1
|
Harris RD, Taylor OA, Raghubar KP, Matheus Gonzalez M, Zobeck M, Gramatges MM, Rabin KR, Scheurer ME, Brown AL. Episodes of acute methotrexate-related neurotoxicity linked to compromised long-term neurocognitive function. Pediatr Blood Cancer 2024; 71:e31169. [PMID: 38961583 DOI: 10.1002/pbc.31169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/28/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
Methotrexate is a critical component of curative chemotherapy for pediatric acute lymphoblastic leukemia (ALL), but is associated with neurotoxicity. Information on long-term outcomes following an acute neurotoxic event is limited. Therefore, this report compares neurocognitive performance more than 12 months post diagnosis (mean = 4 years) between ALL patients with (n = 25) and without (n = 146) a history of acute neurotoxicity. Compared to children with no documented on-treatment neurotoxic event, children who experienced a neurotoxic event during treatment exhibited poorer performance on measures of fine motor function (p = .02) and attention (p = .02). Children with ALL who experience acute neurotoxicity may be candidates for early neuropsychological screening and intervention.
Collapse
Affiliation(s)
- Rachel D Harris
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
| | - Olga A Taylor
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
| | - Kimberly P Raghubar
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatric Psychology and Neuropsychology, Texas Children's Hospital, Houston, Texas, USA
| | - Mariana Matheus Gonzalez
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
| | - Mark Zobeck
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
| | - M Monica Gramatges
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
| | - Karen R Rabin
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
| | - Michael E Scheurer
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
| | - Austin L Brown
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
2
|
Jochems ACC, Muñoz Maniega S, Chappell FM, Clancy U, Arteaga C, Jaime Garcia D, Hamilton OKL, Hewins W, Locherty R, Backhouse EV, Barclay G, Jardine C, McIntyre D, Gerrish I, Cheng Y, Liu X, Zhang J, Kampaite A, Sakka E, Valdés Hernández M, Wiseman S, Stringer MS, Thrippleton MJ, Doubal FN, Wardlaw JM. Impact of long-term white matter hyperintensity changes on mobility and dexterity. Brain Commun 2024; 6:fcae133. [PMID: 38715716 PMCID: PMC11074793 DOI: 10.1093/braincomms/fcae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 06/30/2024] Open
Abstract
White matter hyperintensities (WMH), a common feature of cerebral small vessel disease, are related to worse clinical outcomes after stroke. We assessed the impact of white matter hyperintensity changes over 1 year after minor stroke on change in mobility and dexterity, including differences between the dominant and non-dominant hands and objective in-person assessment versus patient-reported experience. We recruited participants with lacunar or minor cortical ischaemic stroke, performed medical and cognitive assessments and brain MRI at presentation and at 1 year. At both time points, we used the timed-up and go test and the 9-hole peg test to assess mobility and dexterity. At 1 year, participants completed the Stroke Impact Scale. We ran two linear mixed models to assess change in timed-up and go and 9-hole peg test, adjusted for age, sex, stroke severity (National Institutes of Health Stroke Scale), dependency (modified Rankin Score), vascular risk factor score, white matter hyperintensity volume (as % intracranial volume) and additionally for 9-hole peg test: Montreal cognitive assessment, hand (dominant/non-dominant), National Adult Reading Test (premorbid IQ), index lesion side. We performed ordinal logistic regression, corrected for age and sex, to assess relations between timed-up and go and Stroke Impact Scale mobility, and 9-hole peg test and Stroke Impact Scale hand function. We included 229 participants, mean age 65.9 (standard deviation = 11.13); 66% male. 215/229 attended 1-year follow-up. Over 1 year, timed-up and go time increased with aging (standardized β [standardized 95% Confidence Interval]: 0.124[0.011, 0.238]), increasing National Institutes of Health Stroke Scale (0.106[0.032, 0.180]), increasing modified Rankin Score (0.152[0.073, 0.231]) and increasing white matter hyperintensity volume (0.176[0.061, 0.291]). Men were faster than women (-0.306[0.011, 0.238]). Over 1 year, slower 9-hole peg test was related to use of non-dominant hand (0.290[0.155, 0.424]), aging (0.102[0.012, 0.192]), male sex (0.182[0.008, 0.356]), increasing National Institutes of Health Stroke Scale (0.160 [0.094, 0.226]), increasing modified Rankin Score (0.100[0.032, 0.169]), decreasing Montreal cognitive assessment score (-0.090[-0.167, -0.014]) and increasing white matter hyperintensity volume (0.104[0.015, 0.193]). One year post-stroke, Stroke Impact Scale mobility worsened per second increase on timed-up and go, odds ratio 0.67 [95% confidence interval 0.60, 0.75]. Stroke Impact Scale hand function worsened per second increase on the 9-hole peg test for the dominant hand (odds ratio 0.79 [0.71, 0.86]) and for the non-dominant hand (odds ratio 0.88 [0.83, 0.93]). Decline in mobility and dexterity is associated with white matter hyperintensity volume increase, independently of stroke severity. Mobility and dexterity declined more gradually for stable and regressing white matter hyperintensity volume. Dominant and non-dominant hands might be affected differently. In-person measures of dexterity and mobility are associated with self-reported experience 1-year post-stroke.
Collapse
Affiliation(s)
- Angela C C Jochems
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Francesca M Chappell
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Una Clancy
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Carmen Arteaga
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Daniela Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Olivia K L Hamilton
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, G12 8TB Glasgow, United Kingdom
| | - Will Hewins
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Rachel Locherty
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Ellen V Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Gayle Barclay
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Charlotte Jardine
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Donna McIntyre
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Iona Gerrish
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Yajun Cheng
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Department of Neurology, West China Hospital of Sichuan University, 610041 Chengdu, China
| | - Xiaodi Liu
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Junfang Zhang
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of medicine, 200080 Shanghai, China
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Eleni Sakka
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Maria Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Stewart Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Michael S Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| |
Collapse
|
3
|
Iandolo R, Avci E, Bommarito G, Sandvig I, Rohweder G, Sandvig A. Characterizing upper extremity fine motor function in the presence of white matter hyperintensities: A 7 T MRI cross-sectional study in older adults. Neuroimage Clin 2024; 41:103569. [PMID: 38281363 PMCID: PMC10839532 DOI: 10.1016/j.nicl.2024.103569] [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: 07/10/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND White matter hyperintensities (WMH) are a prevalent radiographic finding in the aging brain studies. Research on WMH association with motor impairment is mostly focused on the lower-extremity function and further investigation on the upper-extremity is needed. How different degrees of WMH burden impact the network of activation recruited during upper limb motor performance could provide further insight on the complex mechanisms of WMH pathophysiology and its interaction with aging and neurological disease processes. METHODS 40 healthy elderly subjects without a neurological/psychiatric diagnosis were included in the study (16F, mean age 69.3 years). All subjects underwent ultra-high field 7 T MRI including structural and finger tapping task-fMRI. First, we quantified the WMH lesion load and its spatial distribution. Secondly, we performed a data-driven stratification of the subjects according to their periventricular and deep WMH burdens. Thirdly, we investigated the distribution of neural recruitment and the corresponding activity assessed through BOLD signal changes among different brain regions for groups of subjects. We clustered the degree of WMH based on location, numbers, and volume into three categories; ranging from mild, moderate, and severe. Finally, we explored how the spatial distribution of WMH, and activity elicited during task-fMRI relate to motor function, measured with the 9-Hole Peg Test. RESULTS Within our population, we found three subgroups of subjects, partitioned according to their periventricular and deep WMH lesion load. We found decreased activity in several frontal and cingulate cortex areas in subjects with a severe WMH burden. No statistically significant associations were found when performing the brain-behavior statistical analysis for structural or functional data. CONCLUSION WMH burden has an effect on brain activity during fine motor control and the activity changes are associated with varying degrees of the total burden and distributions of WMH lesions. Collectively, our results shed new light on the potential impact of WMH on motor function in the context of aging and neurodegeneration.
Collapse
Affiliation(s)
- Riccardo Iandolo
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Esin Avci
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Giulia Bommarito
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ioanna Sandvig
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gitta Rohweder
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Stroke Unit, Department of Medicine, St Olav's University Hospital, Trondheim, Norway
| | - Axel Sandvig
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway; Department of Clinical Neurosciences, Division of Neuro, Head and Neck, Umeå University Hospital, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Umeå University Hospital, Umeå, Sweden.
| |
Collapse
|
4
|
Wade BSC, Tate DF, Kennedy E, Bigler ED, York GE, Taylor BA, Troyanskaya M, Hovenden ES, Goodrich-Hunsaker N, Newsome MR, Dennis EL, Abildskov T, Pugh MJ, Walker WC, Kenney K, Betts A, Shih R, Welsh RC, Wilde EA. Microstructural Organization of Distributed White Matter Associated With Fine Motor Control in US Service Members With Mild Traumatic Brain Injury. J Neurotrauma 2024; 41:32-40. [PMID: 37694678 DOI: 10.1089/neu.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is the most common form of brain injury. While most individuals recover from mTBI, roughly 20% experience persistent symptoms, potentially including reduced fine motor control. We investigate relationships between regional white matter organization and subcortical volumes associated with performance on the Grooved Pegboard (GPB) test in a large cohort of military Service Members and Veterans (SM&Vs) with and without a history of mTBI(s). Participants were enrolled in the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium. SM&Vs with a history of mTBI(s) (n = 847) and without mTBI (n = 190) underwent magnetic resonance imaging and the GPB test. We first examined between-group differences in GPB completion time. We then investigated associations between GPB performance and regional structural imaging measures (tractwise diffusivity, subcortical volumes, and cortical thickness) in SM&Vs with a history of mTBI(s). Lastly, we explored whether mTBI history moderated associations between imaging measures and GPB performance. SM&Vs with mTBI(s) performed worse than those without mTBI(s) on the non-dominant hand GPB test at a trend level (p < 0.1). Higher fractional anisotropy (FA) of tracts including the posterior corona radiata, superior longitudinal fasciculus, and uncinate fasciculus were associated with better GPB performance in the dominant hand in SM&Vs with mTBI(s). These findings support that the organization of several white matter bundles are associated with fine motor performance in SM&Vs. We did not observe that mTBI history moderated associations between regional FA and GPB test completion time, suggesting that chronic mTBI may not significantly influence fine motor control.
Collapse
Affiliation(s)
- Benjamin S C Wade
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - David F Tate
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Eamonn Kennedy
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Erin D Bigler
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | | | - Brian A Taylor
- Department of Imaging Physics, the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Maya Troyanskaya
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Elizabeth S Hovenden
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Naomi Goodrich-Hunsaker
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Emily L Dennis
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Tracy Abildskov
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Mary Jo Pugh
- Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Decision-Enhancement and Analytic Sciences Center, Department of Informatics, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - William C Walker
- Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Center for Neuroscience and Regenerative Medicine, Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Aaron Betts
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Robert Shih
- American Institute for Radiologic Pathology, Silver Spring, Maryland, USA
| | - Robert C Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
| | - Elisabeth A Wilde
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
5
|
Connor M, Salans M, Karunamuni R, Unnikrishnan S, Huynh-Le MP, Tibbs M, Qian A, Reyes A, Stasenko A, McDonald C, Moiseenko V, El-Naqa I, Hattangadi-Gluth JA. Fine Motor Skill Decline After Brain Radiation Therapy-A Multivariate Normal Tissue Complication Probability Study of a Prospective Trial. Int J Radiat Oncol Biol Phys 2023; 117:581-593. [PMID: 37150258 PMCID: PMC10911396 DOI: 10.1016/j.ijrobp.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/20/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Brain radiation therapy can impair fine motor skills (FMS). Fine motor skills are essential for activities of daily living, enabling hand-eye coordination for manipulative movements. We developed normal tissue complication probability (NTCP) models for the decline in FMS after fractionated brain radiation therapy (RT). METHODS AND MATERIALS On a prospective trial, 44 patients with primary brain tumors received fractioned RT; underwent high-resolution volumetric magnetic resonance imaging, diffusion tensor imaging, and comprehensive FMS assessments (Delis-Kaplan Executive Function System Trail Making Test Motor Speed [DKEFS-MS]; and Grooved Pegboard dominant/nondominant hands) at baseline and 6 months postRT. Regions of interest subserving motor function (including cortex, superficial white matter, thalamus, basal ganglia, cerebellum, and white matter tracts) were autosegmented using validated methods and manually verified. Dosimetric and clinical variables were included in multivariate NTCP models using automated bootstrapped logistic regression, least absolute shrinkage and selection operator logistic regression, and random forests with nested cross-validation. RESULTS Half of the patients showed a decline on grooved pegboard test of nondominant hands, 17 of 42 (40.4%) on grooved pegboard test of -dominant hands, and 11 of 44 (25%) on DKEFS-MS. Automated bootstrapped logistic regression selected a 1-term model including maximum dose to dominant postcentral white matter. The least absolute shrinkage and selection operator logistic regression selected this term and steroid use. The top 5 variables in the random forest were all dosimetric: maximum dose to dominant thalamus, mean dose to dominant caudate, mean and maximum dose to the dominant corticospinal tract, and maximum dose to dominant postcentral white matter. This technique performed best with an area under the curve of 0.69 (95% CI, 0.68-0.70) on nested cross-validation. CONCLUSIONS We present the first NTCP models for FMS impairment after brain RT. Dose to several supratentorial motor-associated regions of interest correlated with a decline in dominant-hand fine motor dexterity in patients with primary brain tumors in multivariate models, outperforming clinical variables. These data can guide prospective fine motor-sparing strategies for brain RT.
Collapse
Affiliation(s)
- Michael Connor
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Mia Salans
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Soumya Unnikrishnan
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | | | - Michelle Tibbs
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Alexander Qian
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Anny Reyes
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Alena Stasenko
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Carrie McDonald
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California; Department of Psychiatry, University of California San Diego, San Diego, California
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Issam El-Naqa
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California.
| |
Collapse
|
6
|
Wang Z, Wang J, Guo J, Dove A, Arfanakis K, Qi X, Bennett DA, Xu W. Association of Motor Function With Cognitive Trajectories and Structural Brain Differences: A Community-Based Cohort Study. Neurology 2023; 101:e1718-e1728. [PMID: 37657942 PMCID: PMC10624482 DOI: 10.1212/wnl.0000000000207745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The association of motor function with cognitive health remains controversial, and the mechanisms underlying this relationship are unclear. We aimed to examine the association between motor function and long-term cognitive trajectories and further explore the underlying mechanisms using brain MRI. METHODS In the Rush Memory and Aging Project, a prospective cohort study, a total of 2,192 volunteers were recruited from the communities in northeastern Illinois and followed up for up to 22 years (from 1997 to 2020). Individuals with dementia, disability, missing data on motor function at baseline, and missing follow-up data on cognitive function were excluded. At baseline, global motor function was evaluated using the averaged z scores of 10 motor tests covering dexterity, gait, and hand strength; the composite score was tertiled as low, moderate, or high. Global and domain-specific cognitive functions-including episodic memory, semantic memory, working memory, visuospatial ability, and perceptual speed-were measured annually through 19 cognitive tests. A subsample (n = 401) underwent brain MRI scans and regional brain volumes were measured. Data were analyzed using linear mixed-effects models and linear regression. RESULTS Among the 1,618 participants (mean age 79.45 ± 7.32 years) included in this study, baseline global motor function score ranged from 0.36 to 1.82 (mean 1.03 ± 0.22). Over the follow-up (median 6.03 years, interquartile range 3.00-10.01 years), low global motor function and its subcomponents were related to significantly faster declines in global cognitive function (β = -0.005, 95% CI -0.006 to -0.005) and each of the 5 cognitive domains. Of the 344 participants with available MRI data, low motor function was also associated with smaller total brain (β = -25.848, 95% CI -44.902 to -6.795), total white matter (β = -18.252, 95% CI -33.277 to -3.226), and cortical white matter (β = -17.503, 95% CI -32.215 to -2.792) volumes, but a larger volume of white matter hyperintensities (β = 0.257, 95% CI 0.118-0.397). DISCUSSION Low motor function is associated with an accelerated decline in global and domain-specific cognitive functions. Both neurodegenerative and cerebrovascular pathologies might contribute to this association.
Collapse
Affiliation(s)
- Zhangyu Wang
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Jiao Wang
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Jie Guo
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Abigail Dove
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Konstantinos Arfanakis
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Xiuying Qi
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - David A Bennett
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Weili Xu
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago.
| |
Collapse
|
7
|
Zhào H, Teulings HL, Xia C, Huang Y. Aged Patients With Severe Small Vessel Disease Exhibit Poor Bimanual Coordination During the Anti-Phase Horizontal Line Drawing Task. Percept Mot Skills 2022; 130:750-769. [PMID: 36562499 DOI: 10.1177/00315125221146230] [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: 12/24/2022]
Abstract
The present study explores whether SVD affects bimanual coordination, which is easier to detect than by conventional, MRI-based methods. We tested nine severe SVD patients, eight non-severe (i.e., moderate or mild) SVD patients, eleven healthy age-matched controls, and eight young adults. They were grouped according to Fazekas scale and by age. Participants performed horizontal line drawings with both hands simultaneously on two pen tablets. The movements consisted of rhythmic patterns where participants used both hands to draw horizontal lines in anti-phase on two pen tablets. Each participant underwent a series of neuropsychiatric assessments. Results showed that SVD patients exhibited in each hand smaller horizontal movement amplitudes with variability larger compared to the healthy age-matched controls. Only movement amplitudes appeared to decrease significantly with severity of SVD. Interestingly, we found no relevant differences between the age-matched, elderly controls and the young controls. Therefore, this effect appeared indicative of SVD. The variability of the lines orthogonal to the horizontal lines of the left, non-dominant hand differed only between the severe SVD group and the other groups. Furthermore, partial correlations demonstrated that the mean horizontal movement amplitude of the left hand was positively associated with the clock drawing test score, and the inter-manual asynchrony of the horizontal movements was positively associated with the Trail Making Test-B time. These results indicated that SVD patients show poor bimanual coordination, as reflected by spatial features such as movement amplitudes and variabilities, and abnormal bimanual coordination was associated with executive dysfunction.
Collapse
Affiliation(s)
- Hóngyi Zhào
- Department of Neurology, 617516The Seventh Medical Center of People's Liberation Army General Hospital, Beijing, China.,Department of Psychiatry, NO 984 Hospital of PLA, Beijing, China
| | | | - Cuiqiao Xia
- Department of Neurology, 617516The Seventh Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - Yonghua Huang
- Department of Neurology, 617516The Seventh Medical Center of People's Liberation Army General Hospital, Beijing, China
| |
Collapse
|
8
|
Hannawi Y, Vaidya D, Yanek LR, Johansen MC, Kral BG, Becker LC, Becker DM, Nyquist PA. Association of Vascular Properties With the Brain White Matter Hyperintensity in Middle-Aged Population. J Am Heart Assoc 2022; 11:e024606. [PMID: 35621212 PMCID: PMC9238713 DOI: 10.1161/jaha.121.024606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The periventricular white matter is more sensitive to the systemic hemodynamic alterations than the deep white matter because of differences in its vascular structure and systemic circulation relationship. We hypothesize that periventricular white matter hyperintensity (PVWMH) volume shows greater association than deep white matter hyperintensity (DWMH) volume with vascular properties (VPs) reflecting arterial stiffness and cardiovascular remodeling, indicators of the systemic circulation. Methods and Results A total of 426 participants (age, 59.0±6.1 years; 57.5% women; and 39.7% Black race) in the Genetic Study of Atherosclerosis Risk who were aged ≥50 years and had brain magnetic resonance imaging were studied. VPs included pulse pressure, hypertensive response to exercise, diastolic brachial artery diameter, diastolic common carotid artery diameter, common carotid artery distensibility coefficient, and left ventricular function. The relative associations of VPs with PVWMH and DWMH as multiple measures within the same individual were determined using multilevel linear models. We also determined if age modified the differences in VPs associations with PVWMH and DWMH. Our findings indicated that, within the same subject, PVWMH volume had greater association than DWMH volume with pulse pressure (P=0.002), hypertensive response to exercise (P=0.04), diastolic brachial artery diameter (P=0.012), and diastolic common carotid artery diameter (P=0.04), independent of age and cardiovascular risk factors. The differences of PVWMH versus DWMH associations with VPs did not differ at any age threshold. Conclusions We show, for the first time, that PVWMH has greater association than DWMH, independent of age, with vascular measurements of arterial stiffness and cardiovascular remodeling suggesting that changes in the systemic circulation affect the PVWMH and DWMH differently.
Collapse
Affiliation(s)
- Yousef Hannawi
- Division of Cerebrovascular Diseases and Neurocritical Care Department of Neurology The Ohio State University Columbus OH
| | - Dhananjay Vaidya
- GeneSTAR Research Program Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Lisa R Yanek
- GeneSTAR Research Program Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Michelle C Johansen
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD
| | - Brian G Kral
- GeneSTAR Research Program Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Lewis C Becker
- GeneSTAR Research Program Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Diane M Becker
- GeneSTAR Research Program Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Paul A Nyquist
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD.,Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore MD.,Division of Neurocritical Care Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD
| |
Collapse
|
9
|
Dewey BE, Xu X, Knutsson L, Jog A, Prince JL, Barker PB, van Zijl PCM, Leigh R, Nyquist P. MTT and Blood-Brain Barrier Disruption within Asymptomatic Vascular WM Lesions. AJNR Am J Neuroradiol 2021; 42:1396-1402. [PMID: 34083262 PMCID: PMC8367617 DOI: 10.3174/ajnr.a7165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/13/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE White matter lesions of presumed ischemic origin are associated with progressive cognitive impairment and impaired BBB function. Studying the longitudinal effects of white matter lesion biomarkers that measure changes in perfusion and BBB patency within white matter lesions is required for long-term studies of lesion progression. We studied perfusion and BBB disruption within white matter lesions in asymptomatic subjects. MATERIALS AND METHODS Anatomic imaging was followed by consecutive dynamic contrast-enhanced and DSC imaging. White matter lesions in 21 asymptomatic individuals were determined using a Subject-Specific Sparse Dictionary Learning algorithm with manual correction. Perfusion-related parameters including CBF, MTT, the BBB leakage parameter, and volume transfer constant were determined. RESULTS MTT was significantly prolonged (7.88 [SD, 1.03] seconds) within white matter lesions compared with normal-appearing white (7.29 [SD, 1.14] seconds) and gray matter (6.67 [SD, 1.35] seconds). The volume transfer constant, measured by dynamic contrast-enhanced imaging, was significantly elevated (0.013 [SD, 0.017] minutes-1) in white matter lesions compared with normal-appearing white matter (0.007 [SD, 0.011] minutes-1). BBB disruption within white matter lesions was detected relative to normal white and gray matter using the DSC-BBB leakage parameter method so that increasing BBB disruption correlated with increasing white matter lesion volume (Spearman correlation coefficient = 0.44; P < .046). CONCLUSIONS A dual-contrast-injection MR imaging protocol combined with a 3D automated segmentation analysis pipeline was used to assess BBB disruption in white matter lesions on the basis of quantitative perfusion measures including the volume transfer constant (dynamic contrast-enhanced imaging), the BBB leakage parameter (DSC), and MTT (DSC). This protocol was able to detect early pathologic changes in otherwise healthy individuals.
Collapse
Affiliation(s)
- B E Dewey
- From the Department of Electrical and Computer Engineering (B.E.D., J.L.P.), Johns Hopkins University, Baltimore, Maryland
- F.M. Kirby Research Center for Functional Brain Imaging (B.E.D., X.X., P.B.B., P.C.M.v.Z.), Kennedy Krieger Institute, Baltimore, Maryland
| | - X Xu
- F.M. Kirby Research Center for Functional Brain Imaging (B.E.D., X.X., P.B.B., P.C.M.v.Z.), Kennedy Krieger Institute, Baltimore, Maryland
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
| | - L Knutsson
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
- Department of Medical Radiation Physics (L.K.), Lund University, Lund, Sweden
| | - A Jog
- Athinoula A. Martinos Center for Biomedical Imaging (A.J.), Harvard University Medical School, Boston Massachusetts
| | - J L Prince
- From the Department of Electrical and Computer Engineering (B.E.D., J.L.P.), Johns Hopkins University, Baltimore, Maryland
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
| | - P B Barker
- F.M. Kirby Research Center for Functional Brain Imaging (B.E.D., X.X., P.B.B., P.C.M.v.Z.), Kennedy Krieger Institute, Baltimore, Maryland
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
| | - P C M van Zijl
- F.M. Kirby Research Center for Functional Brain Imaging (B.E.D., X.X., P.B.B., P.C.M.v.Z.), Kennedy Krieger Institute, Baltimore, Maryland
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
| | - R Leigh
- Department of Neurology (R.L., P.N.), Electrical and Computer Engineering (B.E.D., J.L.P.), Johns Hopkins University, Baltimore, Maryland
| | - P Nyquist
- Department of Neurology (R.L., P.N.), Electrical and Computer Engineering (B.E.D., J.L.P.), Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
10
|
Johansen MC, Nyquist P, Sullivan KJ, Fornage M, Gottesman RF, Becker DM. Cerebral Small-Vessel Disease in Individuals with a Family History of Coronary Heart Disease: The Atherosclerosis Risk in Communities Study. Neuroepidemiology 2021; 55:316-322. [PMID: 34139692 PMCID: PMC8371924 DOI: 10.1159/000516428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The degree to which a family history of coronary heart disease (FHCHD) is associated with silent cerebral small-vessel disease (cSVD) among healthy adults, independent of prevalent CHD and traditional risk factors, is unknown. METHODS The Atherosclerosis Risk in Communities (ARIC) study is a community-based cohort study with self-reported family history data and brain magnetic resonance imaging (ages 68-88). The association between markers of cSVD (lacunar infarcts and cerebral microbleeds), or log-transformed white matter hyperintensity (WMH) volume, and FHCHD, or the number of affected relatives was examined using separate adjusted logistic or linear regression models, respectively. Race interaction terms were evaluated. RESULTS Of 1,639 participants without prevalent CHD (76 ± 5 years, 62% female, 29% black), 686 (42%) had FHCHD. There were higher odds of lacunar infarct (OR 1.40, 95% CI 1.07-1.84) among those with parental FHCHD and higher odds of microhemorrhages (lobar OR 1.86, 95% CI 1.13-3.06; subcortical OR 1.47, 95% CI 1.01-2.15) among those with sibling FHCHD. A greater number of any relative affected was associated with higher odds of lacunar infarct (OR 1.24, 95% CI 1.04-1.47) and lobar microhemorrhages (OR 1.31, 95% CI 1.05-1.64) but not subcortical microhemorrhages (OR 1.09, 95% CI 0.92-1.28). Odds of having a lacunar infarct were higher among blacks (p-interaction 0.04) with paternal FHCHD (OR 2.20, CI 1.35-3.58) than whites with paternal FHCHD (OR 1.17, CI 0.87-1.56). There was no association with WMH. DISCUSSION/CONCLUSION Markers of cSVD, specifically lacunar infarcts and microhemorrhages, appear to be associated with FHCHD, potentially representing shared mechanisms in different vascular beds, and perhaps a genetic propensity for vascular disease.
Collapse
Affiliation(s)
- Michelle C. Johansen
- Johns Hopkins University School of Medicine (JHUSOM) Department of Neurology, Baltimore, MD
| | - Paul Nyquist
- Johns Hopkins University School of Medicine (JHUSOM) Department of Neurology, Baltimore, MD
- JHUSOM Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Kevin J. Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Myriam Fornage
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Rebecca F. Gottesman
- Johns Hopkins University School of Medicine (JHUSOM) Department of Neurology, Baltimore, MD
| | - Diane M. Becker
- JHUSOM Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| |
Collapse
|
11
|
What does hand motor function tell us about our aging brain in association with WMH? Aging Clin Exp Res 2021; 33:1577-1584. [PMID: 32860625 PMCID: PMC8203504 DOI: 10.1007/s40520-020-01683-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Abstract
Background White matter hyperintensities (WMH) are a common cerebral finding in older people. WMH are usually asymptomatic, but excessive WMH are associated with cognitive decline and dementia. WMH are also among the neurological findings most consistently associated with declining motor performance in healthy ageing. Aims To determine if WMH load is associated with simple and complex motor movements in dominant and non-dominant hands in cognitively intact older subjects. Methods Hand motor performance was assessed with the Purdue Pegboard and Finger-tapping tests on 44 healthy right-handed participants, mean age 70.9 years (range 59–84 years). Participants also underwent magnetic resonance (MR) imaging, which were used to quantify WMH volume. The effect of WMH on the motor parameters was assessed via mediation analyses. Results WMH load increased significantly with age, while the motor scores decreased significantly with age. WMH load mediated only the relationship between age and left-hand pegboard scores. Discussion WMH mediated only the more complex Purdue Pegboard task for the non-dominant hand. This is likely because complex movements in the non-dominant hand recruit a larger cerebral network, which is more vulnerable to WMH. Conclusions Complex hand movements in the non-dominant hand are mediated by WMH. Subtle loss of motor movements of non-dominant hand might predict future excessive white matter atrophy.
Collapse
|
12
|
Lammers F, Zacharias N, Borchers F, Mörgeli R, Spies CD, Winterer G. Functional Connectivity of the Supplementary Motor Network Is Associated with Fried's Modified Frailty Score in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 75:2239-2248. [PMID: 31900470 DOI: 10.1093/gerona/glz297] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Indexed: 01/22/2023] Open
Abstract
Frailty is a geriatric syndrome defined by coexistence of unintentional weight loss, low physical reserve, or activity and is associated with adverse health events. Neuroimaging studies reported structural white matter changes in frail patients. In the current study, we hypothesized that clinical frailty is associated also with functional changes in motion-related cortical areas, that is, (pre-)supplementary motor areas (SMA, pre-SMA). We expected that observed functional changes are related to motor-cognitive test performance. We studied a clinical sample of 143 cognitively healthy patients ≥65 years presenting for elective surgery, enrolled in the BioCog prospective multicentric cohort study on postoperative cognitive disorders. Participants underwent preoperative resting-state functional magnetic resonance imaging, motor-cognitive testing, and assessment of Fried's modified frailty criteria. We analyzed functional connectivity associations with frailty and motor-cognitive test performance. Clinically robust patients (N = 60) showed higher connectivity in the SMA network compared to frail (N = 13) and prefrail (N = 70) patients. No changes were found in the pre-SMA network. SMA connectivity correlated with motor speed (Trail-Making-Test A) and manual dexterity (Grooved Pegboard Test). Our results suggest that diminished functional connectivity of the SMA is an early correlate of functional decline in the older adults . The SMA may serve as a potential treatment target in frailty.
Collapse
Affiliation(s)
- Florian Lammers
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Norman Zacharias
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany.,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
| | - Friedrich Borchers
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Rudolf Mörgeli
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Claudia Doris Spies
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Georg Winterer
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany.,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
| |
Collapse
|
13
|
Hannawi Y, Yanek LR, Kral BG, Becker LC, Vaidya D, Haughey NJ, Becker DM, Nyquist PA. White Matter Injury Is Associated with Reduced Manual Dexterity and Elevated Serum Ceramides in Subjects with Cerebral Small Vessel Disease. Cerebrovasc Dis 2020; 50:100-107. [PMID: 33279889 PMCID: PMC7878290 DOI: 10.1159/000511937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We have demonstrated that asymptomatic cerebral small vessel disease (cSVD) measured by white matter hyperintensity volume is associated with reduced manipulative manual dexterity on the Grooved Peg Board Test (GPBT) in middle-aged healthy individuals with a family history of early coronary artery disease. In this current study, we aim to identify the association of subcortical white matter microstructural impairment measured by diffusion tensor imaging, manual dexterity measured by GPBT and circulating serums ceramide, another marker for white matter injury. We hypothesize that lower regional fractional anisotropy (rFA) is associated with worse performance on GPBT and elevated serum ceramides in the same study population. METHODS rFA of 48 regions representing the subcortical white matters were analyzed in GeneSTAR participants in addition to serum ceramides and GPBT scores. Unadjusted univariable analyses with Bonferroni correction for multiple comparisons were completed using Spearman correlation for testing the associations between ceramides, rFA of subcortical white matter, and GPBT performance. Subsequently, sensitivity analyses were performed after excluding the participants that had any physical limitation that may influence their performance on GPBT. Finally, in the adjusted analysis using generalized estimating equation, linear regression models were performed for the areas that met significance threshold in the unadjusted analyses. RESULTS 112 subjects (age [49 ± 11], 51% female, 39.3% African American) were included. Adjusted analyses for the significant correlations that met the Bonferroni correction threshold in the unadjusted univariable analyses identified significant negative associations between rFA of the right fornix (RF) and log-GPBT score (β = -0.497, p = 0.037). In addition, rFA of RF negatively correlated with log serum ceramide levels (C18: β = -0.03, p = 0.003, C20: β = -0.0002, p = 0.004) and rFA of left genu of corpus callosum negatively correlated with log C18 level (β = -0.0103, p = 0.027). CONCLUSIONS These results demonstrate that subcortical microstructural white matter disruption is associated with elevated serum ceramides and reduced manual dexterity in a population with cSVD. These findings suggest that injury to white matter tracts undermines neural networks, with functional consequences in a middle-aged population with cardiovascular risk factors.
Collapse
Affiliation(s)
- Yousef Hannawi
- Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University, Columbus, Ohio, USA
| | - Lisa R Yanek
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian G Kral
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lewis C Becker
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dhananjay Vaidya
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Norman J Haughey
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Diane M Becker
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul A Nyquist
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
- Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology and Critical Care Medicine, Neurosurgery, Johns Hopkins University, University School of Medicine, Baltimore, Maryland, USA,
| |
Collapse
|
14
|
Disrupted white matter integrity and network connectivity are related to poor motor performance. Sci Rep 2020; 10:18369. [PMID: 33110225 PMCID: PMC7591496 DOI: 10.1038/s41598-020-75617-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 10/15/2020] [Indexed: 11/24/2022] Open
Abstract
Motor impairment is common in the elderly population. Disrupted white matter tracts and the resultant loss of connectivity between cortical regions play an essential role in motor control. Using diffusion tensor imaging (DTI), we investigated the effect of white matter microstructure on upper-extremity and lower-extremity motor function in a community-based sample. A total of 766 participants (57.3 ± 9.2 years) completed the assessment of motor performance, including 3-m walking speed, 5-repeat chair-stand time, 10-repeat hand pronation-supination time, and 10-repeat finger-tapping time. Fractional anisotropy (FA), mean diffusivity (MD), and structural network connectivity parameters were calculated based on DTI. Lower FA and higher MD were associated with poor performance in walking, chair-stand, hand pronation-supination, and finger-tapping tests, independent of the presence of lacunes, white matter hyperintensities volume, and brain atrophy. Reduced network density, network strength, and global efficiency related to slower hand pronation-supination and finger-tapping, but not related to walking speed and chair-stand time. Disrupted white matter integrity and reduced cerebral network connectivity were associated with poor motor performance. Diffusion-based methods provide a more in-depth insight into the neural basis of motor dysfunction.
Collapse
|
15
|
Gutierrez J, Byrd D, Yin MT, Morgello S. Relationship Between Brain Arterial Pathology and Neurocognitive Performance Among Individuals With Human Immunodeficiency Virus. Clin Infect Dis 2020; 68:490-497. [PMID: 30107467 DOI: 10.1093/cid/ciy501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/11/2018] [Indexed: 12/24/2022] Open
Abstract
Background Human immunodeficiency virus-positive (HIV+) individuals have higher rates of cognitive impairment and cerebrovascular disease compared with uninfected populations. We hypothesize that cerebrovascular disease, specifically brain large artery disease, may play a role in HIV-associated neurocognitive disorders (HAND). Methods Participants (N = 94) in the Manhattan HIV Brain Bank study were followed on average 32 ± 33 months with repeated neuropsychological examinations until death. We used five cognitive domains (motor, processing speed, working memory, verbal fluency, and executive functioning) to assess ante mortem performance. We quantified the diameter of the lumen and arterial wall thickness obtained during autopsy. The diagnoses of HAND were attributed using the American Academy of Neurology nosology. We used generalized linear mixed model to account for repeated measures, follow-up time, and codependence between arteries. Models were adjusted for demographics, viral loads, CD4 counts, history of opportunistic infections, and vascular risks. Results We included 94 HIV+ individuals (mean age 56 ± 8.3, 68% men, 54% African American). In adjusted models, there was an association between arterial wall thickness and global cognitive score (B = -0.176, P value = .03), processing speed (B = -0.175, P = .05), and verbal fluency (B = -0.253, P = .02). Participants with incident or worsening HAND had thicker brain arterial walls (B = 0.523 ± 0.234, P = .03) and smaller arterial lumen (B = -0.633 ± 0.252, P = .01). Conclusions We report here a novel association between brain arterial wall thickening and poorer ante mortem cognitive performance and diagnosis of incident or worsening HAND at death. Strategies to preserve the arterial lumen or to prevent wall thickening may impact HAND.
Collapse
Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Stroke Division, New York Presbyterian/Columbia University Medical Center, New York
| | - Desiree Byrd
- Departments of Neurology and Pathology, Mount Sinai School of Medicine, New York Presbyterian/Columbia University Medical Center, New York
| | - Michael T Yin
- Department of Medicine, Infectious Disease Division, New York Presbyterian/Columbia University Medical Center, New York
| | - Susan Morgello
- Departments of Neurology and Pathology, Mount Sinai School of Medicine, New York Presbyterian/Columbia University Medical Center, New York
| |
Collapse
|
16
|
Ljubisavljevic MR, Oommen J, Filipovic S, Bjekic J, Szolics M, Nagelkerke N. Effects of tDCS of Dorsolateral Prefrontal Cortex on Dual-Task Performance Involving Manual Dexterity and Cognitive Task in Healthy Older Adults. Front Aging Neurosci 2019; 11:144. [PMID: 31275139 PMCID: PMC6592113 DOI: 10.3389/fnagi.2019.00144] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 05/31/2019] [Indexed: 01/29/2023] Open
Abstract
Healthy aging limits the activities of daily living and personal independence. Furthermore, cognitive-motor interference in dual-task (e.g., walking while talking) appears to be more pronounced in the elderly. Transcranial direct current stimulation (tDCS), a form of the non-invasive brain stimulation technique, is known to modify cortical excitability and has been investigated as a tool for enhancing motor and cognitive performance in health and disease. The present study examined whether tDCS targeting the dorsolateral prefrontal cortex (DLPFC) could improve dual-task performance in healthy older adults. The effects of tDCS, among other factors, depend on stimulation polarity (anodal vs. cathodal), electrode setup (unilateral vs. bilateral) and the time of application (off-line vs. on-line). We therefore explored the effects of unilateral and simultaneous bilateral tDCS (anodal and cathodal) of left DLPFC while performing (on-line) the Grooved Pegboard Test (GPT) and Serial Seven Subtraction Test (SSST) alone or together (dual-tasking). The number of pegs and the number of correct subtractions were recorded before, during and 30 min after tDCS. The dual-task performance was measured as the percent change from single- to the dual-task condition (dual-task cost DTC). Only bilateral, anode left tDCS, induced a significant increase in subtracted numbers while dual-tasking, i.e., it reduced the DTC of manual dexterity (GPT) to a cognitive task. Significant changes 30 min after the stimulation were only present after bilateral anode right (BAR) tDCS on GPT dual-task costs. These findings suggest that anodal tDCS applied on-line interacts with a dual-task performance involving demanding cognitive and manual dexterity tasks. The results support the potential use of non-invasive brain stimulation for improvement of cognitive functioning in daily activities in older individuals.
Collapse
Affiliation(s)
- Milos R Ljubisavljevic
- Department of Physiology, College of Medicine and Health Sciences (CMHS), UAE University, Al Ain, United Arab Emirates
| | - Joji Oommen
- Department of Physiology, College of Medicine and Health Sciences (CMHS), UAE University, Al Ain, United Arab Emirates
| | - Sasa Filipovic
- Department of Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Jovana Bjekic
- Department of Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Miklos Szolics
- Department of Internal Medicine, Neurology Section, Tawam Hospital, Al Ain, United Arab Emirates
| | - Nico Nagelkerke
- Institute of Public Health, College of Medicine and Health Sciences (CMHS), UAE University, Al Ain, United Arab Emirates
| |
Collapse
|
17
|
Frey BM, Petersen M, Mayer C, Schulz M, Cheng B, Thomalla G. Characterization of White Matter Hyperintensities in Large-Scale MRI-Studies. Front Neurol 2019; 10:238. [PMID: 30972001 PMCID: PMC6443932 DOI: 10.3389/fneur.2019.00238] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/22/2019] [Indexed: 01/18/2023] Open
Abstract
Background: White matter hyperintensities of presumed vascular origin (WMH) are a common finding in elderly people and a growing social malady in the aging western societies. As a manifestation of cerebral small vessel disease, WMH are considered to be a vascular contributor to various sequelae such as cognitive decline, dementia, depression, stroke as well as gait and balance problems. While pathophysiology and therapeutical options remain unclear, large-scale studies have improved the understanding of WMH, particularly by quantitative assessment of WMH. In this review, we aimed to provide an overview of the characteristics, research subjects and segmentation techniques of these studies. Methods: We performed a systematic review according to the PRISMA statement. One thousand one hundred and ninety-six potentially relevant articles were identified via PubMed search. Six further articles classified as relevant were added manually. After applying a catalog of exclusion criteria, remaining articles were read full-text and the following information was extracted into a standardized form: year of publication, sample size, mean age of subjects in the study, the cohort included, and segmentation details like the definition of WMH, the segmentation method, reference to methods papers as well as validation measurements. Results: Our search resulted in the inclusion and full-text review of 137 articles. One hundred and thirty-four of them belonged to 37 prospective cohort studies. Median sample size was 1,030 with no increase over the covered years. Eighty studies investigated in the association of WMH and risk factors. Most of them focussed on arterial hypertension, diabetes mellitus type II and Apo E genotype and inflammatory markers. Sixty-three studies analyzed the association of WMH and secondary conditions like cognitive decline, mood disorder and brain atrophy. Studies applied various methods based on manual (3), semi-automated (57), and automated segmentation techniques (75). Only 18% of the articles referred to an explicit definition of WMH. Discussion: The review yielded a large number of studies engaged in WMH research. A remarkable variety of segmentation techniques was applied, and only a minority referred to a clear definition of WMH. Most addressed topics were risk factors and secondary clinical conditions. In conclusion, WMH research is a vivid field with a need for further standardization regarding definitions and used methods.
Collapse
Affiliation(s)
- Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
18
|
Hannawi Y, Yanek L, Kral B, Vaidya D, Becker L, Becker D, Nyquist P. Hypertension Is Associated with White Matter Disruption in Apparently Healthy Middle-Aged Individuals. AJNR Am J Neuroradiol 2018; 39:2243-2248. [PMID: 30442693 PMCID: PMC6368444 DOI: 10.3174/ajnr.a5871] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/21/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Traditional cardiovascular risk factors have been associated with white matter disease. Because hypertension results in vascular stiffness and impaired cerebral perfusion, we hypothesized that it would be the most relevant risk factor for microstructural white matter disruption in apparently healthy middle-aged individuals with a family history of early-onset coronary artery disease. MATERIALS AND METHODS This was a cross-sectional analysis of participants in the Genetic Study of Atherosclerosis Risk with DTI. Regional fractional anisotropy of 181 segmented brain regions was measured using Eve WM Atlas. Risk factors were examined using univariate analysis for 48 regions representing deep WM structures. Minimal multivariable linear regression models adjusting for age, sex, and race and maximal linear regression models adjusting for cardiovascular risk factors were performed for regions meeting the Bonferroni threshold in the initial analysis. RESULTS Included were 116 subjects (mean age, 49 ± 11 years; 57% men) with a moderate load of cardiovascular risk factors. Subjects with hypertension had significantly lower regional fractional anisotropy in the right cingulum and left stria terminalis in the minimal and maximal regression models. Additionally, there was lower regional fractional anisotropy in the left fornix in the maximal model and right sagittal stratum in the minimal model. Systolic blood pressure values were significantly associated with regional fractional anisotropy in the left superior longitudinal fasciculus in the maximal model. There were no significant differences among regional fractional anisotropy values for other cardiovascular risk factors. CONCLUSIONS In middle-aged apparently healthy individuals with susceptibility to vascular disease, among all known cardiovascular risk factors, hypertension was associated with microstructural WM disruption.
Collapse
Affiliation(s)
- Y. Hannawi
- From the Department of Neurology (Y.H.), Division of Cerebrovascular Diseases and Neurocritical Care, Ohio State University, Columbus, Ohio
| | - L.R. Yanek
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - B.G. Kral
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D. Vaidya
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - L.C. Becker
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D.M. Becker
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - P.A. Nyquist
- Department of Anesthesiology and Critical Care Medicine (P.A.N.), Neurosciences Critical Care,Department of Neurology (P.A.N.), Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
19
|
Nyquist PA, Yanek LR, Kral BG, Becker LC, Vaidya D, Becker DM. White Matter Lesion Progression and Cognitive Function Over 5 Years in a Young Susceptible Population. Neuroepidemiology 2017; 49:62-63. [PMID: 28850949 DOI: 10.1159/000480238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/09/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Paul A Nyquist
- The Johns Hopkins GeneSTAR Research Program, Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | |
Collapse
|
20
|
A Robust Energy Minimization Algorithm for MS-Lesion Segmentation. ADVANCES IN VISUAL COMPUTING : ... INTERNATIONAL SYMPOSIUM, ISVC ... : PROCEEDINGS. INTERNATIONAL SYMPOSIUM ON VISUAL COMPUTING 2015; 9474:521-530. [PMID: 29034370 DOI: 10.1007/978-3-319-27857-5_47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The detection of multiple sclerosis lesion is important for many neuroimaging studies. In this paper, a new automatic robust algorithm for lesion segmentation based on MR images is proposed. This method takes full advantage of the decomposition of MR images into the true image that characterizes a physical property of the tissues and the bias field that accounts for the intensity inhomogeneity. An energy function is defined in term of the property of true image and bias field. The energy minimization is proposed for seeking the optimal segmentation result of lesions and white matter. Then postprocessing operations is used to select the most plausible lesions in the obtained hyperintense signals. The experimental results show that our approach is effective and robust for the lesion segmentation.
Collapse
|
21
|
Mudumbi SV. RLS and PLMS: an avenue toward better understanding the natural history and spectrum of cerebrovascular disease? Sleep Med 2015; 16:1427-1428. [DOI: 10.1016/j.sleep.2015.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/23/2015] [Indexed: 12/13/2022]
|