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McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, Christodorescu RM, Daskalopoulou SS, Ferro CJ, Gerdts E, Hanssen H, Harris J, Lauder L, McManus RJ, Molloy GJ, Rahimi K, Regitz-Zagrosek V, Rossi GP, Sandset EC, Scheenaerts B, Staessen JA, Uchmanowicz I, Volterrani M, Touyz RM. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024; 45:3912-4018. [PMID: 39210715 DOI: 10.1093/eurheartj/ehae178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Coenen M, de Kort FA, Weaver NA, Kuijf HJ, Aben HP, Bae HJ, Bordet R, Chen CP, Dewenter A, Doeven T, Dondaine T, Duering M, Fang R, van der Giessen RS, Kim J, Kim BJ, de Kort PL, Koudstaal PJ, Lee M, Lim JS, Lopes R, van Oostenbrugge RJ, Staals J, Yu KH, Biessels GJ, Biesbroek JM. Strategic white matter hyperintensity locations associated with post-stroke cognitive impairment: A multicenter study in 1568 stroke patients. Int J Stroke 2024; 19:916-924. [PMID: 38651756 PMCID: PMC11408955 DOI: 10.1177/17474930241252530] [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: 04/25/2024]
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) occurs in up to 50% of stroke survivors. Presence of pre-existing vascular brain injury, in particular the extent of white matter hyperintensities (WMH), is associated with worse cognitive outcome after stroke, but the role of WMH location in this association is unclear. AIMS We determined if WMH in strategic white matter tracts explain cognitive performance after stroke. METHODS Individual patient data from nine ischemic stroke cohorts with magnetic resonance imaging (MRI) were harmonized through the Meta VCI Map consortium. The association between WMH volumes in strategic tracts and domain-specific cognitive functioning (attention and executive functioning, information processing speed, language and verbal memory) was assessed using linear mixed models and lasso regression. We used a hypothesis-driven design, primarily addressing four white matter tracts known to be strategic in memory clinic patients: the left and right anterior thalamic radiation, forceps major, and left inferior fronto-occipital fasciculus. RESULTS The total study sample consisted of 1568 patients (39.9% female, mean age = 67.3 years). Total WMH volume was strongly related to cognitive performance on all four cognitive domains. WMH volume in the left anterior thalamic radiation was significantly associated with cognitive performance on attention and executive functioning and information processing speed and WMH volume in the forceps major with information processing speed. The multivariable lasso regression showed that these associations were independent of age, sex, education, and total infarct volume and had larger coefficients than total WMH volume. CONCLUSION These results show tract-specific relations between WMH volume and cognitive performance after ischemic stroke, independent of total WMH volume. This implies that the concept of strategic lesions in PSCI extends beyond acute infarcts and also involves pre-existing WMH. DATA ACCESS STATEMENT The Meta VCI Map consortium is dedicated to data sharing, following our guidelines.
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Affiliation(s)
- Mirthe Coenen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floor As de Kort
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo P Aben
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Régis Bordet
- Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France
| | - Christopher Plh Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Ageing and Cognition Center, National University Health System, Singapore
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Thomas Doeven
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thibaut Dondaine
- Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Rong Fang
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Jonguk Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Department of Neurology, School of Medicine, Inha University, Incheon, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Paul Lm de Kort
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Renaud Lopes
- Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France
| | | | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
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Huan S, Zhang S, Wang L, Liu C, Xu J, Ge Y, Huang Z, Cai W, Cao Y, You S. Association between fibrinogen and white matter lesions and cerebral atrophy in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:108008. [PMID: 39265859 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108008] [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: 04/17/2024] [Revised: 08/20/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Inflammation is a potential mechanism underlying the development of white matter lesions (WMLs) and cerebral atrophy. We aimed to investigate the relationship of fibrinogen levels with WMLs and cerebral atrophy in patients with acute ischemic stroke (AIS). METHODS A total of 701 AIS patients were enrolled. Participants were divided into four groups according to the quartiles of fibrinogen levels: Q1 < 2.58 g/L, Q2: 2.58-3.12 g/L, Q3: 3.12-3.67 g/L, Q4: ≥ 3.67 g/L. White matter hyperintensity (WMH), periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) were defined according to the Fazekas scale. Cerebral atrophy was defined according to global cortical atrophy scores. Univariate and multivariate logistic regression were used to explore the relationship of fibrinogen levels and WMHs, PVH, DWMH and cerebral atrophy. RESULTS Among 701 AIS patients, 498 (71.0 %), 425 (60.6 %), 442 (63.1 %), and 560 (79.9 %) had WMHs, PVH, DWMH and cerebral atrophy, respectively. After adjustment for potential covariates, the highest fibrinogen quartiles were significantly associated with increased risk of WMHs (odds ratio [OR] 1.97, 95 % confidence intervals [CI] 1.10-3.50), PVH (OR 1.85, 95 % CI 1.08-3.16) and cerebral atrophy (OR 2.53, 95 % CI 1.19-5.40) but not DWMH (OR 1.37 95 % CI 0.81-2.31) compared with the lowest fibrinogen quartile. Moreover, the association between elevated fibrinogen levels and the risk of WMLs and cerebral atrophy remained significant as continuous variables. CONCLUSIONS Increased baseline fibrinogen levels were independently associated with WMHs, PVH and cerebral atrophy in patients with ischemic stroke. Fibrinogen could be the potential blood biomarker of WMLs and cerebral atrophy.
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Affiliation(s)
- Suqiu Huan
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Shiya Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Lixuan Wang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
| | - Chenchen Liu
- Department of Medical Iconography, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Jiaping Xu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Yilun Ge
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Zhichao Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Wu Cai
- Department of Medical Iconography, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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Clancy U, Arteaga-Reyes C, Jaime Garcia D, Hewins W, Locherty R, Valdés Hernández MDC, Wiseman SJ, Stringer MS, Thrippleton M, Chappell FM, Jochems ACC, Liu X, Cheng Y, Zhang J, Rudilosso S, Kampaite A, Hamilton OKL, Brown R, Bastin ME, Muñoz Maniega S, Hamilton I, Job D, Doubal FN, Wardlaw JM. Incident Infarcts in Patients With Stroke and Cerebral Small Vessel Disease: Frequency and Relation to Clinical Outcomes. Neurology 2024; 103:e209750. [PMID: 39159417 PMCID: PMC11361828 DOI: 10.1212/wnl.0000000000209750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/25/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Factors associated with cerebral small vessel disease (SVD) progression, including incident infarcts, are unclear. We aimed to determine the frequency of incident infarcts over 1 year after minor stroke and their relation to baseline SVD burden, vascular risks, and recurrent stroke and cognitive outcomes. METHODS We recruited patients with lacunar or nondisabling cortical stroke. After diagnostic imaging, we repeated structural MRI at 3-6 monthly intervals for 12 months, visually assessing incident infarcts on diffusion-weighted imaging or FLAIR. We used logistic regression to determine associations of baseline vascular risks, SVD score, and index stroke subtype with subsequent incident infarcts. We assessed cognitive and functional outcomes at 1 year using Montreal Cognitive Assessment (MoCA) and modified Rankin scale (mRS), adjusting for baseline age, mRS, MoCA, premorbid intelligence, and SVD score. RESULTS We recruited 229 participants, mean age 65.9 (SD 11.1). Over half of all participants, 131 of 229 (57.2%) had had an index lacunar stroke. From baseline to 1-year MRI, we detected 117 incident infarcts in n = 57/229 (24.8%) participants. Incident infarcts were mainly of the small subcortical (86/117 [73.5%] in n = 38/57 [66.7%]) vs cortical infarct subtype (n = 19/57 [33.3%]). N = 39/57 participants had incident infarcts at 1 visit; 18 of 57 at 2 or more visits; and 19 of 57 participants had multiple infarcts at a single visit. Only 7 of 117 incident infarcts corresponded temporally to clinical stroke syndromes. The baseline SVD score was the strongest predictor of incident infarcts (adjusted odds ratio [OR] 1.87, 95% CI 1.39-2.58), while mean arterial pressure was not associated. All participants with incident infarcts were prescribed an antiplatelet or anticoagulant. Lower 1-year MoCA was associated with lower baseline MoCA (β 0.47, 95% CI 0.33-0.61), lower premorbid intelligence, and older age. Higher 1-year mRS was associated with higher baseline mRS only (OR 5.57 [3.52-9.10]). Neither outcome was associated with incident infarcts. DISCUSSION In the year after stroke in a population enriched for lacunar stroke, incident infarcts occurred in one-quarter and were associated with worse baseline SVD. Most incident infarcts detected on imaging did not correspond to clinical stroke/transient ischemic attack. Worse 1-year cognition and function were not associated with incident infarcts.
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Affiliation(s)
- Una Clancy
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Carmen Arteaga-Reyes
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Daniela Jaime Garcia
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Will Hewins
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Rachel Locherty
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Maria Del C Valdés Hernández
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Stewart J Wiseman
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Michael S Stringer
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Michael Thrippleton
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Francesca M Chappell
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Angela C C Jochems
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Xiaodi Liu
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Yajun Cheng
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Junfang Zhang
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Salvatore Rudilosso
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Agniete Kampaite
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Olivia K L Hamilton
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Rosalind Brown
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Mark E Bastin
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Susana Muñoz Maniega
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Iona Hamilton
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Dominic Job
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Fergus N Doubal
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Joanna M Wardlaw
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
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5
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Li Y, Cho SM, Avadhani R, Ali H, Hao Y, Murthy SB, Goldstein JN, Xia F, Hu X, Ullman NL, Awad I, Hanley D, Ziai WC. Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage. Stroke Vasc Neurol 2024; 9:446-456. [PMID: 37949482 PMCID: PMC11420921 DOI: 10.1136/svn-2023-002463] [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: 03/13/2023] [Accepted: 08/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) for spontaneous supratentorial intracerebral haemorrhage (ICH) is controversial but may be beneficial if end-of-treatment (EOT) haematoma volume is reduced to ≤15 mL. We explored whether MRI findings of cerebral small vessel disease (CSVD) modify the effect of MIS on long-term outcomes. METHODS Prespecified blinded subgroup analysis of 288 subjects with qualified imaging sequences from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation (MISTIE) trial. We tested for heterogeneity in the effects of MIS and MIS+EOT volume ≤15 mL on the trial's primary outcome of good versus poor function at 1 year by the presence of single CSVD features and CSVD scores using multivariable models. RESULTS Of 499 patients enrolled in MISTIE III, 288 patients had MRI, 149 (51.7%) randomised to MIS and 139 (48.3%) to standard medical care (SMC). Median (IQR) ICH volume was 42 (30-53) mL. In the full MRI cohort, there was no statistically significant heterogeneity in the effects of MIS versus SMC on 1-year outcomes by any specific CSVD feature or by CSVD scores (all Pinteraction >0.05). In 94 MIS patients with EOT ICH volume ≤15 mL, significant reduction in odds of poor outcome was found with cerebral amyloid angiopathy score <2 (OR, 0.14 (0.05-0.42); Pinteraction=0.006), absence of lacunes (OR, 0.37 (0.18-0.80); Pinteraction=0.02) and absence of severe white matter hyperintensities (WMHs) (OR, 0.22 (0.08-0.58); Pinteraction=0.03). CONCLUSIONS Following successful haematoma reduction by MIS, we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe WMHs. CSVD features may have utility for prognostication and patient selection in clinical trials of MIS.
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Affiliation(s)
- Yunke Li
- The George Institute for Global Health, Beijing, China
| | - Sung-Min Cho
- Department of Neurology, Division of Neurocritical Care, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Radhika Avadhani
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Hassan Ali
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Yi Hao
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Santosh B Murthy
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fan Xia
- Department of Neurosurgery, West China Hospital of Medicine, Chengdu, Sichuan, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital of Medicine, Chengdu, Sichuan, China
| | - Natalie L Ullman
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Issam Awad
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Daniel Hanley
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Wendy C Ziai
- Department of Neurology, Division of Neurocritical Care, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
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6
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Godefroy O, Aarabi A, Béjot Y, Biessels GJ, Glize B, Mok VC, Schotten MTD, Sibon I, Chabriat H, Roussel M. Are we ready to cure post-stroke cognitive impairment? Many key prerequisites can be achieved quickly and easily. Eur Stroke J 2024:23969873241271651. [PMID: 39129252 DOI: 10.1177/23969873241271651] [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: 08/13/2024] Open
Abstract
PURPOSE Post-stroke (PS) cognitive impairment (CI) is frequent and its devastating functional and vital consequences are well known. Despite recent guidelines, they are still largely neglected. A large number of recent studies have re-examined the epidemiology, diagnosis, imaging determinants and management of PSCI. The aim of this update is to determine whether these new data answer the questions that are essential to reducing PSCI, the unmet needs, and steps still to be taken. METHODS Literature review of stroke unit-era studies examining key steps in the management of PSCI: epidemiology and risk factors, diagnosis (cognitive profile and assessments), imaging determinants (quantitative measures, voxelwise localization, the disconnectome and associated Alzheimer's disease [AD]) and treatment (secondary prevention, symptomatic drugs, rehabilitation and noninvasive brain stimulation) of PSCI. FINDINGS (1) the prevalence of PSCI of approximately 50% is probably underestimated; (2) the sensitivity of screening tests should be improved to detect mild PSCI; (3) comprehensive assessment is now well-defined and should include apathy; (4) easily available factors can identify patients at high risk of PSCI; (5) key imaging determinants are the location and volume of the lesion and the resulting disconnection, associated AD and brain atrophy; WMH, ePVS, microhemorrhages, hemosiderosis, and cortical microinfarcts may contribute to cognitive impairment but are more likely to be markers of brain vulnerability or associated AD that reduce PS recovery; (6) remote and online assessment is a promising approach for selected patients; (7) secondary stroke prevention has not been proven to prevent PSCI; (8) symptomatic drugs are ineffective in treating PSCI and apathy; (9) in addition to cognitive rehabilitation, the benefits of training platforms and computerized training are yet to be documented; (10) the results and the magnitude of improvement of noninvasive brain stimulation, while very promising, need to be substantiated by large, high-quality, sham-controlled RCTs. DISCUSSION AND CONCLUSION These major advances pave the way for the reduction of PSCI. They include (1) the development of more sensitive screening tests applicable to all patients and (2) online remote assessment; crossvalidation of (3) clinical and (4) imaging factors to (5) identify patients at risk, as well as (6) factors that prompt a search for associated AD; (7) the inclusion of cognitive outcome as a secondary endpoint in acute and secondary stroke prevention trials; and (8) the validation of the benefit of noninvasive brain stimulation through high-quality, randomized, sham-controlled trials. Many of these objectives can be rapidly and easily attained.
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Affiliation(s)
- Olivier Godefroy
- Departments of Neurology, Amiens University Hospital, France
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Ardalan Aarabi
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Yannick Béjot
- Department of Neurology, Dijon University Hospital, France
- Dijon Stroke Registry, EA7460, University of Burgundy, France
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Bertrand Glize
- Department of Rehabilitation, University Hospital, Bordeaux, France
| | - Vincent Ct Mok
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Michel Thiebaut de Schotten
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodegeneratives-UMR 5293 CNRS CEA University of Bordeaux, Bordeaux, France
- Brain Connectivity and Behaviour Laboratory Sorbonne Universities Paris, France
| | - Igor Sibon
- Department of Neurology, University Hospital, Bordeaux, France
| | - Hugues Chabriat
- Department of Neurology, Lariboisière Hospital, and INSERM NeuroDiderot UMR 1141, Paris, France
| | - Martine Roussel
- Departments of Neurology, Amiens University Hospital, France
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
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7
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Yuan Y, Li N, Wang L, Heizhati M, Liu Y, Zhu Q, Hong J, Wu T. Aldosterone is Associated With New-onset Cerebrovascular Events in Patients With Hypertension and White Matter Lesions: A Cohort Study. Endocr Pract 2024; 30:718-725. [PMID: 38734410 DOI: 10.1016/j.eprac.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE White matter lesions (WMLs) increase the risk of stroke, stroke recurrence, and death. Higher plasma aldosterone concentration (PAC) increases the risk of stroke, acute myocardial infarction, and hypertension. The objective is to evaluate the relationship between PAC and cerebrovascular events in patients with hypertension and WMLs. METHODS We conducted a retrospective cohort study that included 1041 participants hospitalized. The outcome was new-onset cerebrovascular events including intracerebral hemorrhage and stroke. A Cox regression model was used to evaluate the relationship between baseline PAC and the risk of cerebrovascular events. RESULTS The mean age of participants was 60.9 ± 10.2 years and 565 (53.4%) were males. The median follow-up duration was 42 months (interquartile range: 25-67), and 92 patients experienced new-onset cerebrovascular events. In a multivariate-adjusted model, with PAC as a continuous variable, higher PAC increased the risk of cerebrovascular events; patient risk increased per 1 (hazard ratio [HR: 1.03], 95% confidence interval [CI]: 1.01-1.06, P < .01), per 5 (HR: 1.17, 95% CI: 1.06-1.31, P < .01), and per 10 ng/dL (HR: 1.41, 95%: 1.14-1.75, P < .01) increase in PAC. When PAC was expressed as a categorical variable (quartile: Q1-Q4), patients in Q4 (HR: 2.12, 95% CI: 1.18-3.79, P < .05) exhibited an increased risk of cerebrovascular events compared to Q1. Restrictive spline regression showed a linear association between PAC and the risk of new-onset cerebrovascular events after adjusting for all possible variables. CONCLUSIONS Our study identified a linear association between PAC and the risk of new-onset cerebrovascular events in patients with hypertension and WMLs.
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Affiliation(s)
- Yujuan Yuan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health, Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang, China
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health, Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang, China.
| | - Lei Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health, Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang, China
| | - Mulalibieke Heizhati
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health, Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang, China
| | - Yan Liu
- Radiography Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Qing Zhu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health, Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang, China
| | - Jing Hong
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health, Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang, China
| | - Ting Wu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health, Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang, China
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Rahmani M, Dierker D, Yaeger L, Saykin A, Luckett PH, Vlassenko AG, Owens C, Jafri H, Womack K, Fripp J, Xia Y, Tosun D, Benzinger TLS, Masters CL, Lee JM, Morris JC, Goyal MS, Strain JF, Kukull W, Weiner M, Burnham S, CoxDoecke TJ, Fedyashov V, Fripp J, Shishegar R, Xiong C, Marcus D, Raniga P, Li S, Aschenbrenner A, Hassenstab J, Lim YY, Maruff P, Sohrabi H, Robertson J, Markovic S, Bourgeat P, Doré V, Mayo CJ, Mussoumzadeh P, Rowe C, Villemagne V, Bateman R, Fowler C, Li QX, Martins R, Schindler S, Shaw L, Cruchaga C, Harari O, Laws S, Porter T, O'Brien E, Perrin R, Kukull W, Bateman R, McDade E, Jack C, Morris J, Yassi N, Bourgeat P, Perrin R, Roberts B, Villemagne V, Fedyashov V, Goudey B. Evolution of white matter hyperintensity segmentation methods and implementation over the past two decades; an incomplete shift towards deep learning. Brain Imaging Behav 2024:10.1007/s11682-024-00902-w. [PMID: 39083144 DOI: 10.1007/s11682-024-00902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 08/22/2024]
Abstract
This systematic review examines the prevalence, underlying mechanisms, cohort characteristics, evaluation criteria, and cohort types in white matter hyperintensity (WMH) pipeline and implementation literature spanning the last two decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we categorized WMH segmentation tools based on their methodologies from January 1, 2000, to November 18, 2022. Inclusion criteria involved articles using openly available techniques with detailed descriptions, focusing on WMH as a primary outcome. Our analysis identified 1007 visual rating scales, 118 pipeline development articles, and 509 implementation articles. These studies predominantly explored aging, dementia, psychiatric disorders, and small vessel disease, with aging and dementia being the most prevalent cohorts. Deep learning emerged as the most frequently developed segmentation technique, indicative of a heightened scrutiny in new technique development over the past two decades. We illustrate observed patterns and discrepancies between published and implemented WMH techniques. Despite increasingly sophisticated quantitative segmentation options, visual rating scales persist, with the SPM technique being the most utilized among quantitative methods and potentially serving as a reference standard for newer techniques. Our findings highlight the need for future standards in WMH segmentation, and we provide recommendations based on these observations.
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Affiliation(s)
- Maryam Rahmani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Andrew Saykin
- Department School of Medicine, Indiana University, Bloomington, IN, USA
| | - Patrick H Luckett
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrei G Vlassenko
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Knight Alzheimer Disease Research Center, St. Louis, MO, USA
- Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher Owens
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hussain Jafri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kyle Womack
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jurgen Fripp
- The Australian E-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, QLD, Australia
| | - Ying Xia
- The Australian E-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, QLD, Australia
| | - Duygu Tosun
- Division of Radiology and Biomedical Imaging, University of CA - San Francisco, San Francisco, CA, USA
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Knight Alzheimer Disease Research Center, St. Louis, MO, USA
| | - Colin L Masters
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Knight Alzheimer Disease Research Center, St. Louis, MO, USA
| | - Manu S Goyal
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeremy F Strain
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
- Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis, MO, USA.
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9
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Lawson B, Martin J, Aarabi A, Ouin E, Tasseel-Ponche S, Barbay M, Andriuta D, Roussel M, Godefroy O. Poststroke cognitive outcome is better accounted for by white matter abnormalities automated segmentation than visual analysis. Rev Neurol (Paris) 2024:S0035-3787(24)00557-5. [PMID: 39004559 DOI: 10.1016/j.neurol.2024.06.004] [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: 01/11/2023] [Revised: 04/06/2024] [Accepted: 06/11/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND AND AIMS The association between white matter abnormalities (WMA) and cognitive decline previously reported in poststroke patients has been mainly documented using visual scales. However, automated segmentation of WMA provides a precise determination of the volume of WMA. Nonetheless, it is rarely used in the stroke population and its potential advantage over visual scales is still unsettled. The objective of this study was to examine whether automated segmentation of WMA provides a better account than the visual Fazekas and Wahlund scales of the decline in executive functions and processing speed in stroke patients. METHODS The analyses were conducted on the 358 patients of the GRECogVASC cohort with an MRI performed at six months poststroke in the Amiens center. WMA were visually analyzed using the Fazekas (subcortical abnormalities) and Wahlund scales. Segmentation was performed using LST (3.0.3). Following preliminary studies to determine the optimal segmentation threshold, we examined the relationship between cognitive status and WMA volume computed at each threshold using receiver operating characteristic (ROC) curves. Finally, we assessed the ability of both Fazekas and Wahlund visual scores and WMA volume to account for cognitive scores by using a bivariate Pearson correlation analysis, comparing correlation coefficients with the Fisher transformation and repeating correlation analysis after adjustment for the lesion volume. RESULTS Increasing the threshold led to an underestimation of WMA (P=0.0001) (significant for a threshold ≥0.2) and an improvement in correct rejection of signal changes in the stroke cavity (P=0.02) (significant for a threshold ≤0.5), susceptibility artifacts (P=0.002) (significant for a threshold ≤0.6), and corticospinal degeneration (P=0.03) (significant for a threshold ≤0.5). WMA volume decreased with increasing threshold (P=0.0001). Areas under the curve (AUC) did not differ according to the threshold (processing speed: P=0.85, executive cognitive functions: P=0.7). Correlation coefficients between cognitive scores and WMA were higher for WMA volume than the Fazekas (processing speed: Z=-3.442, P=0.001; executive functions: Z=-2.751, P=0.006) and Wahlund scores (processing speed: Z=-3.615, P=0.0001; executive functions: Z=-2.769, P=0.006). Adjustment for lesion volume did not alter the correlations with WMA volume (processing speed: r=-0.327 [95%CI: -0.416; -0.223], P=0.0001; executive functions: r=-0.262 [95%CI: -0.363; -0.150], P=0.0001). CONCLUSION This study shows that WMA volume assessed by automated segmentation provides a better account of cognitive disorders than visual analysis. This should favor its wider use to refine imaging determinants of poststroke cognitive disorders.
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Affiliation(s)
- B Lawson
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - J Martin
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - A Aarabi
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - E Ouin
- Departments of Neurology, Amiens University Hospital, Amiens, France
| | - S Tasseel-Ponche
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - M Barbay
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - D Andriuta
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - M Roussel
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - O Godefroy
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France.
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10
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Wei W, Ma D, Li L, Zhang L. Cognitive impairment in cerebral small vessel disease induced by hypertension. Neural Regen Res 2024; 19:1454-1462. [PMID: 38051887 PMCID: PMC10883517 DOI: 10.4103/1673-5374.385841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/22/2023] [Indexed: 12/07/2023] Open
Abstract
ABSTRACT Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease, the most common cerebrovascular disease. However, the causal relationship between hypertension and cerebral small vessel disease remains unclear. Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease. Chronic hypertension and lifestyle factors are associated with risks for stroke and dementia, and cerebral small vessel disease can cause dementia and stroke. Hypertension is the main driver of cerebral small vessel disease, which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction, leukoaraiosis, white matter lesions, and intracerebral hemorrhage, ultimately resulting in cognitive decline and demonstrating that the brain is the target organ of hypertension. This review updates our understanding of the pathogenesis of hypertension-induced cerebral small vessel disease and the resulting changes in brain structure and function and declines in cognitive ability. We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.
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Affiliation(s)
- Weipeng Wei
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Denglei Ma
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lin Li
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lan Zhang
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
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11
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Ferris JK, Lo BP, Barisano G, Brodtmann A, Buetefisch CM, Conforto AB, Donnelly MR, Egorova-Brumley N, Hayward KS, Khlif MS, Revill KP, Zavaliangos-Petropulu A, Boyd L, Liew SL. Modulation of the Association Between Corticospinal Tract Damage and Outcome After Stroke by White Matter Hyperintensities. Neurology 2024; 102:e209387. [PMID: 38701386 PMCID: PMC11196095 DOI: 10.1212/wnl.0000000000209387] [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: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Motor outcomes after stroke relate to corticospinal tract (CST) damage. The brain leverages surviving neural pathways to compensate for CST damage and mediate motor recovery. Thus, concurrent age-related damage from white matter hyperintensities (WMHs) might affect neurologic capacity for recovery after CST injury. The role of WMHs in post-stroke motor outcomes is unclear. In this study, we evaluated whether WMHs modulate the relationship between CST damage and post-stroke motor outcomes. METHODS We used data from the multisite ENIGMA Stroke Recovery Working Group with T1 and T2/fluid-attenuated inversion recovery imaging. CST damage was indexed with weighted CST lesion load (CST-LL). WMH volumes were extracted with Freesurfer's SAMSEG. Mixed-effects beta-regression models were fit to test the impact of CST-LL, WMH volume, and their interaction on motor impairment, controlling for age, days after stroke, and stroke volume. RESULTS A total of 223 individuals were included. WMH volume related to motor impairment above and beyond CST-LL (β = 0.178, 95% CI 0.025-0.331, p = 0.022). Relationships varied by WMH severity (mild vs moderate-severe). In individuals with mild WMHs, motor impairment related to CST-LL (β = 0.888, 95% CI 0.604-1.172, p < 0.001) with a CST-LL × WMH interaction (β = -0.211, 95% CI -0.340 to -0.026, p = 0.026). In individuals with moderate-severe WMHs, motor impairment related to WMH volume (β = 0.299, 95% CI 0.008-0.590, p = 0.044), but did not significantly relate to CST-LL or a CST-LL × WMH interaction. DISCUSSION WMHs relate to motor outcomes after stroke and modify relationships between motor impairment and CST damage. WMH-related damage may be under-recognized in stroke research as a factor contributing to variability in motor outcomes. Our findings emphasize the importance of brain structural reserve in motor outcomes after brain injury.
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Affiliation(s)
- Jennifer K Ferris
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Bethany P Lo
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Giuseppe Barisano
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Amy Brodtmann
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Cathrin M Buetefisch
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Adriana B Conforto
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Miranda R Donnelly
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Natalia Egorova-Brumley
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Kathryn S Hayward
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Mohamed Salah Khlif
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Kate P Revill
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Artemis Zavaliangos-Petropulu
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Lara Boyd
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Sook-Lei Liew
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
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12
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Cheng YJ, Wang F, Feng J, Yu B, Wang B, Gao Q, Wang TY, Hu B, Gao X, Chen JF, Chen YJ, Lv SQ, Feng H, Xiao L, Mei F. Prolonged myelin deficits contribute to neuron loss and functional impairments after ischaemic stroke. Brain 2024; 147:1294-1311. [PMID: 38289861 DOI: 10.1093/brain/awae029] [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: 08/06/2023] [Revised: 12/29/2023] [Accepted: 01/13/2024] [Indexed: 02/01/2024] Open
Abstract
Ischaemic stroke causes neuron loss and long-term functional deficits. Unfortunately, effective approaches to preserving neurons and promoting functional recovery remain unavailable. Oligodendrocytes, the myelinating cells in the CNS, are susceptible to oxygen and nutrition deprivation and undergo degeneration after ischaemic stroke. Technically, new oligodendrocytes and myelin can be generated by the differentiation of oligodendrocyte precursor cells (OPCs). However, myelin dynamics and their functional significance after ischaemic stroke remain poorly understood. Here, we report numerous denuded axons accompanied by decreased neuron density in sections from ischaemic stroke lesions in human brain, suggesting that neuron loss correlates with myelin deficits in these lesions. To investigate the longitudinal changes in myelin dynamics after stroke, we labelled and traced pre-existing and newly-formed myelin, respectively, using cell-specific genetic approaches. Our results indicated massive oligodendrocyte death and myelin loss 2 weeks after stroke in the transient middle cerebral artery occlusion (tMCAO) mouse model. In contrast, myelin regeneration remained insufficient 4 and 8 weeks post-stroke. Notably, neuronal loss and functional impairments worsened in aged brains, and new myelin generation was diminished. To analyse the causal relationship between remyelination and neuron survival, we manipulated myelinogenesis by conditional deletion of Olig2 (a positive regulator) or muscarinic receptor 1 (M1R, a negative regulator) in OPCs. Deleting Olig2 inhibited remyelination, reducing neuron survival and functional recovery after tMCAO. Conversely, enhancing remyelination by M1R conditional knockout or treatment with the pro-myelination drug clemastine after tMCAO preserved white matter integrity and neuronal survival, accelerating functional recovery. Together, our findings demonstrate that enhancing myelinogenesis is a promising strategy to preserve neurons and promote functional recovery after ischaemic stroke.
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Affiliation(s)
- Yong-Jie Cheng
- Department of Neurosurgery and Key Laboratory of Neurotrauma, 1st affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Department of Histology and Embryology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Fei Wang
- Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Department of Histology and Embryology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jie Feng
- Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Department of Histology and Embryology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Bin Yu
- Department of Neurosurgery, 2nd affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Bin Wang
- Department of Physiology, Chongqing Key Laboratory of Neurobiology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Third Military Medical University, Chongqing 400038, China
| | - Qing Gao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
| | - Teng-Yue Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
| | - Bo Hu
- Department of Physiology, Chongqing Key Laboratory of Neurobiology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Third Military Medical University, Chongqing 400038, China
| | - Xing Gao
- Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Department of Histology and Embryology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jing-Fei Chen
- Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Department of Histology and Embryology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yu-Jie Chen
- Department of Neurosurgery and Key Laboratory of Neurotrauma, 1st affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Sheng-Qing Lv
- Department of Neurosurgery, 2nd affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hua Feng
- Department of Neurosurgery and Key Laboratory of Neurotrauma, 1st affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Lan Xiao
- Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Department of Histology and Embryology, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Department of Neurosurgery, 2nd affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Feng Mei
- Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Department of Histology and Embryology, Third Military Medical University (Army Medical University), Chongqing 400038, China
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13
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Blair G, Appleton JP, Mhlanga I, Woodhouse LJ, Doubal F, Bath PM, Wardlaw JM. Design of trials in lacunar stroke and cerebral small vessel disease: review and experience with the LACunar Intervention Trial 2 (LACI-2). Stroke Vasc Neurol 2024:svn-2023-003022. [PMID: 38569894 DOI: 10.1136/svn-2023-003022] [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: 12/05/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024] Open
Abstract
Cerebral small vessel disease (cSVD) causes lacunar stroke (25% of ischaemic strokes), haemorrhage, dementia, physical frailty, or is 'covert', but has no specific treatment. Uncertainties about the design of clinical trials in cSVD, which patients to include or outcomes to assess, may have delayed progress. Based on experience in recent cSVD trials, we reviewed ways to facilitate future trials in patients with cSVD.We assessed the literature and the LACunar Intervention Trial 2 (LACI-2) for data to inform choice of Participant, Intervention, Comparator, Outcome, including clinical versus intermediary endpoints, potential interventions, effect of outcome on missing data, methods to aid retention and reduce data loss. We modelled risk of missing outcomes by baseline prognostic variables in LACI-2 using binary logistic regression.Imaging versus clinical outcomes led to larger proportions of missing data. We present reasons for and against broad versus narrow entry criteria. We identified numerous repurposable drugs with relevant modes of action to test in various cSVD subtypes. Cognitive impairment is the most common clinical outcome after lacunar ischaemic stroke but was missing more frequently than dependency, quality of life or vascular events in LACI-2. Assessing cognitive status using Diagnostic and Statistical Manual for Mental Disorders Fifth Edition can use cognitive data from multiple sources and may help reduce data losses.Trials in patients with all cSVD subtypes are urgently needed and should use broad entry criteria and clinical outcomes and focus on ways to maximise collection of cognitive outcomes to avoid missing data.
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Affiliation(s)
| | - Jason P Appleton
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Iris Mhlanga
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Lisa J Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | | | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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14
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Zhang Y, Hamidi RE, Hadi M. Cerebral Small Vessel Ischemic Disease: A Source of Patient Panic or a Case of Pragmatic Reporting? Semin Roentgenol 2024; 59:157-164. [PMID: 38880514 DOI: 10.1053/j.ro.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Yi Zhang
- Department of Radiology, University of Louisville, 530 South Jackson Street, CCB-C07, Louisville, KY
| | - Ramin E Hamidi
- Department of Radiology, University of Louisville, 530 South Jackson Street, CCB-C07, Louisville, KY.
| | - Mohiuddin Hadi
- Department of Radiology, University of Louisville, 530 South Jackson Street, CCB-C07, Louisville, KY
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15
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Clancy U, Kancheva AK, Valdés Hernández MDC, Jochems ACC, Muñoz Maniega S, Quinn TJ, Wardlaw JM. Imaging Biomarkers of VCI: A Focused Update. Stroke 2024; 55:791-800. [PMID: 38445496 DOI: 10.1161/strokeaha.123.044171] [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: 03/07/2024]
Abstract
Vascular cognitive impairment is common after stroke, in memory clinics, medicine for the elderly services, and undiagnosed in the community. Vascular disease is said to be the second most common cause of dementia after Alzheimer disease, yet vascular dysfunction is now known to predate cognitive decline in Alzheimer disease, and most dementias at older ages are mixed. Neuroimaging has a major role in identifying the proportion of vascular versus other likely pathologies in patients with cognitive impairment. Here, we aim to provide a pragmatic but evidence-based summary of the current state of potential imaging biomarkers, focusing on magnetic resonance imaging and computed tomography, which are relevant to diagnosing, estimating prognosis, monitoring vascular cognitive impairment, and incorporating our own experiences. We focus on markers that are well-established, with a known profile of association with cognitive measures, but also consider more recently described, including quantitative tissue markers of vascular injury. We highlight the gaps in accessibility and translation to more routine clinical practice.
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Affiliation(s)
- Una Clancy
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Angelina K Kancheva
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (A.K.K., T.J.Q.)
| | - Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Angela C C Jochems
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (A.K.K., T.J.Q.)
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
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16
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Rau A, Reisert M, Taschner CA, Demerath T, Elsheikh S, Frank B, Köhrmann M, Urbach H, Kellner E. Reducing False-Positives in CT Perfusion Infarct Core Segmentation Using Contralateral Local Normalization. AJNR Am J Neuroradiol 2024; 45:277-283. [PMID: 38302197 DOI: 10.3174/ajnr.a8111] [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: 10/07/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND PURPOSE The established global threshold of rCBF <30% for infarct core segmentation can lead to false-positives, as it does not account for the differences in blood flow between GM and WM and patient-individual factors, such as microangiopathy. To mitigate this problem, we suggest normalizing each voxel not only with a global reference value (ie, the median value of normally perfused tissue) but also with its local contralateral counterpart. MATERIALS AND METHODS We retrospectively enrolled 2830 CTP scans with suspected ischemic stroke, of which 335 showed obvious signs of microangiopathy. In addition to the conventional, global normalization, a local normalization was performed by dividing the rCBF maps with their mirrored and smoothed counterpart, which sets each voxel value in relation to the contralateral counterpart, intrinsically accounting for GM and WM differences and symmetric patient individual microangiopathy. Maps were visually assessed and core volumes were calculated for both methods. RESULTS Cases with obvious microangiopathy showed a strong reduction in false-positives by using local normalization (mean 14.7 mL versus mean 3.7 mL in cases with and without microangiopathy). On average, core volumes were slightly smaller, indicating an improved segmentation that was more robust against naturally low blood flow values in the deep WM. CONCLUSIONS The proposed method of local normalization can reduce overestimation of the infarct core, especially in the deep WM and in cases with obvious microangiopathy. False-positives in CTP infarct core segmentation might lead to less-than-optimal therapy decisions when not correctly interpreted. The proposed method might help mitigate this problem.
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Affiliation(s)
- Alexander Rau
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology (A.R.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Diagnostic and Interventional Radiology (M.R., E.K.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery (M.R.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian A Taschner
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samer Elsheikh
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt Frank
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (B.F., M.K.), University Hospital Essen, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (B.F., M.K.), University Hospital Essen, Essen, Germany
| | - Horst Urbach
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Diagnostic and Interventional Radiology (M.R., E.K.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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17
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Hu X, Xiao Z, Shen Y, Yang W, Wang P, Li P, Wang Z, Pu M, Zhao L, Xie P, Li Q. SERPINA3: A novel inflammatory biomarker associated with cerebral small vessel disease burden in ischemic stroke. CNS Neurosci Ther 2024; 30:e14472. [PMID: 37721405 PMCID: PMC10916418 DOI: 10.1111/cns.14472] [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: 07/08/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Inflammation has emerged as a prominent risk factor for cerebral small vessel disease (CSVD). However, the specific association between various inflammatory biomarkers and the development of CSVD remains unclear. Serine proteinase inhibitor A3 (SERPINA3), Matrix metalloproteinase-9 (MMP-9), Tissue inhibitor metalloproteinase-1 (TIMP-1), Monocyte Chemoattractant Protein-1 (MCP-1) are several inflammatory biomarkers that are potentially involved in the development of CSVD. In this present study, we aimed to investigate the relationship between candidate molecules and CSVD features. METHOD The concentration of each biomarker was measured in 79 acute ischemic stroke patients admitted within 72 h after symptom onset. The associations between blood levels of inflammatory markers and CSVD score were investigated, as well as each CSVD feature, including white matter hyperintensities (WMH), lacunes, and enlarged perivascular spaces (EPVS). RESULTS The mean age was 69.0 ± 11.8 years, and 65.8% of participants were male. Higher SERPINA3 level (>78.90 ng/mL) was significantly associated with larger WMH volume and higher scores on Fazekas's scale in all three models. Multiple regression analyses revealed the linear association between absolute WMH burden and SERPINA3 level, especially in model 3 (β = 0.14; 95% confidence interval [CI], 0.04-0.24; p = 0.008 ). Restricted cubic spline regression demonstrated a dose-response relationship between SERPINA3 level and larger WMH volume (p nonlineariy = 0.0366 and 0.0378 in model 2 and mode 3, respectively). Using a receiving operating characteristic (ROC) curve, plasma SERPINA3 level of 64.15 ng/mL distinguished WMH >7.8 mL with the highest sensitivity and specificity (75.92% and 60%, respectively, area under curve [AUC] = 0.668, p = 0.0102). No statistically significant relationship has been found between other candidate biomarkers and CSVD features. CONCLUSION In summary, among four inflammatory biomarkers that we investigated, SERPINA3 level at baseline was associated with WMH severity, which revealed a novel biomarker for CSVD and validated its relationship with inflammation and endothelial dysfunction.
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Affiliation(s)
- Xiao Hu
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zhong‐Song Xiao
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yi‐Qing Shen
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Wen‐Song Yang
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Peng Wang
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Pei‐Zheng Li
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zi‐Jie Wang
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of NeurologyThe Second Hospital of Anhui Medical UniversityHefeiChina
| | - Ming‐Jun Pu
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Li‐Bo Zhao
- Department of NeurologyYongchuan Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of Cerebrovascular Disease ResearchChongqingChina
| | - Peng Xie
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Qi Li
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of NeurologyThe Second Hospital of Anhui Medical UniversityHefeiChina
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18
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Kneihsl M, Gattringer T, Hofer E, Rainer PP, Ranner G, Fandler-Höfler S, Haidegger M, Perl S, Enzinger C, Schmidt R. Cerebral white matter hyperintensities indicate severity and progression of coronary artery calcification. Sci Rep 2024; 14:4664. [PMID: 38409473 PMCID: PMC10897190 DOI: 10.1038/s41598-024-55305-0] [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: 10/27/2023] [Accepted: 02/22/2024] [Indexed: 02/28/2024] Open
Abstract
Cerebral white matter hyperintensities (WMH) have been associated with subclinical atherosclerosis including coronary artery calcification (CAC). However, previous studies on this association are limited by only cross-sectional analysis. We aimed to explore the relationship between WMH and CAC in elderly individuals both cross-sectionally and longitudinally. The study population consisted of elderly stroke- and dementia-free participants from the community-based Austrian Stroke Prevention Family Study (ASPFS). WMH volume and CAC levels (via Agatston score) were analyzed at baseline and after a 6-year follow-up period. Of 324 study participants (median age: 68 years), 115 underwent follow-up. Baseline WMH volume (median: 4.1 cm3) positively correlated with baseline CAC levels in multivariable analysis correcting for common vascular risk factors (p = 0.010). While baseline CAC levels were not predictive for WMH progression (p = 0.447), baseline WMH volume was associated CAC progression (median Agatston score progression: 27) in multivariable analysis (ß = 66.3 ± 22.3 [per cm3], p = 0.004). Ten of 11 participants (91%) with severe WMH (Fazekas Scale: 3) at baseline showed significant CAC progression > 100 during follow-up. In this community-based cohort of elderly individuals, WMH were associated with CAC and predictive of its progression over a 6-year follow-up. Screening for coronary artery disease might be considered in people with more severe WMH.
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Affiliation(s)
- Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
| | - Edith Hofer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | | | - Simon Fandler-Höfler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Melanie Haidegger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Sabine Perl
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
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19
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Hakim A, Gallucci L, Sperber C, Rezny-Kasprzak B, Jäger E, Meinel T, Seiffge D, Goeldlin M, Westphalen F, Fischer U, Wiest R, Arnold M, Umarova R. The analysis of association between single features of small vessel disease and stroke outcome shows the independent impact of the number of microbleeds and presence of lacunes. Sci Rep 2024; 14:3402. [PMID: 38336856 PMCID: PMC10858245 DOI: 10.1038/s41598-024-53500-7] [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: 08/30/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
The impact of small vessel disease (SVD) on stroke outcome was investigated either separately for its single features in isolation or for SVD sum score measuring a qualitative (binary) assessment of SVD-lesions. We aimed to investigate which SVD feature independently impacts the most on stroke outcome and to compare the continuous versus binary SVD assessment that reflects pronouncement and presence correspondingly. Patients with a first-ever anterior circulation ischemic stroke were retrospectively investigated. We performed an ordered logistic regression analysis to predict stroke outcome (mRS 3 months, 0-6) using age, stroke severity, and pre-stroke disability as baseline input variables and adding SVD-features (lacunes, microbleeds, enlarged perivascular spaces, white matter hyperintensities) assessed either continuously (model 1) or binary (model 2). The data of 873 patients (age 67.9 ± 15.4, NIHSS 24 h 4.1 ± 4.8) was analyzed. In model 1 with continuous SVD-features, the number of microbleeds was the only independent predictor of stroke outcome in addition to clinical parameters (OR 1.21; 95% CI 1.07-1.37). In model 2 with the binary SVD assessment, only the presence of lacunes independently improved the prediction of stroke outcome (OR 1.48, 1.1-1.99). In a post hoc analysis, both the continuous number of microbleeds and the presence of lacunes were independent significant predictors. Thus, the number of microbleeds evaluated continuously and the presence of lacunes are associated with stroke outcome independent from age, stroke severity, pre-stroke disability and other SVD-features. Whereas the presence of lacunes is adequately represented in SVD sum score, the microbleeds assessment might require another cutoff and/or gradual scoring, when prediction of stroke outcome is needed.
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Affiliation(s)
- Arsany Hakim
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Laura Gallucci
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Christoph Sperber
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Beata Rezny-Kasprzak
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Eugen Jäger
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Meinel
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Martina Goeldlin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Franziska Westphalen
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Roland Wiest
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland
| | - Roza Umarova
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland.
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21
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Sampatakakis SN, Mourtzi N, Charisis S, Mamalaki E, Ntanasi E, Hatzimanolis A, Ramirez A, Lambert JC, Yannakoulia M, Kosmidis MH, Dardiotis E, Hadjigeorgiou G, Sakka P, Scarmeas N. Genetic Predisposition for White Matter Hyperintensities and Risk of Mild Cognitive Impairment and Alzheimer's Disease: Results from the HELIAD Study. Curr Issues Mol Biol 2024; 46:934-947. [PMID: 38275674 PMCID: PMC10814944 DOI: 10.3390/cimb46010060] [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: 12/28/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
The present study investigated the association of genetic predisposition for white matter hyperintensities (WMHs) with incident amnestic mild cognitive impairment (aMCI) or Alzheimer's disease (AD), as well as whether such an association was influenced by age, sex, and cognitive reserve. Overall, 537 individuals without aMCI or dementia at baseline were included. Among them, 62 individuals developed aMCI/AD at follow up. Genetic propensity to WMH was estimated using a polygenic risk score for WMHs (PRS WMH). The association of PRS WMH with aMCI/AD incidence was examined using COX models. A higher PRS WMH was associated with a 47.2% higher aMCI/AD incidence (p = 0.015) in the fully adjusted model. Subgroup analyses showed significant results in the older age group, in which individuals with a higher genetic predisposition for WMHs had a 3.4-fold higher risk for developing aMCI/AD at follow up (p < 0.001), as well as in the lower cognitive reserve (CR, proxied by education years) group, in which individuals with a higher genetic predisposition for WMHs had an over 2-fold higher risk (p = 0.013). Genetic predisposition for WMHs was associated with aMCI/AD incidence, particularly in the group of participants with a low CR. Thus, CR might be a modifier in the relationship between genetic predisposition for WMHs and incident aMCI/AD.
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Affiliation(s)
- Stefanos N. Sampatakakis
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
| | - Niki Mourtzi
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
| | - Sokratis Charisis
- Department of Neurology, UT Health San Antonio, San Antonio, TX 78229, USA;
| | - Eirini Mamalaki
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
| | - Eva Ntanasi
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
| | - Alexandros Hatzimanolis
- Department of Psychiatry, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece;
| | - Alfredo Ramirez
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, 50923 Cologne, Germany
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE Bonn), 53127 Bonn, Germany
- Department of Psychiatry, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, San Antonio, TX 78229, USA
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50923 Cologne, Germany
| | - Jean-Charles Lambert
- Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liés au Vieillissement, University of Lille, 59000 Lille, France;
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece;
| | - Mary H. Kosmidis
- Lab of Neuropsychology and Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece;
| | | | - Paraskevi Sakka
- Athens Association of Alzheimer’s Disease and Related Disorders, 11636 Marousi, Greece;
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10027, USA
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Umarova RM, Gallucci L, Hakim A, Wiest R, Fischer U, Arnold M. Adaptation of the Concept of Brain Reserve for the Prediction of Stroke Outcome: Proxies, Neural Mechanisms, and Significance for Research. Brain Sci 2024; 14:77. [PMID: 38248292 PMCID: PMC10813468 DOI: 10.3390/brainsci14010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
The prediction of stroke outcome is challenging due to the high inter-individual variability in stroke patients. We recently suggested the adaptation of the concept of brain reserve (BR) to improve the prediction of stroke outcome. This concept was initially developed alongside the one for the cognitive reserve for neurodegeneration and forms a valuable theoretical framework to capture high inter-individual variability in stroke patients. In the present work, we suggest and discuss (i) BR-proxies-quantitative brain characteristics at the time stroke occurs (e.g., brain volume, hippocampus volume), and (ii) proxies of brain pathology reducing BR (e.g., brain atrophy, severity of white matter hyperintensities), parameters easily available from a routine MRI examination that might improve the prediction of stroke outcome. Though the influence of these parameters on stroke outcome has been partly reported individually, their independent and combined impact is yet to be determined. Conceptually, BR is a continuous measure determining the amount of brain structure available to mitigate and compensate for stroke damage, thus reflecting individual differences in neural resources and a capacity to maintain performance and recover after stroke. We suggest that stroke outcome might be defined as an interaction between BR at the time stroke occurs and lesion load. BR in stroke can potentially be influenced, e.g., by modifying cardiovascular risk factors. In addition to the potential power of the BR concept in a mechanistic understanding of inter-individual variability in stroke outcome and establishing individualized therapeutic approaches, it might help to strengthen the synergy of preventive measures in stroke, neurodegeneration, and healthy aging.
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Affiliation(s)
- Roza M. Umarova
- Department of Neurology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (L.G.); (U.F.); (M.A.)
| | - Laura Gallucci
- Department of Neurology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (L.G.); (U.F.); (M.A.)
| | - Arsany Hakim
- Department of Neuroradiology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (A.H.); (R.W.)
| | - Roland Wiest
- Department of Neuroradiology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (A.H.); (R.W.)
| | - Urs Fischer
- Department of Neurology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (L.G.); (U.F.); (M.A.)
- Department of Neurology, University Hospital Basel, University of Basel, 4003 Basel, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (L.G.); (U.F.); (M.A.)
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Karimi E, Arab A, Sepidarkish M, Khorvash F, Saadatnia M, Amani R. Effects of the royal jelly consumption on post-stroke complications in patients with ischemic stroke: results of a randomized controlled trial. Front Nutr 2024; 10:1227414. [PMID: 38260068 PMCID: PMC10800663 DOI: 10.3389/fnut.2023.1227414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Aims There is a paucity of evidence regarding the benefit of royal jelly (RJ) on post-stroke complications in patients with ischemic stroke. To address this knowledge gap, this randomized, triple-blind, placebo-controlled clinical trial was carried out to determine the effects of RJ consumption on post-stroke clinical outcomes. Methods Of 64 eligible ischemic stroke patients (45-80 years), 32 were randomized to the RJ and 32 to the placebo groups and completed a 12-week intervention. The intervention group was advised to receive 1,000 mg of RJ dragee daily after breakfast. Post-stroke complications including cognition, fatigue, mental health, and appetite, along with serum levels of brain-derived neurotrophic factor (BDNF), and mid-upper arm circumference (MUAC) were assessed in groups pre-and post-intervention. Results After 12 weeks of RJ consumption, cognitive function [adjusted mean difference, 4.71; 95% confidence interval (CI), 1.75 to 7.67], serum levels of BDNF (adjusted mean difference, 0.36; 95% CI, 0.05 to 0.67), stress (adjusted mean difference, -3.33; 95% CI, -6.50 to -0.17), and appetite (adjusted mean difference, 1.38; 95% CI, 0.19 to 2.56) were significantly improved. However, the findings for fatigue (adjusted mean difference, -4.32; 95% CI, -10.28 to 1.63), depression (adjusted mean difference, -1.71; 95% CI, -5.58 to 2.16), anxiety (adjusted mean difference, -2.50; 95% CI, -5.50 to 0.49), and MUAC (adjusted mean difference, 0.36; 95% CI, -0.11 to 0.84) were less favorable. Conclusion Findings support the benefits of RJ consumption in improving post-stroke complications and clinical outcomes.Clinical trial registration: https://www.irct.ir/trial/59275, Identifier IRCT20180818040827N4.
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Affiliation(s)
- Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
- Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arman Arab
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Mahdi Sepidarkish
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Amani
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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24
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Filler J, Georgakis MK, Dichgans M. Risk factors for cognitive impairment and dementia after stroke: a systematic review and meta-analysis. THE LANCET. HEALTHY LONGEVITY 2024; 5:e31-e44. [PMID: 38101426 DOI: 10.1016/s2666-7568(23)00217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Cognitive impairment and dementia are highly prevalent among stroke survivors and represent a major burden for patients, carers, and health-care systems. We studied the risk factors for post-stroke cognitive impairment (PSCI) and dementia (PSD) beyond the well established risk factors of age and stroke severity. METHODS In this systematic review and meta-analysis we conducted a systematic literature search from database inception until Sept 15, 2023. We selected prospective and retrospective cohort studies, post-hoc analyses from randomised controlled trials, and nested case-control studies of patients with acute stroke (ischaemic, haemorrhagic, and transient ischaemic attack), exploring associations between risk factors at baseline and PSCI or PSD over a follow-up period of at least 3 months. Study quality was assessed using the Newcastle-Ottawa quality assessment scale. We calculated pooled relative risks (RRs) with random-effects meta-analyses and performed subgroup, meta-regression, and sensitivity analyses. This study was preregistered with PROSPERO, CRD42020164959. FINDINGS We identified 162 eligible articles for our systematic review, of which 113 articles (89 studies, 160 783 patients) were eligible for meta-analysis. Baseline cognitive impairment was the strongest risk factor for PSCI (RR 2·00, 95% CI 1·66-2·40) and PSD (3·10, 2·77-3·47). We identified diabetes (1·29, 1·14-1·45), presence or history of atrial fibrillation (1·29, 1·04-1·60), presence of moderate or severe white matter hyperintensities (WMH; 1·51, 1·20-1·91), and WMH severity (1·30, 1·10-1·55, per SD increase) as treatable risk factors for PSCI, independent of age and stroke severity. For PSD, we identified diabetes (1·38, 1·10-1·72), presence of moderate or severe WMH (1·55, 1·01-2·38), and WMH severity (1·61, 1·20-2·14, per SD increase) as treatable risk factors. Additional risk factors included lower educational attainment, previous stroke, left hemisphere stroke, presence of three or more lacunes, brain atrophy, and low baseline functional status. Associations of risk factors with PSD were weaker in studies conducted and published more recently. We found substantial interstudy heterogeneity and evidence of reporting bias. INTERPRETATION Our results highlight the importance of cognitive impairment in the acute phase after stroke for long-term prediction of PSCI and PSD. Treatable risk factors include diabetes, atrial fibrillation, and markers of cerebral small vessel disease (ie, white matter hyperintensities and lacunes). Future trials should explore these risk factors as potential targets for prevention of PSCI and PSD. FUNDING German Research Foundation.
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Affiliation(s)
- Jule Filler
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Graduate School for Systemic Neurosciences, Ludwig-Maximilians-University, Munich, Germany
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases, Munich, Germany; German Center for Cardiovascular Research, Munich, Germany.
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25
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Vadinova V, Sihvonen AJ, Wee F, Garden KL, Ziraldo L, Roxbury T, O'Brien K, Copland DA, McMahon KL, Brownsett SLE. The volume and the distribution of premorbid white matter hyperintensities: Impact on post-stroke aphasia. Hum Brain Mapp 2024; 45:e26568. [PMID: 38224539 PMCID: PMC10789210 DOI: 10.1002/hbm.26568] [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: 01/18/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024] Open
Abstract
White matter hyperintensities (WMH) are a radiological manifestation of progressive white matter integrity loss. The total volume and distribution of WMH within the corpus callosum have been associated with pathological cognitive ageing processes but have not been considered in relation to post-stroke aphasia outcomes. We investigated the contribution of both the total volume of WMH, and the extent of WMH lesion load in the corpus callosum to the recovery of language after first-ever stroke. Behavioural and neuroimaging data from individuals (N = 37) with a left-hemisphere stroke were included at the early subacute stage of recovery. Spoken language comprehension and production abilities were assessed using word and sentence-level tasks. Neuroimaging data was used to derive stroke lesion variables (volume and lesion load to language critical regions) and WMH variables (WMH volume and lesion load to three callosal segments). WMH volume did not predict variance in language measures, when considered together with stroke lesion and demographic variables. However, WMH lesion load in the forceps minor segment of the corpus callosum explained variance in early subacute comprehension abilities (t = -2.59, p = .01) together with corrected stroke lesion volume and socio-demographic variables. Premorbid WMH lesions in the forceps minor were negatively associated with early subacute language comprehension after aphasic stroke. This negative impact of callosal WMH on language is consistent with converging evidence from pathological ageing suggesting that callosal WMH disrupt the neural networks supporting a range of cognitive functions.
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Affiliation(s)
- Veronika Vadinova
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
| | - A. J. Sihvonen
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
- Cognitive Brain Research Unit (CBRU)University of HelsinkiHelsinkiFinland
- Centre of Excellence in Music, Mind, Body and BrainUniversity of HelsinkiHelsinkiFinland
| | - F. Wee
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - K. L. Garden
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
| | - L. Ziraldo
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - T. Roxbury
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - K. O'Brien
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - D. A. Copland
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
| | - K. L. McMahon
- School of Clinical Sciences, Centre for Biomedical TechnologiesQueensland University of TechnologyBrisbaneAustralia
| | - S. L. E. Brownsett
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
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Hou Y, Qin W, Yang S, Li Y, Yang L, Hu W. Diffusion-weighted Imaging Detection of Acute Ischemia Brain Lesions in Spontaneous Intracerebral Hemorrhage Associated with White Matter Hyperintensities, Enlarged Perivascular Spaces and Diabetes Mellitus. Curr Neurovasc Res 2024; 20:544-552. [PMID: 38288839 DOI: 10.2174/0115672026283323240108052711] [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: 09/20/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 07/16/2024]
Abstract
OBJECTIVE Diffusion-weighted imaging (DWI) is commonly detected after spontaneous intracerebral hemorrhage (sICH) and is associated with poor functional outcomes. However, the etiology and significance of DWI lesions remain unclear. Thus, our study aimed to explore the prevalence and risk factors of acute ischemic lesions in sICH and discussed the possible mechanisms. METHODS We conducted a retrospective review of a consecutive cohort of 408 patients from June 2013 to October 2019 with sICH, who had brain computed tomography (CT) and magnetic resonance imaging (MRI) within 14 days of symptoms onset. Acute ischemic lesions were assessed on MRI using DWI lesions. We compared the clinical and imaging characteristics of patients with and without DWI lesions. The data were analyzed by univariate and multivariate logistic regression. RESULTS Among the enrolled 408 patients, the mean age was 56.8 ± 14.5 years, 68 (16.7%) of them had been diagnosed with diabetes mellitus (DM). DWI lesions were observed in 89 (21.8%) patients, and most of them had a history of lacunar infarctions, which were located in cortical or subcortical. In multivariate logistic regression analysis, DM (odds ratio (OR) 3.962, p <0.001), severe deep white matter hypertensities (DWMH) (OR 2.463, p =0.001) and severe centrum semiovale enlarged perivascular spaces (CSO-EPVS) (OR 2.679, p =0.001) were independently associated with the presence of DWI lesions. CONCLUSION In our cohort, we found DM, severe DWMH and severe CSO-EPVS were the independent risk factors in sICH patients with DWI lesions.
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Affiliation(s)
- Yutong Hou
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lei Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Goodman GW, Do TH, Tan C, Ritzel RM. Drivers of Chronic Pathology Following Ischemic Stroke: A Descriptive Review. Cell Mol Neurobiol 2023; 44:7. [PMID: 38112809 DOI: 10.1007/s10571-023-01437-2] [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: 08/22/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023]
Abstract
Stroke is the third leading cause of death and long-term disability in the world. Considered largely a disease of aging, its global economic and healthcare burden is expected to rise as more people survive into advanced age. With recent advances in acute stroke management, including the expansion of time windows for treatment with intravenous thrombolysis and mechanical thrombectomy, we are likely to see an increase in survival rates. It is therefore critically important to understand the complete pathophysiology of ischemic stroke, both in the acute and subacute stages and during the chronic phase in the months and years following an ischemic event. One of the most clinically relevant aspects of the chronic sequelae of stroke is its extended negative effect on cognition. Cognitive impairment may be related to the deterioration and dysfunctional reorganization of white matter seen at later timepoints after stroke, as well as ongoing progressive neurodegeneration. The vasculature of the brain also undergoes significant insult and remodeling following stroke, undergoing changes which may further contribute to chronic stroke pathology. While inflammation and the immune response are well established drivers of acute stroke pathology, the chronicity and functional role of innate and adaptive immune responses in the post-ischemic brain and in the peripheral environment remain largely uncharacterized. In this review, we summarize the current literature on post-stroke injury progression, its chronic pathological features, and the putative secondary injury mechanisms underlying the development of cognitive impairment and dementia. We present findings from clinical and experimental studies and discuss the long-term effects of ischemic stroke on both brain anatomy and functional outcome. Identifying mechanisms that occur months to years after injury could lead to treatment strategies in the chronic phase of stroke to help mitigate stroke-associated cognitive decline in patients.
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Affiliation(s)
- Grant W Goodman
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Trang H Do
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Chunfeng Tan
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rodney M Ritzel
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Backhouse EV, Bauermeister S, Wardlaw JM. Lifetime influences on imaging markers of adverse brain health and vascular disease. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100194. [PMID: 38292018 PMCID: PMC10827485 DOI: 10.1016/j.cccb.2023.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/13/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
Cerebral small vessel disease (cSVD) is highly prevalent in the general population, increases with age and vascular risk factor exposure, and is a common cause of stroke and dementia. There is great variation in cSVD burden experienced in older age, and maintaining brain health across the life course requires looking beyond an individual's current clinical status and traditional vascular risk factors. Of particular importance are social determinants of health which can be more important than healthcare or lifestyle choices in influencing later life health outcomes, including brain health. In this paper we discuss the social determinants of cerebrovascular disease, focusing on the impact of socioeconomic status on markers of cSVD. We outline the potential mechanisms behind these associations, including early life exposures, health behaviours and brain reserve and maintenance, and we highlight the importance of public health interventions to address the key determinants and risk factors for cSVD from early life stages.
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Affiliation(s)
- Ellen V Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- MRC UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Bauermeister
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- MRC UK Dementia Research Institute, University of Oxford, Oxford OX3 7JX, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- MRC UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
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29
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Gunkel S, Schötzau A, Fluri F. Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke. Sci Rep 2023; 13:22070. [PMID: 38086878 PMCID: PMC10716411 DOI: 10.1038/s41598-023-49502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023] Open
Abstract
Elevated and low blood pressure (BP) may lead to poor functional outcome after ischemic stroke, which is conflicting. Hence, there must be another factor-such as cerebral small vessel disease (cSVD) -interacting with BP and thus, affecting outcome. Here, we investigate the relationship between BP and cSVD regarding outcome after stroke. Data of 423/503 stroke patients were prospectively analyzed. Diastolic (DBP) and systolic BP (SBP) were collected on hospital admission (BPad) and over the first 72 h (BP72h). cSVD-burden was determined on MR-scans. Good functional outcome was defined as a modified Rankin Scale score ≤ 2 at hospital discharge and 12 months thereafter. cSVD was a predictor of poor outcome (OR 2.8; p < 0.001). SBPad, DBPad and SBP72h were not significantly associated with outcome at any time. A significant relationship was found between DBP72h, (p < 0.01), cSVD (p = 0.013) and outcome at discharge. At 12 months, we found a relationship between outcome and DBP72h (p = 0.018) and a statistical tendency regarding cSVD (p = 0.08). Changes in DBP72h were significantly related with outcome. There was a U-shaped relationship between DBP72h and outcome at discharge. Our results suggest an individualized stroke care by either lowering or elevating DBP depending on cSVD-burden in order to influence functional outcome.
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Affiliation(s)
- Sarah Gunkel
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Strasse 11, 97080, Würzburg, Germany
| | - Andreas Schötzau
- Eudox Statistics, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Felix Fluri
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Strasse 11, 97080, Würzburg, Germany.
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Wei C, Tan C, Zhang X, Shen X, Xu Z, Li J, Xu G. Chronic gastritis may predict risk of cerebral small vessel disease. BMC Gastroenterol 2023; 23:429. [PMID: 38062366 PMCID: PMC10702041 DOI: 10.1186/s12876-023-03009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Chronic gastritis, especially that caused by helicobacter pylori (HP) infection, has been associated with increased risk of ischemic stroke. But the relationship between chronic gastritis and cerebral small vessel disease (CSVD) remains largely undetermined. This study aimed to determine the potential predictors for CSVD, with chronic gastritis and its proxies as alternatives. METHOD Patients aged 18 years or older with indications for electronic gastroscopy were enrolled. Presence of CSVD was evaluated with brain magnetic resonance imaging (MRI) results. Degree of CSVD was scored according to established criteria. Logistic regression analysis was used for identifying possible risk factors for CSVD. RESULTS Of the 1191 enrolled patients, 757 (63.6%) were identified as with, and 434 (36.4%) as without CSVD. Multivariate analysis indicated that patients with chronic atrophic gastritis had an increased risk for CSVD than those without (adjusted odds ratio = 1.58; 95% CI, 1.08-2.32; P < 0.05). CONCLUSIONS Chronic atrophic gastritis is associated with the presence of CSVD. We should routinely screen the presence of CSVD for patients with chronic atrophic gastritis.
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Affiliation(s)
- Cunsheng Wei
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Chang Tan
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Xuemei Zhang
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Xin Shen
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Zongliang Xu
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Junrong Li
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China.
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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31
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Ferris JK, Lo BP, Barisano G, Brodtmann A, Buetefisch CM, Conforto AB, Donnelly MH, Egorova-Brumley N, Hayward KS, Khlif MS, Revill KP, Zavaliangos-Petropulu A, Boyd LA, Liew SL. White matter hyperintensities modify relationships between corticospinal tract damage and motor outcomes after stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.29.23297734. [PMID: 37961329 PMCID: PMC10635227 DOI: 10.1101/2023.10.29.23297734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Motor outcomes after stroke relate to corticospinal tract (CST) damage. Concurrent damage from white matter hyperintensities (WMHs) might impact neurological capacity for recovery after CST injury. Here, we evaluated if WMHs modulate the relationship between CST damage and post-stroke motor impairment outcome. We included 223 individuals from the ENIGMA Stroke Recovery Working Group. CST damage was indexed with weighted CST lesion load (CST-LL). Mixed effects beta-regression models were fit to test the impact of CST-LL, WMH volume, and their interaction on motor impairment. WMH volume related to motor impairment above and beyond CST-LL (β = 0.178, p = 0.022). We tested if relationships varied by WMH severity (mild vs. moderate-severe). In individuals with mild WMHs, motor impairment related to CST-LL (β = 0.888, p < 0.001) with a CST-LL x WMH interaction (β = -0.211, 0.026). In individuals with moderate-severe WMHs, motor impairment related to WMH volume (β = 0.299, p = 0.044), but did not significantly relate to CST-LL or a CST-LL x WMH interaction. WMH-related damage may be under-recognised in stroke research as a factor contributing to variability in motor outcomes. Our findings emphasize the importance of brain structural reserve in motor outcomes after brain injury.
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Affiliation(s)
- Jennifer K Ferris
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
- Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bethany P Lo
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Giuseppe Barisano
- Department of Neurosurgery, Stanford School of Medicine, Stanford University, California, USA
| | - Amy Brodtmann
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Cathrin M Buetefisch
- Department of Neurology, Emory University, Atlanta, Georgia, USA
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, USA
- Department of Radiology, Emory University, Atlanta, Georgia, USA
| | - Adriana B Conforto
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Miranda H Donnelly
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Natalia Egorova-Brumley
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kathryn S Hayward
- Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Kate P Revill
- Facility for Education and Research in Neuroscience, Emory University, Atlanta, Georgia, USA
| | - Artemis Zavaliangos-Petropulu
- Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Lara A Boyd
- Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sook-Lei Liew
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Sperber C, Hakim A, Gallucci L, Seiffge D, Rezny-Kasprzak B, Jäger E, Meinel T, Wiest R, Fischer U, Arnold M, Umarova R. A typology of cerebral small vessel disease based on imaging markers. J Neurol 2023; 270:4985-4994. [PMID: 37368130 PMCID: PMC10511610 DOI: 10.1007/s00415-023-11831-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Lacunes, microbleeds, enlarged perivascular spaces (EPVS), and white matter hyperintensities (WMH) are brain imaging features of cerebral small vessel disease (SVD). Based on these imaging markers, we aimed to identify subtypes of SVD and to evaluate the validity of these markers as part of clinical ratings and as biomarkers for stroke outcome. METHODS In a cross-sectional study, we examined 1207 first-ever anterior circulation ischemic stroke patients (mean age 69.1 ± 15.4 years; mean NIHSS 5.3 ± 6.8). On acute stroke MRI, we assessed the numbers of lacunes and microbleeds and rated EPVS and deep and periventricular WMH. We used unsupervised learning to cluster patients based on these variables. RESULTS We identified five clusters, of which the last three appeared to represent distinct late stages of SVD. The two largest clusters had no to only mild or moderate WMH and EPVS, respectively, and favorable stroke outcome. The third cluster was characterized by the largest number of lacunes and a likewise favorable outcome. The fourth cluster had the highest age, most pronounced WMH, and poor outcome. Showing the worst outcome, the fifth cluster presented pronounced microbleeds and the most severe SVD burden. CONCLUSION The study confirmed the existence of different SVD types with different relationships to stroke outcome. EPVS and WMH were identified as imaging features of presumably early progression. The number of microbleeds and WMH severity appear to be promising biomarkers for distinguishing clinical subgroups. Further understanding of SVD progression might require consideration of refined SVD features, e.g., for EPVS and type of lacunes.
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Affiliation(s)
- Christoph Sperber
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Laura Gallucci
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Beata Rezny-Kasprzak
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Eugen Jäger
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Meinel
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Roland Wiest
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Roza Umarova
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
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Lin MP, Demirer M, Middlebrooks EH, Tawk RG, Erben YM, Mateti NR, Youssef H, Anisetti B, Elkhair AM, Gupta V, Erdal BS, Barrett KM, Brott TG, Meschia JF. Greater burden of white matter lesions and silent infarcts ipsilateral to carotid stenosis. J Stroke Cerebrovasc Dis 2023; 32:107287. [PMID: 37531723 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107287] [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: 05/05/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES Carotid stenosis may cause silent cerebrovascular disease (CVD) through atheroembolism and hypoperfusion. If so, revascularization may slow progression of silent CVD. We aimed to compare the presence and severity of silent CVD to the degree of carotid bifurcation stenosis by cerebral hemisphere. MATERIALS AND METHODS Patients age ≥40 years with carotid stenosis >50% by carotid ultrasound who underwent MRI brain from 2011-2015 at Mayo Clinic were included. Severity of carotid stenosis was classified by carotid duplex ultrasound as 50-69% (moderate), 70-99% (severe), or occluded. White matter lesion (WML) volume was quantified using an automated deep-learning algorithm applied to axial T2 FLAIR images. Differences in WML volume and prevalent silent infarcts were compared across hemispheres and severity of carotid stenosis. RESULTS Of the 183 patients, mean age was 71±10 years, and 39.3% were female. Moderate stenosis was present in 35.5%, severe stenosis in 46.5% and occlusion in 18.0%. Patients with carotid stenosis had greater WML volume ipsilateral to the side of carotid stenosis than the contralateral side (mean difference, 0.42±0.21cc, p=0.046). Higher degrees of stenosis were associated with greater hemispheric difference in WML volume (moderate vs. severe; 0.16±0.27cc vs 0.74±0.31cc, p=0.009). Prevalence of silent infarct was 23.5% and was greater on the side of carotid stenosis than the contralateral side (hemispheric difference 8.8%±3.2%, p=0.006). Higher degrees of stenosis were associated with higher burden of silent infarcts (moderate vs severe, 10.8% vs 31.8%; p=0.002). CONCLUSIONS WML and silent infarcts were greater on the side of severe carotid stenosis.
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Affiliation(s)
| | - Mutlu Demirer
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | | | - Rabih G Tawk
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL
| | - Young M Erben
- Department of Vascular Surgery, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | - Vikash Gupta
- Department of Radiology, Mayo Clinic, Jacksonville, FL
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Zhong W, Chen H, Gong X, Tong L, Xu X, Zong G, Yuan C, Lou M. Prevalent stroke, age of its onset, and post-stroke lifestyle in relation to dementia: A prospective cohort study. Alzheimers Dement 2023; 19:3998-4007. [PMID: 37157186 DOI: 10.1002/alz.13122] [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: 11/13/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The association of age at stroke onset with dementia and the role of post-stroke lifestyle on dementia risk remains unclear. METHODS We leveraged data of 496,251 dementia-free participants from UK Biobank and explored the relationship between age at stroke onset and incident dementia. Among 8328 participants with stroke history, we further investigated the association of a healthy lifestyle with risk of dementia. RESULTS Participants with stroke history had a higher risk of dementia (hazard ratio [HR], 2.02). The association was stronger among participants with stroke onset at a younger age (≤50: HR, 2.63) compared with those at the age > 50 years (50-60: HR, 2.17; ≥60: HR, 1.58). Among participants with stroke history, a favorable lifestyle was associated with a lower risk of incident dementia. DISCUSSION Stroke onset in earlier life stage predicted a higher risk for dementia, but a favorable post-stroke lifestyle may protect against dementia.
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Affiliation(s)
- Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Hui Chen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoxian Gong
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Lusha Tong
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Xin Xu
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Changzheng Yuan
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition, Harvard T.H. School of Public Health, Boston, Massachusetts, USA
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
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Duering M, Biessels GJ, Brodtmann A, Chen C, Cordonnier C, de Leeuw FE, Debette S, Frayne R, Jouvent E, Rost NS, Ter Telgte A, Al-Shahi Salman R, Backes WH, Bae HJ, Brown R, Chabriat H, De Luca A, deCarli C, Dewenter A, Doubal FN, Ewers M, Field TS, Ganesh A, Greenberg S, Helmer KG, Hilal S, Jochems ACC, Jokinen H, Kuijf H, Lam BYK, Lebenberg J, MacIntosh BJ, Maillard P, Mok VCT, Pantoni L, Rudilosso S, Satizabal CL, Schirmer MD, Schmidt R, Smith C, Staals J, Thrippleton MJ, van Veluw SJ, Vemuri P, Wang Y, Werring D, Zedde M, Akinyemi RO, Del Brutto OH, Markus HS, Zhu YC, Smith EE, Dichgans M, Wardlaw JM. Neuroimaging standards for research into small vessel disease-advances since 2013. Lancet Neurol 2023; 22:602-618. [PMID: 37236211 DOI: 10.1016/s1474-4422(23)00131-x] [Citation(s) in RCA: 183] [Impact Index Per Article: 183.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/03/2023] [Accepted: 03/28/2023] [Indexed: 05/28/2023]
Abstract
Cerebral small vessel disease (SVD) is common during ageing and can present as stroke, cognitive decline, neurobehavioural symptoms, or functional impairment. SVD frequently coexists with neurodegenerative disease, and can exacerbate cognitive and other symptoms and affect activities of daily living. Standards for Reporting Vascular Changes on Neuroimaging 1 (STRIVE-1) categorised and standardised the diverse features of SVD that are visible on structural MRI. Since then, new information on these established SVD markers and novel MRI sequences and imaging features have emerged. As the effect of combined SVD imaging features becomes clearer, a key role for quantitative imaging biomarkers to determine sub-visible tissue damage, subtle abnormalities visible at high-field strength MRI, and lesion-symptom patterns, is also apparent. Together with rapidly emerging machine learning methods, these metrics can more comprehensively capture the effect of SVD on the brain than the structural MRI features alone and serve as intermediary outcomes in clinical trials and future routine practice. Using a similar approach to that adopted in STRIVE-1, we updated the guidance on neuroimaging of vascular changes in studies of ageing and neurodegeneration to create STRIVE-2.
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Affiliation(s)
- Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Medical Image Analysis Center, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Geert Jan Biessels
- Department of Neurology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, VIC, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher Chen
- Department of Pharmacology, Memory Aging and Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, Memory Aging and Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Charlotte Cordonnier
- Université de Lille, INSERM, CHU Lille, U1172-Lille Neuroscience and Cognition (LilNCog), Lille, France
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Center for Medical Neuroscience, Radboudumc, Nijmegen, Netherlands
| | - Stéphanie Debette
- Bordeaux Population Health Research Center, University of Bordeaux, INSERM, UMR 1219, Bordeaux, France; Department of Neurology, Institute for Neurodegenerative Diseases, CHU de Bordeaux, Bordeaux, France
| | - Richard Frayne
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Eric Jouvent
- AP-HP, Lariboisière Hospital, Translational Neurovascular Centre, FHU NeuroVasc, Université Paris Cité, Paris, France; Université Paris Cité, INSERM UMR 1141, NeuroDiderot, Paris, France
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Walter H Backes
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands; School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea; Cerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongn-si, South Korea
| | - Rosalind Brown
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Hugues Chabriat
- Centre Neurovasculaire Translationnel, CERVCO, INSERM U1141, FHU NeuroVasc, Université Paris Cité, Paris, France
| | - Alberto De Luca
- Image Sciences Institute, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Charles deCarli
- Department of Neurology and Center for Neuroscience, University of California, Davis, CA, USA
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Thalia S Field
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada; Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Steven Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Karl G Helmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Athinoula A Martinos Center for Biomedical Imaging, Boston, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Angela C C Jochems
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hugo Kuijf
- Image Sciences Institute, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bonnie Y K Lam
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Margaret KL Cheung Research Centre for Management of Parkinsonism, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Chinese, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Jessica Lebenberg
- AP-HP, Lariboisière Hospital, Translational Neurovascular Centre, FHU NeuroVasc, Université Paris Cité, Paris, France; Université Paris Cité, INSERM UMR 1141, NeuroDiderot, Paris, France
| | - Bradley J MacIntosh
- Sandra E Black Centre for Brain Resilience and Repair, Hurvitz Brain Sciences, Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Computational Radiology and Artificial Intelligence Unit, Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Pauline Maillard
- Department of Neurology and Center for Neuroscience, University of California, Davis, CA, USA
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Margaret KL Cheung Research Centre for Management of Parkinsonism, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Chinese, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Neurology, Boston University Medical Center, Boston, MA, USA; Framingham Heart Study, Framingham, MA, USA
| | - Markus D Schirmer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julie Staals
- School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Yilong Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - David Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Department of Neuromotor Physiology and Rehabilitation, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oscar H Del Brutto
- School of Medicine and Research Center, Universidad de Especialidades Espiritu Santo, Ecuador
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Eric E Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
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Vadinova V, Sihvonen AJ, Garden KL, Ziraldo L, Roxbury T, O'Brien K, Copland DA, McMahon KL, Brownsett SLE. Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke. Neurorehabil Neural Repair 2023; 37:218-227. [PMID: 37083133 PMCID: PMC10152219 DOI: 10.1177/15459683231168384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. OBJECTIVE To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. METHODS Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. RESULTS The presence of severe WMH explained an additional 18% and 25% variance in early subacute (t = -3.00, p = .004) and chronic (t = -3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. CONCLUSIONS Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.
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Affiliation(s)
- Veronika Vadinova
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Aleksi J Sihvonen
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
- Cognitive Brain Research Unit (CBRU), University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
| | - Kimberley L Garden
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Laura Ziraldo
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Tracy Roxbury
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Kate O'Brien
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - David A Copland
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Queensland, Australia
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
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Ferris JK, Lo BP, Khlif MS, Brodtmann A, Boyd LA, Liew SL. Optimizing automated white matter hyperintensity segmentation in individuals with stroke. FRONTIERS IN NEUROIMAGING 2023; 2:1099301. [PMID: 37554631 PMCID: PMC10406248 DOI: 10.3389/fnimg.2023.1099301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/15/2023] [Indexed: 08/10/2023]
Abstract
White matter hyperintensities (WMHs) are a risk factor for stroke. Consequently, many individuals who suffer a stroke have comorbid WMHs. The impact of WMHs on stroke recovery is an active area of research. Automated WMH segmentation methods are often employed as they require minimal user input and reduce risk of rater bias; however, these automated methods have not been specifically validated for use in individuals with stroke. Here, we present methodological validation of automated WMH segmentation methods in individuals with stroke. We first optimized parameters for FSL's publicly available WMH segmentation software BIANCA in two independent (multi-site) datasets. Our optimized BIANCA protocol achieved good performance within each independent dataset, when the BIANCA model was trained and tested in the same dataset or trained on mixed-sample data. BIANCA segmentation failed when generalizing a trained model to a new testing dataset. We therefore contrasted BIANCA's performance with SAMSEG, an unsupervised WMH segmentation tool available through FreeSurfer. SAMSEG does not require prior WMH masks for model training and was more robust to handling multi-site data. However, SAMSEG performance was slightly lower than BIANCA when data from a single site were tested. This manuscript will serve as a guide for the development and utilization of WMH analysis pipelines for individuals with stroke.
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Affiliation(s)
- Jennifer K. Ferris
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - Bethany P. Lo
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Mohamed Salah Khlif
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Lara A. Boyd
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sook-Lei Liew
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1459] [Impact Index Per Article: 1459.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Li QY, Li XM, Hu HY, Ma YH, Ou YN, Wang AY, Tan L, Yu JT. Associations of Lung Function Decline with Risks of Cognitive Impairment and Dementia: A Meta-Analysis and Systematic Review. J Alzheimers Dis 2023; 92:853-873. [PMID: 36806509 DOI: 10.3233/jad-221136] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND There are controversies surrounding the effects of lung function decline on cognitive impairment and dementia. OBJECTIVE We conducted a meta-analysis and systematic review to explore the associations of lung function decline with the risks of cognitive impairment and dementia. METHODS The PubMed, EMBASE, and the Cochrane Library were searched to identify prospective studies published from database inception through January 10, 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using random-effects models. The Egger test, funnel plots, meta-regression, sensitivity, and subgroup analyses were conducted to detect publication bias and investigate the source of heterogeneity. RESULTS Thirty-three articles with a total of 8,816,992 participants were subjected to meta-analysis. Poorer pulmonary function was associated with an increased risk of dementia (FEV: RR = 1.25 [95% CI, 1.17-1.33]; FVC: RR = 1.40 [95% CI, 1.16-1.69]; PEF: RR = 1.84 [95% CI, 1.37-2.46]). The results of the subgroup analyses were similar to the primary results. Individuals with lung diseases had a higher combined risk of dementia and cognitive impairment (RR = 1.39 [95% CI, 1.20-1.61]). Lung disease conferred an elevated risk of cognitive impairment (RR = 1.37 [95% CI, 1.14-1.65]). The relationship between lung disease and an increased risk of dementia was only shown in total study participants (RR = 1.32 [95% CI, 1.11-1.57]), but not in the participants with Alzheimer's disease (RR = 1.39 [95% CI, 1.00-1.93]) or vascular dementia (RR = 2.11 [95% CI, 0.57-7.83]). CONCLUSION Lung function decline was significantly associated with higher risks of cognitive impairment and dementia. These findings might provide implications for the prevention of cognitive disorders and the promotion of brain health.
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Affiliation(s)
- Qiong-Yao Li
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xue-Mei Li
- Department of Outpatient, Qingdao Municipal Hospital, Qingdao University, China
| | - He-Ying Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - An-Yi Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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Sallinen H, Tomppo L, Martinez-Majander N, Virtanen P, Sibolt G, Tiainen M, Strbian D. Impact of white matter hypodensities on outcome after intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2023; 32:106919. [PMID: 36473394 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106919] [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: 08/31/2022] [Revised: 10/27/2022] [Accepted: 11/27/2022] [Indexed: 12/10/2022] Open
Abstract
OBJECTIVES White matter hypodensities (WMH), a surrogate of small vessel disease, associate with cognitive decline and stroke risk. The impact of WMH on functional outcome after intracerebral hemorrhage (ICH) has differed between studies. We aimed to examine factors associated with the severity of WMH in ICH, and whether there is an independent association between the extent of WMH and outcome. MATERIALS AND METHODS This was a prospective study of consented patients with non-traumatic primary ICH, admitted to the Helsinki University Hospital between May 2014 and December 2018. To evaluate the extent of the WMH, modified van Swieten score of the side contralateral to the ICH was obtained. Patients were grouped into 3 categories of the scores. We performed univariate and multivariable analyses to find out factors associated with the severity of WMH, and whether WMH associate with functional outcome and mortality up to 12 months, adjusted for the known major outcome predictors. RESULTS In our cohort of 417 ICH patients, WMH severity associated with older age, female sex, admission National Institutes of Health Stroke Scale (NIHSS) points, and signs of previous ischemic stroke on CT. We found an independent association between WMH severity and poor functional outcome at 3 months (OR 1.72, 95% CI 1.27-2.33), and 1 year (OR 2.16, 95% CI 1.57-2.95), and mortality at 1 year (OR 1.91, 95% CI 1.29-2.85). CONCLUSIONS In our ICH patients, vascular comorbidities and older age associated with the presence of WMH, which, in turn, strongly associated with poor functional outcome.
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Affiliation(s)
- Hanne Sallinen
- Department of Neurology and Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Liisa Tomppo
- Department of Neurology and Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Nicolas Martinez-Majander
- Department of Neurology and Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Pekka Virtanen
- Department of Radiology, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
| | - Gerli Sibolt
- Department of Neurology and Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Marjaana Tiainen
- Department of Neurology and Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Daniel Strbian
- Department of Neurology and Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Mayer C, Nägele FL, Petersen M, Schell M, Aarabi G, Beikler T, Borof K, Frey BM, Nikorowitsch J, Senftinger J, Walther C, Wenzel JP, Zyriax BC, Cheng B, Thomalla G. Association between Coffee Consumption and Brain MRI Parameters in the Hamburg City Health Study. Nutrients 2023; 15:674. [PMID: 36771381 PMCID: PMC9919011 DOI: 10.3390/nu15030674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Despite associations of regular coffee consumption with fewer neurodegenerative disorders, its association with microstructural brain alterations is unclear. To address this, we examined the association of coffee consumption with brain MRI parameters representing vascular brain damage, neurodegeneration, and microstructural integrity in 2316 participants in the population-based Hamburg City Health Study. Cortical thickness and white matter hyperintensity (WMH) load were measured on FLAIR and T1-weighted images. Microstructural white matter integrity was quantified as peak width of skeletonized mean diffusivity (PSMD) on diffusion-weighted MRI. Daily coffee consumption was assessed in five groups (<1 cup, 1-2 cups, 3-4 cups, 5-6 cups, >6 cups). In multiple linear regressions, we examined the association between brain MRI parameters and coffee consumption (reference group <1 cup). After adjustment for covariates, 3-4 cups of daily coffee were associated with lower PSMD (p = 0.028) and higher cortical thickness (p = 0.015) compared to <1 cup. Moreover, 1-2 cups per day was also associated with lower PSMD (p = 0.022). Associations with WMH load or other groups of coffee consumption were not significant (p > 0.05). The findings indicate that regular coffee consumption is positively associated with microstructural white matter integrity and cortical thickness. Further research is necessary to determine longitudinal effects of coffee on brain microstructure.
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Affiliation(s)
- Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Felix L. Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thomas Beikler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Katrin Borof
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Benedikt M. Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart and Vascular Center, 20246 Hamburg, Germany
| | - Juliana Senftinger
- Department of Cardiology, University Heart and Vascular Center, 20246 Hamburg, Germany
| | - Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jan-Per Wenzel
- Department of Cardiology, University Heart and Vascular Center, 20246 Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Midwifery Science—Health Service Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Kent DM, Leung LY, Zhou Y, Luetmer PH, Kallmes DF, Nelson J, Fu S, Puttock EJ, Zheng C, Liu H, Chen W. Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia. J Am Heart Assoc 2023; 12:e027672. [PMID: 36565208 PMCID: PMC9973577 DOI: 10.1161/jaha.122.027672] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/09/2022] [Indexed: 12/25/2022]
Abstract
Background Covert cerebrovascular disease (CCD) has been shown to be associated with dementia in population-based studies with magnetic resonance imaging (MRI) screening, but dementia risk associated with incidentally discovered CCD is not known. Methods and Results Individuals aged ≥50 years enrolled in the Kaiser Permanente Southern California health system receiving head computed tomography (CT) or MRI for nonstroke indications from 2009 to 2019, without prior ischemic stroke/transient ischemic attack, dementia/Alzheimer disease, or visit reason/scan indication suggestive of cognitive decline or stroke were included. Natural language processing identified incidentally discovered covert brain infarction (id-CBI) and white matter disease (id-WMD) on the neuroimage report; white matter disease was characterized as mild, moderate, severe, or undetermined. We estimated risk of dementia associated with id-CBI and id-WMD. Among 241 050 qualified individuals, natural language processing identified 69 931 (29.0%) with id-WMD and 11 328 (4.7%) with id-CBI. Dementia incidence rates (per 1000 person-years) were 23.5 (95% CI, 22.9-24.0) for patients with id-WMD, 29.4 (95% CI, 27.9-31.0) with id-CBI, and 6.0 (95% CI, 5.8-6.2) without id-CCD. The association of id-WMD with future dementia was stronger in younger (aged <70 years) versus older (aged ≥70 years) patients and for CT- versus MRI-discovered lesions. For patients with versus without id-WMD on CT, the adjusted HR was 2.87 (95% CI, 2.58-3.19) for older and 1.87 (95% CI, 1.79-1.95) for younger patients. For patients with versus without id-WMD on MRI, the adjusted HR for dementia risk was 2.28 (95% CI, 1.99-2.62) for older and 1.48 (95% CI, 1.32-1.66) for younger patients. The adjusted HR for id-CBI was 2.02 (95% CI, 1.70-2.41) for older and 1.22 (95% CI, 1.15-1.30) for younger patients for either modality. Dementia risk was strongly correlated with id-WMD severity; adjusted HRs compared with patients who were negative for id-WMD by MRI ranged from 1.41 (95% CI, 1.25-1.60) for those with mild disease on MRI to 4.11 (95% CI, 3.58-4.72) for those with severe disease on CT. Conclusions Incidentally discovered CCD is common and associated with a high risk of dementia, representing an opportunity for prevention. The association is strengthened when discovered at younger age, by increasing id-WMD severity, and when id-WMD is detected by CT scan rather than MRI.
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Affiliation(s)
- David M. Kent
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical CenterBostonMA
| | | | - Yichen Zhou
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | | | | | - Jason Nelson
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical CenterBostonMA
| | - Sunyang Fu
- Department of AI and InformaticsMayo ClinicRochesterMN
| | - Eric J. Puttock
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Chengyi Zheng
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Hongfang Liu
- Department of AI and InformaticsMayo ClinicRochesterMN
| | - Wansu Chen
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
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Nair R, Sarmiento R, Sheriff A, Shuaib A, Buck B, Gauthier M, Mushahwar V, Ferguson-Pell M, Kate M. Assessment of remote ischemic conditioning delivery with optical sensor in acute ischemic stroke: Randomised clinical trial protocol. PLoS One 2023; 18:e0284879. [PMID: 37141237 PMCID: PMC10159200 DOI: 10.1371/journal.pone.0284879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Remote ischemic conditioning (RIC) is delivered by a blood pressure cuff over the limb, raising pressure 50 mmHg above the systolic blood pressure, to a maximum of 200 mmHg. The cuff is inflated for five minutes and then deflated for five minutes in a sequential ischemia-reperfusion cycle 4-5 times per session. Elevated pressure in the limb may be associated with discomfort and consequently reduced compliance. Continuous assessment of relative blood concentration and oxygenation with a tissue reflectance spectroscopy (a type of optical sensor device) placed over the forearm during the RIC sessions of the arm will allow us to observe the effect of inflation and deflation of the pressure cuff. We hypothesize, in patients with acute ischemic stroke (AIS) and small vessel disease, RIC delivered together with a tissue reflectance sensor will be feasible. METHODS The study is a prospective, single-center, randomized control trial testing the feasibility of the device. Patients with AIS within 7 days from symptoms onset; who also have small vessel disease will be randomized 2:1 to intervention or sham control arms. All patients randomized to the intervention arm will receive 5 cycles of ischemia/reperfusion in the non-paralyzed upper limb with a tissue reflectance sensor and patients in the sham control arm will receive pressure by keeping the cuff pressure at 30 mmHg for 5 minutes. A total of 51 patients will be randomized, 17 in the sham control arm and 34 in the intervention arm. The primary outcome measure will be the feasibility of RIC delivered for 7 days or at the time of discharge. The secondary device-related outcome measures are fidelity of RIC delivery and the completion rate of intervention. The secondary clinical outcome includes a modified Rankin scale, recurrent stroke and cognitive assessment at 90 days. DISCUSSION RIC delivery together with a tissue reflectance sensor will allow insight into the blood concentration and blood oxygenation changes in the skin. This will allow individualized delivery of the RIC and improve compliance. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05408130, June 7, 2022.
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Affiliation(s)
- Radhika Nair
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Sarmiento
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Asif Sheriff
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brian Buck
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michel Gauthier
- Department of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vivian Mushahwar
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Ferguson-Pell
- Department of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mahesh Kate
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Lewis FD, Horn GJ. Comparison of TBI and CVA outcomes: Durability of gains following post-hospital neurological rehabilitation. NeuroRehabilitation 2023; 52:425-433. [PMID: 36806521 DOI: 10.3233/nre-220261] [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: 02/19/2023]
Abstract
BACKGROUND With the effectiveness of post-hospital brain injury rehabilitation clearly demonstrated, research focus has shifted to durability of treatment gains over time. OBJECTIVE Study objectives were threefold: (1) examined the stability of outcomes following post-hospital rehabilitation for persons with acquired brain injury, (2) compare differences in short and long-term outcome for TBI and CVA groups, and (3) identify predictors of long-term outcomes. METHODS Subjects (n = 108) were selected from 2,177 neurologically impaired adults with consecutive discharges from 18 post-hospital programs in 12 states from 2011 through 2019. The study sample included TBI, CVA, and Mixed neurological groups. All persons were evaluated using the Mayo Portland Adaptability Inventory -4 Participation Index at four assessment intervals: admission, discharge, and 3 and 12 month follow-up. Additional analyses included repeated measures 2x4 design addressing TBI and CVA by the four measurement periods, and hierarchical multiple regression to identify outcome predictors. RESULTS The total sample demonstrated a reduction in Participation T-scores (indicating less disability) from admission to discharge. Reductions in disability were maintained at the 3 and 12 month follow-up assessments (Greenhouse-Geisser F (2.37) = 76.87, p < 0.001, partial eta2 = 0.418, power to detect = 0.99). The CVA group demonstrated greater disability at each assessment interval, however, those differences were not statistically significant. Significant predictors of outcome at 12 months post-discharge were length of stay in program and type of injury. TBIs with longer length of stay experienced better outcome at 12 months than non-TBIs with shorter length of stays (hierarchical multiple regression adjusted R2 = 0.085, p < 0.05). CONCLUSION Post-hospital residential neurorehabilitation programs provide a return on investment. Gains are realized from admission to discharge, and maintained one year following discharge from rehabilitation.
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Affiliation(s)
- Frank D Lewis
- NeuroRestorative Research Institute, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Gordon J Horn
- NeuroRestorative Research Institute, Florida State University College of Medicine, Tallahassee, FL, USA
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Li W, Zeng L, Yuan S, Shang Y, Zhuang W, Chen Z, Lyu J. Machine learning for the prediction of cognitive impairment in older adults. Front Neurosci 2023; 17:1158141. [PMID: 37179565 PMCID: PMC10172509 DOI: 10.3389/fnins.2023.1158141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
Objective The purpose of this study was to develop and validate a predictive model of cognitive impairment in older adults based on a novel machine learning (ML) algorithm. Methods The complete data of 2,226 participants aged 60-80 years were extracted from the 2011-2014 National Health and Nutrition Examination Survey database. Cognitive abilities were assessed using a composite cognitive functioning score (Z-score) calculated using a correlation test among the Consortium to Establish a Registry for Alzheimer's Disease Word Learning and Delayed Recall tests, Animal Fluency Test, and the Digit Symbol Substitution Test. Thirteen demographic characteristics and risk factors associated with cognitive impairment were considered: age, sex, race, body mass index (BMI), drink, smoke, direct HDL-cholesterol level, stroke history, dietary inflammatory index (DII), glycated hemoglobin (HbA1c), Patient Health Questionnaire-9 (PHQ-9) score, sleep duration, and albumin level. Feature selection is performed using the Boruta algorithm. Model building is performed using ten-fold cross-validation, machine learning (ML) algorithms such as generalized linear model (GLM), random forest (RF), support vector machine (SVM), artificial neural network (ANN), and stochastic gradient boosting (SGB). The performance of these models was evaluated in terms of discriminatory power and clinical application. Results The study ultimately included 2,226 older adults for analysis, of whom 384 (17.25%) had cognitive impairment. After random assignment, 1,559 and 667 older adults were included in the training and test sets, respectively. A total of 10 variables such as age, race, BMI, direct HDL-cholesterol level, stroke history, DII, HbA1c, PHQ-9 score, sleep duration, and albumin level were selected to construct the model. GLM, RF, SVM, ANN, and SGB were established to obtain the area under the working characteristic curve of the test set subjects 0.779, 0.754, 0.726, 0.776, and 0.754. Among all models, the GLM model had the best predictive performance in terms of discriminatory power and clinical application. Conclusions ML models can be a reliable tool to predict the occurrence of cognitive impairment in older adults. This study used machine learning methods to develop and validate a well performing risk prediction model for the development of cognitive impairment in the elderly.
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Affiliation(s)
- Wanyue Li
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Li Zeng
- The Second Clinical Medical College of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Shiqi Yuan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yaru Shang
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Weisheng Zhuang
- Department of Rehabilitation, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhuoming Chen
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Zhuoming Chen
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong, China
- *Correspondence: Jun Lyu
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Jiang M, Wu S, Zhang Y, Li Y, Lin B, Pan Q, Tian S, Ni R, Liu Q, Zhu Y. Impact of White Matter Hyperintensity and Age on Gait Parameters in Patients With Cerebral Small Vessel Disease. J Am Med Dir Assoc 2022; 24:672-678. [PMID: 36592938 DOI: 10.1016/j.jamda.2022.12.001] [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: 10/14/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aimed to investigate the effect of white matter hyperintensity (WMH), a common cerebral small vessel disease (CSVD) imaging marker, and age on gait parameters in middle-aged and geriatric populations. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 1076 participants (62.9% female; age 61.0 ± 9.3 years), who visited the neurology clinic or obtained a physical check-up from the Affiliated Hospital of Guizhou Medical University. In total, 883 patients with WMH and 193 healthy controls were included in this study. METHODS The Fazekas scores of patients with CSVD were used to assess the burden of WMH. Based on the Fazekas scores, all participants were divided into 4 groups: 553 patients with Fazekas I, 257 patients with Fazekas II, 73 patients with Fazekas III, and 193 controls. Gait parameters, including step speed, frequency, length, width, stance time, and swing time, were quantitatively assessed using a vision-based artificial intelligence gait analyzer (SAIL system). The relationships among the Fazekas scores, age, and gait parameters were analyzed. RESULTS Step speed, step length, step width, stance time, and swing time were significantly different among the 4 groups. Furthermore, Fazekas scores and age were both associated with gait parameters, including step speed, step length, stance time, and swing time. The Fazekas scores were associated with step width, whereas age was not. Age was associated with step frequency, whereas Fazekas scores were not. CONCLUSIONS AND IMPLICATIONS Fazekas score and age are useful for evaluating gait parameters in patients with CSVD. Emerging WMH (such as Fazekas Ⅰ) could be a clinical warning sign of gait disturbance in a geriatric population.
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Affiliation(s)
- Mingzhu Jiang
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Shan Wu
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
| | - Yunyun Zhang
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yan Li
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Bo Lin
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Qi Pan
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Shufen Tian
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Ruihan Ni
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Qi Liu
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yingwu Zhu
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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Einstad MS, Schellhorn T, Thingstad P, Lydersen S, Aamodt EB, Beyer MK, Saltvedt I, Askim T. Neuroimaging markers of dual impairment in cognition and physical performance following stroke: The Nor-COAST study. Front Aging Neurosci 2022; 14:1037936. [PMID: 36561134 PMCID: PMC9765078 DOI: 10.3389/fnagi.2022.1037936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background Cognitive decline and decline in physical performance are common after stroke. Concurrent impairments in the two domains are reported to give increased risk of dementia and functional decline. The concept of dual impairment of physical performance and cognition after stroke is poorly investigated. Clinically accessible imaging markers of stroke and pre-existing brain pathology might help identify patients at risk. Objective The primary aim of this study was to investigate to which extent pre-stroke cerebral pathology was associated with dual impairment in cognition and physical performance at time of stroke. Secondary aims were to examine whether white matter hyperintensities, medial temporal lobe atrophy, and stroke lesion volume and location were associated with dual impairment. Methods Participants from the Norwegian Cognitive Impairment After Stroke (Nor-COAST) study with available MRI data at baseline were included in this cross-sectional study. Logistic regression analyses were conducted, with impairment status (no impairment, impaired cognition, impaired physical performance, and dual impairment) as the dependent variable and MRI markers as covariates. Pre-existing brain pathologies were classified into neurodegenerative, cerebrovascular, or mixed pathology. In addition, white matter hyperintensities and medial temporal lobe atrophy were included as independent covariates. Stroke volume and location were also ascertained from study-specific MRI scans. Results Participants' (n = 348) mean (SD) age was 72.3 (11.3) years; 148 (42.5%) were women. Participants with dual impairment (n = 99) were significantly older, had experienced a more severe stroke, and had a higher comorbidity burden and poorer pre-stroke function. Stroke lesion volume (odds ratio 1.03, 95%, confidence interval 1.00 to 1.05, p = 0.035), but not stroke location or pre-existing brain pathology, was associated with dual impairment, after adjusting for age and sex. Conclusion In this large cohort of stroke survivors having suffered mainly mild to moderate stroke, stroke lesion volume-but not pre-existing brain pathology-was associated with dual impairment early after stroke, confirming the role of stroke severity in functional decline.
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Affiliation(s)
- Marte Stine Einstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway,*Correspondence: Marte Stine Einstad,
| | - Till Schellhorn
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Eva Birgitte Aamodt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Mona Kristiansen Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway,Department of Geriatric Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway,Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Yan H, Chen H, Liu Y, Zhang Q, Guo Y, Fu Y, Ren H, Wang H, Wang C, Ge Y. Assessment of cognitive impairment after acute cerebral infarction with T1 relaxation time measured by MP2RAGE sequence and cerebral hemodynamic by transcranial Doppler. Front Neurol 2022; 13:1056423. [PMID: 36561306 PMCID: PMC9763460 DOI: 10.3389/fneur.2022.1056423] [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: 09/28/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to investigate early brain microstructural changes discovered using magnetization-prepared two rapid acquisition gradient echo (MP2RAGE) sequence and cerebral hemodynamic using TCD for cognitive impairment after acute cerebral infarction. Methods We enrolled 43 patients with acute cerebral infarction and 21 healthy people in the study, who were subjected to cognitive assessments, the MP2RAGE sequence, and a cerebral hemodynamic examination. A total of 26 brain regions of interest were investigated. Furthermore, we used cerebral hemodynamics to explain brain microstructural changes, which helped us better understand the pathophysiology of cognitive impairment after acute cerebral infarction and guide treatment. Results T1 relaxation times in the left frontal lobe, right frontal lobe, right temporal lobe, left precuneus, left thalamus, right hippocampus, right head of caudate nucleus, and splenium of corpus callosum were substantially different across the three groups, which were significantly correlated with neuropsychological test scores. CI group patients had significantly lower cerebral blood flow velocity than those in the N-CI and Normal groups. The receiver operating curve analysis revealed that most T1 relaxation times had high sensitivity and specificity, especially on the right temporal lobe and right frontal lobe. There was a potential correlation between T1 relaxation times and MMSE scores through TCD parameters. Conclusion The MP2RAGE sequence can detect alterations in whole brain microstructure in patients with cognitive impairment after acute cerebral infarction. Brain microstructural changes could influence cognitive function through cerebral hemodynamics. T1 relaxation times on the right temporal lobe and the right frontal lobe are expected to be a prospective biomarker of cognitive impairment after acute cerebral infarction.
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Affiliation(s)
- Hongting Yan
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Honghai Chen
- The Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yanzhi Liu
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Qiannan Zhang
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yunchu Guo
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yu Fu
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hongling Ren
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hairong Wang
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Chun Wang
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yusong Ge
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
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Zhao J, Li Q, Meng L, Wang F, Li Q, Yang F, Wang M, Yu M, Zhang J, Li S, Ji S. Relationship between MMP-9 serum levels and tHcy levels and total imaging load and cognitive dysfunction. J Stroke Cerebrovasc Dis 2022; 31:106759. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022] Open
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Cerebral Small Vessel Diseases and Outcomes for Acute Ischemic Stroke Patients after Endovascular Therapy. J Clin Med 2022; 11:jcm11236883. [PMID: 36498456 PMCID: PMC9736173 DOI: 10.3390/jcm11236883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
The correlation between cerebral small vessel disease (CSVD) and the outcomes of acute ischemic stroke (AIS) patients after endovascular therapy (EVT) remains elusive. We aimed to investigate the effect of combined white matter hyperintensities (WMH) and enlarged perivascular spaces (EPVS) as detected in magnetic resonance imaging (MRI) at baseline on clinical outcomes in patients with AIS who underwent EVT. AIS patients that experienced EVT were retrospectively analyzed in this single-center study. Using MRIs taken prior to EVT, we rated WMH and EPVS as the burden of CSVD and dichotomized the population into two groups: absent-to-moderate and severe. Neurological outcome was assessed at day 90 with a modified Rankin Scale (mRS). Symptomatic intracerebral hemorrhage (sICH), early neurological deterioration (END), malignant cerebral edema (MCE), and hospital death were secondary outcomes. Of the 100 patients (64.0% male; mean age 63.71 ± 11.79 years), periventricular WMHs (28%), deep WMHs (41%), EPVS in basal ganglia (53%), and EPVS in centrum semiovale (73%) were observed. In addition, 69% had an absent-to-moderate total CSVD burden and 31.0% had a severe burden. The severe CSVD was not substantially linked to either the primary or secondary outcomes. Patients with AIS who underwent EVT had an elevated risk (OR: 7.89, 95% CI: 1.0, 62.53) of END if they also had EPVS. When considering WMH and EPVS together as a CSVD burden, there seemed to be no correlation between severe CSVD burden and sICH, END, or MCE following EVT for AIS patients. Further studies are warranted to clarify the relationship between CSVD burden and the occurrence, progression, and prognosis of AIS.
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