzheimer's disease has highlighted the importance of establishing how and why CAA develops; without this information, the use of these treatments may be unnecessarily restricted. Our understanding of the clinical and radiological spectrum of CAA has continued to evolve, and there are new insights into the independent impact that CAA has on cognition in the context of ageing and intracerebral haemorrhage, as well as in Alzheimer's and other dementias. While the association between CAA and lobar intracerebral haemorrhage (with its high recurrence risk) is now well recognised, a number of management dilemmas remain, particularly when considering the use of antithrombotics, anticoagulants and statins. The Boston criteria for CAA, in use in one form or another for the last 20 years, are now being reviewed to reflect these new wide-ranging clinical and radiological findings. This review aims to provide a 5-year update on these recent advances, as well as a look towards future directions for CAA research and clinical practice.
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Affiliation(s)
- Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Roxana Carare
- Division of Clinical Neurosciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Charlotte Cordonnier
- Department of Neurology, Université de Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Steven M Greenberg
- J P Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie A Schneider
- Departments of Pathology and Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel M Verbeek
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Departments of Neurology and Laboratory Medicine, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
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45
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van Veluw SJ, Shih AY, Smith EE, Chen C, Schneider JA, Wardlaw JM, Greenberg SM, Biessels GJ. Detection, risk factors, and functional consequences of cerebral microinfarcts. Lancet Neurol 2017; 16:730-740. [PMID: 28716371 PMCID: PMC5861500 DOI: 10.1016/s1474-4422(17)30196-5] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/17/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023]
Abstract
Cerebral microinfarcts are small lesions that are presumed to be ischaemic. Despite the small size of these lesions, affected individuals can have hundreds to thousands of cerebral microinfarcts, which cause measurable disruption to structural brain connections, and are associated with dementia that is independent of Alzheimer's disease pathology or larger infarcts (ie, lacunar infarcts, and large cortical and non-lacunar subcortical infarcts). Substantial progress has been made with regard to understanding risk factors and functional consequences of cerebral microinfarcts, partly driven by new in-vivo detection methods and the development of animal models that closely mimic multiple aspects of cerebral microinfarcts in human beings. Evidence from these advances suggests that cerebral microinfarcts can be manifestations of both small vessel and large vessel disease, that cerebral microinfarcts are independently associated with cognitive impairment, and that these lesions are likely to cause damage to brain structure and function that extends beyond their actual lesion boundaries. Criteria for the identification of cerebral microinfarcts with in-vivo MRI are provided to support further studies of the association between these lesions and cerebrovascular disease and dementia.
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Affiliation(s)
- Susanne J van Veluw
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andy Y Shih
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Chen
- Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
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Charidimou A, Boulouis G, Gurol ME, Ayata C, Bacskai BJ, Frosch MP, Viswanathan A, Greenberg SM. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain 2017; 140:1829-1850. [PMID: 28334869 DOI: 10.1093/brain/awx047] [Citation(s) in RCA: 310] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/17/2017] [Indexed: 12/27/2022] Open
Abstract
Sporadic cerebral amyloid angiopathy is a common, well-defined small vessel disease and a largely untreatable cause of intracerebral haemorrhage and contributor to age-related cognitive decline. The term 'cerebral amyloid angiopathy' now encompasses not only a specific cerebrovascular pathological finding, but also different clinical syndromes (both acute and progressive), brain parenchymal lesions seen on neuroimaging and a set of diagnostic criteria-the Boston criteria, which have resulted in increasingly detected disease during life. Over the past few years, it has become clear that, at the pathophysiological level, cerebral amyloid angiopathy appears to be in part a protein elimination failure angiopathy and that this dysfunction is a feed-forward process, which potentially leads to worsening vascular amyloid-β accumulation, activation of vascular injury pathways and impaired vascular physiology. From a clinical standpoint, cerebral amyloid angiopathy is characterized by individual focal lesions (microbleeds, cortical superficial siderosis, microinfarcts) and large-scale alterations (white matter hyperintensities, structural connectivity, cortical thickness), both cortical and subcortical. This review provides an interdisciplinary critical outlook on various emerging and changing concepts in the field, illustrating mechanisms associated with amyloid cerebrovascular pathology and neurological dysfunction.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian J Bacskai
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Matthew P Frosch
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA.,C.S. Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.,Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
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47
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Xiong L, Davidsdottir S, Reijmer YD, Shoamanesh A, Roongpiboonsopit D, Thanprasertsuk S, Martinez-Ramirez S, Charidimou A, Ayres AM, Fotiadis P, Gurol E, Blacker DL, Greenberg SM, Viswanathan A. Cognitive Profile and its Association with Neuroimaging Markers of Non-Demented Cerebral Amyloid Angiopathy Patients in a Stroke Unit. J Alzheimers Dis 2017; 52:171-8. [PMID: 27060947 DOI: 10.3233/jad-150890] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is increasingly recognized as a cause of cognitive impairment in the elderly, but the cognitive profile in patients with the disease has not been well characterized. OBJECTIVE To characterize the neuropsychological profile of CAA patients without dementia and to determine the association between cognitive performance in different domains and neuroimaging lesions characteristic of CAA. METHODS Fifty-eight non-demented CAA patients were compared to 138 cognitively normal subjects using a standard neuropsychological test battery. Total brain volume (TBV), white matter hyperintensities, number of lobar cerebral microbleeds, hippocampal volume, and cortical superficial siderosis in all CAA patients were assessed. The association between these neuroimaging markers and neuropsychological performance in different cognitive domains in the CAA group were analyzed. RESULTS Patients with CAA had significantly worse performance on all individual neuropsychological domains tested, when compared to the cognitive normal group. The cognitive decline of CAA patients was most noticeable in tests for processing speed with a Z score of -1.92±1.56 (mean±SD), then followed by executive function (-0.93±1.01), episodic memory (-0.87±1.29), semantic fluency (-0.73±1.06), and attention (-0.42±0.98). TBV of the CAA patients was correlated with processing speed (β= 0.335, p = 0.03) and executive function (β= 0.394, p = 0.01). CONCLUSIONS Non-demented patients with CAA had cognitive deficits in multiple areas. Lower TBV was related to slower processing speed and worse executive function.
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Affiliation(s)
- Li Xiong
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Sigurros Davidsdottir
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yael D Reijmer
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashkan Shoamanesh
- Department of Neurology, McMaster University / Population Health Research Institute, Canada
| | - Duangnapa Roongpiboonsopit
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Sergi Martinez-Ramirez
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alison M Ayres
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Panagiotis Fotiadis
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah L Blacker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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48
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Raman MR, Kantarci K, Murray ME, Jack CR, Vemuri P. Imaging markers of cerebrovascular pathologies: Pathophysiology, clinical presentation, and risk factors. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 5:5-14. [PMID: 28054023 PMCID: PMC5198884 DOI: 10.1016/j.dadm.2016.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebrovascular pathologies (CVPs) are common pathologies associated with age-related cognitive decline along with Alzheimer disease pathologies. The impact of CVP on the prevalence of dementia is increasingly being recognized. The goal of this review is to improve our understanding of the pathophysiological underpinnings and the multimodal magnetic resonance imaging and positron emission tomography imaging changes that are associated with the hallmarks of CVP. This knowledge will facilitate the development of early detection, intervention, and prevention strategies that may contribute to lowering the risk of dementia. In this review, we will first discuss currently known risk factors of CVPs including cardiovascular, lifestyle, genetic, sex differences, and head injury. Next, we will focus on the pathophysiology of CVPs and their impact on neurodegeneration and downstream cognitive impairment. Specifically, we will discuss three of the most common cerebrovascular lesions seen on MRI: white-matter hyperintensity, microbleeds, and infarcts. Finally, we will discuss the unanswered open questions in this field.
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Affiliation(s)
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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49
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Ince PG, Minett T, Forster G, Brayne C, Wharton SB. Microinfarcts in an older population-representative brain donor cohort (MRC CFAS): Prevalence, relation to dementia and mobility, and implications for the evaluation of cerebral Small Vessel Disease. Neuropathol Appl Neurobiol 2016; 43:409-418. [PMID: 27664944 PMCID: PMC5516203 DOI: 10.1111/nan.12363] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/22/2016] [Accepted: 09/24/2016] [Indexed: 01/14/2023]
Abstract
Introduction Microinfarcts, small ischaemic foci common in ageing brain, are associated with dementia and gait dysfunction. We determined their relationship with dementia, mobility and cerebrovascular disease in an older population‐representative brain donor cohort. These data on microinfarcts were evaluated in relation to pathological assessments of clinically significant cerebral small vessel disease (SVD). Methods Microinfarcts were assessed in the MRC Cognitive Function and Ageing Study (n = 331). Nine brain areas were staged according to the number of areas affected. Results 36% of brains showed at least 1 microinfarct. Higher cortical microinfarct stage was associated with dementia at death (OR 1.41, 95% CI 1.02; 1.96, P = 0.038), whilst cortical and subcortical microinfarct stages were associated with impaired mobility (OR 1.36, 95% CI 1.05–1.74; P 0.018) and falls (OR 1.96, 95% CI 1.11–3.43; P = 0.02). Adding data on microinfarcts to a definition of SVD, based on white matter lesions (WMLs), lacunes and significant arteriosclerosis, were assessed by comparing area under ROC curve (AUC) with and without microinfarcts. SVD was significantly related to dementia status with or without inclusion of microinfarcts. Modelling potential pathological definitions of SVD to predict dementia or impaired mobility indicated optimal prediction using combined assessment of WMLs, lacunes and microinfarcts. Conclusion Cortical (dementia) and subcortical microinfarcts (impaired mobility) are related to diverse clinical outcomes. Optimal pathological assessment of significant SVD in brain ageing is achieved based on WMLs, lacunes and microinfarcts and may not require subjective assessment of the extent and severity of arteriosclerosis.
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Affiliation(s)
- P G Ince
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - T Minett
- Institute of Public Health, University of Cambridge, Cambridge, UK.,Department of Radiology, University of Cambridge, Cambridge, UK
| | - G Forster
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - C Brayne
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - S B Wharton
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
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50
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Molad JA, Blumenthal DT, Bokstein F, Findler M, Finkel I, Bornstein NM, Yust-Katz S, Auriel E. Mechanisms of post-radiation injury: cerebral microinfarction not a significant factor. J Neurooncol 2016; 131:277-281. [DOI: 10.1007/s11060-016-2291-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022]
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