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Wu TS, Wu PH, Lin HF, Chen WC, Huang TH, Lin MY, Chuang YS, Yang FPG, Chiu YW, Chang JM, Kuo MC, Lin YT. Cerebral white matter burden is linked to cognitive function in patients undergoing hemodialysis. Ann Med 2024; 56:2310142. [PMID: 38324920 PMCID: PMC10851831 DOI: 10.1080/07853890.2024.2310142] [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: 06/30/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Chronic kidney disease is related to neurodegeneration and structural changes in the brain which might lead to cognitive decline. The Fazekas scale used for assessing white matter hyperintensities (WMHs) was associated with poor cognitive performance. Therefore, this study investigated the associations between the mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI), and Fazekas scale in patients under hemodialysis (HD). METHODS The periventricular (PV) WMHs and deep WMHs (DWMHs) in brain magnetic resonance images of 59 patients under dialysis were graded using the Fazekas scale. Three cognition function tests were also performed, then multivariable ordinal regression and logistic regression were used to identify the associations between cognitive performance and the Fazekas scale. RESULTS There were inverse associations between the three cognitive function tests across the Fazekas scale of PVWMHs (p = .037, .006, and .008 for MMSE, MoCA, and CASI, respectively), but the associations were attenuated in the DWMHs group. In CASI, significant differences were identified in short-term memory, mental manipulation, abstract thinking, language, spatial construction, and name fluency in the PVWMHs group. However, DWMHs were only significantly correlated with abstract thinking and short-term memory. CONCLUSION An inverse correlation existed between the Fazekas scale, predominantly in PVWMHs, and cognition in patients undergoing HD. The PVWMHs were associated with cognitive performance assessed by MMSE, MoCA, and CASI, as well as with subdomains of CASI such as memory, language and name fluency in patients undergoing HD.
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Affiliation(s)
- Tsai-Shan Wu
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsiu-Fen Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ching Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Teng-Hui Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yun-Shiuan Chuang
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Fan-Pei Gloria Yang
- Department of Foreign Languages and Literature, National Tsing Hua University, Hsinchu, Taiwan
- Center for Cognition and Mind Sciences, National Tsing Hua University, Hsinchu, Taiwan
- Department of Radiology, Graduate School of Dentistry, Osaka University, Suita, Japan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Lin
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Shinto LH, Murchison CF, Silbert LC, Dodge HH, Lahna D, Rooney W, Kaye J, Quinn JF, Bowman GL. ω-3 PUFA for Secondary Prevention of White Matter Lesions and Neuronal Integrity Breakdown in Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2426872. [PMID: 39088212 PMCID: PMC11294966 DOI: 10.1001/jamanetworkopen.2024.26872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/07/2024] [Indexed: 08/02/2024] Open
Abstract
Importance Older adults with lower intake and tissue levels of long-chain ω-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA; 20:5) and docosahexaenoic acid (DHA; 22:6) have more brain white matter lesions (WMLs), an association suggesting that small-vessel ischemic disease, a major contributor to the development of dementia, including Alzheimer disease, may be preventable through ω-3 treatment. Objective To determine whether ω-3 treatment reduces WML accumulation in older adults without dementia harboring WMLs and with suboptimal ω-3 status. Design, Setting, and Participants This quadruple-blinded, placebo-controlled, randomized clinical trial with treatment stratification by apolipoprotein E ε4 allele (APOE*E4) carrier status used linear mixed-effects models to estimate mean annual change between groups. The study was conducted at Oregon Health & Science University, a major academic medical center in the Pacific Northwest, from May 2014 to final participant visit in September 2019. Data analysis concluded in July 2022. Participants were adults without dementia aged 75 years and older with WMLs greater than or equal to 5 cm3 and plasma ω-3 PUFA less than 5.5 weight percentage of total. Intervention Three-year treatment with 1.65 g of ω-3 PUFA (975 mg of EPA and 650 mg of DHA) vs a soybean oil placebo matched for taste, smell, and appearance. Main Outcomes and Measures The primary outcome was annual WML progression measured using magnetic resonance imaging. Secondary outcomes included diffusion tensor imaging of fractional anisotropy (DTI-FA), representing neuronal integrity breakdown. Results A total of 102 participants (62 women [60.8%]; mean age, 81 years [range, 75-96 years]) were equally randomized, 51 per treatment group. Although the ω-3 group had less annual WML accumulation than the placebo group, the difference was not statistically significant (1.19 cm3 [95% CI, 0.64-1.74 cm3] vs 1.34 cm3 [95% CI, 0.80-1.88 cm3]; P = .30). Similarly, the ω-3 group had less annual DTI-FA decline than the placebo group, but the difference was not statistically significant (-0.0014 mm2/s [95% CI, -0.0027 to 0.0002 mm2/s] vs -0.0027 mm2/s [95% CI, -0.0041 to -0.0014 mm2/s]; P = .07). Among APOE*E4 carriers, the annual DTI-FA decline was significantly lower in the group treated with ω-3 than the placebo group (-0.0016 mm2/s [95% CI, -0.0032 to 0.0020 mm2/s] vs -0.0047 mm2/s [95% CI, -0.0067 to -0.0025 mm2/s]; P = .04). Adverse events were similar between treatment groups. Conclusions and Relevance In this 3-year randomized clinical trial, ω-3 treatment was safe and well-tolerated but failed to reach significant reductions in WML accumulation or neuronal integrity breakdown among all participants, which may be attributable to sample size limitations. However, neuronal integrity breakdown was reduced by ω-3 treatment in APOE*E4 carriers, suggesting that this treatment may be beneficial for this specific group. Trial Registration ClinicalTrials.gov Identifier: NCT01953705.
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Affiliation(s)
- Lynne H. Shinto
- NIA-Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
| | - Charles F. Murchison
- NIA-Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
- Department of Biostatistics, University of Alabama, Birmingham
| | - Lisa C. Silbert
- NIA-Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
- Portland VA, Portland, Oregon
| | - Hiroko H. Dodge
- NIA-Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
- Interdisciplinary Brain Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - David Lahna
- NIA-Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
| | - William Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland
| | - Jeffrey Kaye
- NIA-Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
- Portland VA, Portland, Oregon
| | - Joseph F. Quinn
- NIA-Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
- Portland VA, Portland, Oregon
- Parkinson’s Disease Center, Oregon Health & Science University, Portland
| | - Gene L. Bowman
- NIA-Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
- McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
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Hsu CL, Holtzer R, Tam RC, Al Keridy W, Liu-Ambrose T. Physical reserve and its underpinning functional neural networks moderate the relationship between white matter hyperintensity and postural balance in older adults with subcortical ischemic vascular cognitive impairment. Sci Rep 2024; 14:17161. [PMID: 39060551 PMCID: PMC11282073 DOI: 10.1038/s41598-024-68050-1] [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: 05/03/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
White matter hyperintensities (WMH) are markers of subcortical ischemic vascular cognitive impairment (SIVCI) associated with impaired postural balance. Physical reserve (PR) is a recently established construct that reflects one's capacity to maintain physical function despite brain pathology. This cross-sectional study aims to map functional networks associated with PR, and examining the relationship between PR, WMH, and postural balance. PR was defined in 22 community-dwelling older adults with SIVCI. Functional networks of PR were computed using general linear model. Subsequent analyses examined whether PR and relevant networks moderated the relationship between WMH and postural balance under two conditions-eyes open while standing on foam (EOF) or on floor (EONF). We found that PR and the relevant networks-frontoparietal network (FPN) and default mode network (DMN)-significantly moderated the association between WMH and postural balance. For individuals with high PR, postural balance remained stable regardless of the extent of WMH load; whereas for those with low PR, postural balance worsened as WMH load increased. These results suggest the attenuated effects of WMH on postural stability due to PR may be underpinned by functional neural network reorganization in the FPN and DMN as a part of compensatory processes.
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Affiliation(s)
- Chun Liang Hsu
- The Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China.
| | - Roee Holtzer
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Roger C Tam
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Walid Al Keridy
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Neurology, University of British Columbia Hospital, Vancouver, BC, Canada
- Geriatric Division, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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Silbert LC, Roese NE, Krajbich V, Hurworth J, Lahna D, Schwartz DL, Dodge HH, Woltjer RL. White matter hyperintensities and the surrounding normal appearing white matter are associated with water channel disruption in the oldest old. Alzheimers Dement 2024; 20:3839-3851. [PMID: 38629888 PMCID: PMC11180942 DOI: 10.1002/alz.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/08/2024] [Accepted: 03/08/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Age-related magnetic resonance imaging (MRI) T2 white matter hyperintensities (WMHs) are common and associated with neurological decline. We investigated the histopathological underpinnings of MRI WMH and surrounding normal appearing white matter (NAWM), with a focus on astroglial phenotypes. METHODS Brain samples from 51 oldest old Oregon Alzheimer's Disease Research Center participants who came to autopsy underwent post mortem (PM) 7 tesla MRI with targeted histopathological sampling of WMHs and NAWM. Stained slides were digitized and quantified. Mixed-effects models determined differences in molecular characteristics between WMHs and the NAWM and across NAWM. RESULTS PM MRI-targeted WMHs are characterized by demyelination, microglial activation, and prominent astrocytic alterations, including disrupted aquaporin (AQP) expression. Similar changes occur within the surrounding NAWM in a pattern of decreasing severity with increased distance from WMHs. DISCUSSION Decreased AQP expression within WMH and proximal NAWM suggest an overwhelmed system wherein water homeostasis is no longer maintained, contributing to WM damage in older individuals. HIGHLIGHTS Post mortem magnetic resonance imaging (MRI) was used to characterize the pathology of white matter hyperintensities (WMHs) and surrounding normal appearing white matter (NAWM). Stained immunohistochemical (IHC) slides from targeted WMH and NAWM samples were digitized and quantified. WMHs and NAWM were associated with inflammation, demyelination, and gliosis. WMHs and NAWM astrocytic changes included decreased AQP1 and AQP4 expression. Abnormal NAWM pathology diminished in severity with increasing distance from WMH.
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Affiliation(s)
- Lisa C. Silbert
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Department of NeurologyPortland Veterans Affairs Health Care SystemPortlandOregonUSA
| | - Natalie E. Roese
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Victoria Krajbich
- Department of PathologyOregon Health & Science UniversityPortlandOregonUSA
| | - Justin Hurworth
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - David Lahna
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Daniel L. Schwartz
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Advanced Imaging Research CenterOregon Health & Science UniversityPortlandOregonUSA
| | - Hiroko H. Dodge
- Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Randall L. Woltjer
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Department of PathologyOregon Health & Science UniversityPortlandOregonUSA
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Jansma A, de Bresser J, Schoones JW, van Heemst D, Akintola AA. Sporadic cerebral small vessel disease and cognitive decline in healthy older adults: A systematic review and meta-analysis. J Cereb Blood Flow Metab 2024; 44:660-679. [PMID: 38415688 PMCID: PMC11197143 DOI: 10.1177/0271678x241235494] [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: 06/16/2022] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 02/29/2024]
Abstract
We performed a systematic review and meta-analysis on prospective studies that provided risk estimates for the impact of 3 different MRI markers of small vessel disease (SVD), namely white matter hyperintensities (WMH), cerebral microbleeds (CMB) and lacunes, on cognitive decline in relatively healthy older adults without cognitive deficits at baseline. A total of 23 prospective studies comprising 11,486 participants were included for analysis. Extracted data was pooled, reviewed and meta-analysed separately for global cognition, executive function, memory and attention. The pooled effect size for the association between cerebral SVD and cognitive decline was for global cognition -0.10 [-0.14; -0.05], for executive functioning -0.18 [-0.24; - 0.11], for memory -0.12 [-0.17; -0.07], and for attention -0.17 [-0.23; -0.11]. Results for the association of individual MRI markers of cerebral SVD were statistically significant for WMH and global cognition -0.15 [-0.24; -0.06], WMH and executive function -0.23 [-0.33; -0.13], WMH and memory -0.19 [-0.29; -0.09], WMH and attention -0.24 [-0.39; -0.08], CMB and executive function -0.07 [-0.13; -0.02], CMB and memory -0.11 [-0.21; -0.02] and CMB and attention -0.13 [-0.25; -0.02]. In conclusion, presence of MRI markers of cerebral SVD were found to predict an increased risk of cognitive decline in relatively healthy older adults. While WMH were found to significantly affect all cognitive domains, CMB influenced decline in executive functioning over time as well as (in some studies) decline in memory and attention.
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Affiliation(s)
- Alexander Jansma
- Department of Internal Medicine, Section Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy (formerly: Walaeus Library), Leiden University Medical Centre, Leiden, The Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Abimbola A Akintola
- Department of Internal Medicine, Section Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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Yang J, Liu X, Oveisgharan S, Zammit AR, Nag S, Bennett DA, Buchman AS. Inferring Alzheimer's disease pathologic traits from clinical measures in living adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.05.08.23289668. [PMID: 37214885 PMCID: PMC10197717 DOI: 10.1101/2023.05.08.23289668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background Alzheimer's disease neuropathologic changes (AD-NC) are important for identify people with high risk for AD dementia (ADD) and subtyping ADD. Objective Develop imputation models based on clinical measures to infer AD-NC. Methods We used penalized generalized linear regression to train imputation models for four AD-NC traits (amyloid-β, tangles, global AD pathology, and pathologic AD) in Rush Memory and Aging Project decedents, using clinical measures at the last visit prior to death as predictors. We validated these models by inferring AD-NC traits with clinical measures at the last visit prior to death for independent Religious Orders Study (ROS) decedents. We inferred baseline AD-NC traits for all ROS participants at study entry, and then tested if inferred AD-NC traits at study entry predicted incident ADD and postmortem pathologic AD. Results Inferred AD-NC traits at the last visit prior to death were related to postmortem measures with R2=(0.188,0.316,0.262) respectively for amyloid-β, tangles, and global AD pathology, and prediction Area Under the receiver operating characteristic Curve (AUC) 0.765 for pathologic AD. Inferred baseline levels of all four AD-NC traits predicted ADD. The strongest prediction was obtained by the inferred baseline probabilities of pathologic AD with AUC=(0.919,0.896) for predicting the development of ADD in 3 and 5 years from baseline. The inferred baseline levels of all four AD-NC traits significantly discriminated pathologic AD profiled eight years later with p-values<1.4 × 10-10. Conclusion Inferred AD-NC traits based on clinical measures may provide effective AD biomarkers that can estimate the burden of AD-NC traits in aging adults.
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Affiliation(s)
- Jingjing Yang
- Center for Computational and Quantitative Genetics, Department of Human Genetics, Emory University School of Medicine, 615 Michael St, Atlanta, GA, 30322, USA
| | - Xizhu Liu
- Department of Biostatistics, Yale University School of Public Health, 60 College St, New Haven, CT, 06510, USA
| | - Shahram Oveisgharan
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
| | - Andrea R. Zammit
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
| | - Sukriti Nag
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
| | - Aron S Buchman
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
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Yang J, Liu X, Oveisgharan S, Zammit AR, Nag S, Bennett DA, Buchman AS. Inferring Alzheimer's Disease Pathologic Traits from Clinical Measures in Living Adults. J Alzheimers Dis 2024; 98:95-107. [PMID: 38427476 PMCID: PMC11034758 DOI: 10.3233/jad-230639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background Alzheimer's disease neuropathologic changes (AD-NC) are important to identify people with high risk for AD dementia (ADD) and subtyping ADD. Objective Develop imputation models based on clinical measures to infer AD-NC. Methods We used penalized generalized linear regression to train imputation models for four AD-NC traits (amyloid-β, tangles, global AD pathology, and pathologic AD) in Rush Memory and Aging Project decedents, using clinical measures at the last visit prior to death as predictors. We validated these models by inferring AD-NC traits with clinical measures at the last visit prior to death for independent Religious Orders Study (ROS) decedents. We inferred baseline AD-NC traits for all ROS participants at study entry, and then tested if inferred AD-NC traits at study entry predicted incident ADD and postmortem pathologic AD. Results Inferred AD-NC traits at the last visit prior to death were related to postmortem measures with R2 = (0.188,0.316,0.262) respectively for amyloid-β, tangles, and global AD pathology, and prediction Area Under the receiver operating characteristic Curve (AUC) 0.765 for pathologic AD. Inferred baseline levels of all four AD-NC traits predicted ADD. The strongest prediction was obtained by the inferred baseline probabilities of pathologic AD with AUC = (0.919,0.896) for predicting the development of ADD in 3 and 5 years from baseline. The inferred baseline levels of all four AD-NC traits significantly discriminated pathologic AD profiled eight years later with p-values < 1.4×10-10. Conclusions Inferred AD-NC traits based on clinical measures may provide effective AD biomarkers that can estimate the burden of AD-NC traits in aging adults.
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Affiliation(s)
- Jingjing Yang
- Center for Computational and Quantitative Genetics, Department of Human Genetics, Emory University School of Medicine, 615 Michael St, Atlanta, GA, 30322, USA
| | - Xizhu Liu
- Department of Biostatistics, Yale University School of Public Health, 60 College St, New Haven, CT, 06510, USA
| | - Shahram Oveisgharan
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
| | - Andrea R. Zammit
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
| | - Sukriti Nag
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
| | - Aron S Buchman
- Rush Alzheimer’s Disease Center, Rush University Medicine Center, 1620 W Harrison St, Chicago, IL, 60612, USA
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Keller JA, Sigurdsson S, Klaassen K, Hirschler L, van Buchem MA, Launer LJ, van Osch MJ, Gudnason V, de Bresser J. White matter hyperintensity shape is associated with long-term dementia risk. Alzheimers Dement 2023; 19:5632-5641. [PMID: 37303267 PMCID: PMC10713858 DOI: 10.1002/alz.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/11/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION We aimed to investigate the association between white matter hyperintensity (WMH) shape and volume and the long-term dementia risk in community-dwelling older adults. METHODS Three thousand seventy-seven participants (mean age: 75.6 ± 5.2 years) of the Age Gene/Environment Susceptibility (AGES)-Reykjavik study underwent baseline 1.5T brain magnetic resonance imaging and were followed up for dementia (mean follow-up: 9.9 ± 2.6 years). RESULTS More irregular shape of periventricular/confluent WMH (lower solidity (hazard ratio (95% confidence interval) 1.34 (1.17 to 1.52), p < .001) and convexity 1.38 (1.28 to 1.49), p < .001); higher concavity index 1.43 (1.32 to 1.54), p < .001) and fractal dimension 1.45 (1.32 to 1.58), p < .001)), higher total WMH volume (1.68 (1.54 to 1.87), p < .001), higher periventricular/confluent WMH volume (1.71 (1.55 to 1.89), p < .001), and higher deep WMH volume (1.17 (1.08 to 1.27), p < .001) were associated with an increased long-term dementia risk. DISCUSSION WMH shape markers may in the future be useful in determining patient prognosis and may aid in patient selection for future preventive treatments in community-dwelling older adults.
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Affiliation(s)
- Jasmin A. Keller
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | | | - Kelly Klaassen
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Lydiane Hirschler
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Mark A. van Buchem
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, MD 20898, United States
| | - Matthias J.P. van Osch
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Vilmundur Gudnason
- Icelandic Heart Association, 201 Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
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Zhao W, Cheng B, Zhu T, Cui Y, Shen Y, Fu X, Li M, Feng Y, Zhang S. Effects of white matter hyperintensity on cognitive function in PD patients: a meta-analysis. Front Neurol 2023; 14:1203311. [PMID: 37621858 PMCID: PMC10445042 DOI: 10.3389/fneur.2023.1203311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Background Parkinson's disease (PD) is often accompanied by cognitive dysfunction, which imposes a heavy burden on patients, their families, and society. Early identification and intervention are particularly important, but reliable biomarkers for identifying PD-related cognitive impairment at an early stage are currently lacking. Although numerous clinical studies have investigated the association between brain white matter hyperintensity (WMH) and cognitive decline, the findings regarding the relationships between WMH and cognitive dysfunction in PD patients have been inconsistent. Therefore, this study aims to conduct a meta-analysis of the effect of WMH on PD cognitive function. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We systematically searched relevant literature from databases such as PubMed, Web of Science, EMBASE, CNKI, and CBM. The retrieval time was limited to database records created up until December 31, 2022. Additionally, we manually retrieved references for full-text reading. Statistical data analysis was performed using RevMan 5.3 and Stata 15.0 software. Results This study encompassed 23 individual studies and involved 2,429 patients with PD. The group of PD with mild cognitive impairment (PD-MCI) exhibited a significantly higher overall level of WMH than the group of PD with normal cognitive function (PD-NC) (SMD = 0.37, 95% CI: 0.21-0.52, p < 0.01). This finding was consistent across subgroup analyses based on different ethnicities (Asian or Caucasian), WMH assessment methods (visual rating scale or volumetry), and age matching. In addition to the overall differences in WMH load between the PD-MCI and PD-NC groups, the study found that specific brain regions, including periventricular white matter hyperintensity (PVH) and deep white matter hyperintensity (DWMH), had significantly higher WMH load in the PD-MCI group compared to the PD-NC group. The study also conducted a meta-analysis of WMH load data for PD with dementia (PDD) and PD without dementia (PDND), revealing that the overall WMH load in the PDD group was significantly higher than that in the PDND group (SMD = 0.98, 95% CI: 0.56-1.41, p < 0.01). This finding was consistent across subgroup analyses based on different ethnicities and age matching. Moreover, regarding specific brain regions (PVH or DWMH), the study found that the PDD group had significantly higher WMH load than the PDND group (p < 0.01). Conclusion WMH was associated with PD cognitive dysfunction. The early appearance of WMH may indicate PD with MCI.
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Affiliation(s)
- Wenhao Zhao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Bo Cheng
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Tao Zhu
- Department of Preventive Medicine, North Sichuan Medical College, Nanchong, China
| | - Yingjuan Cui
- Department of Nursing, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Yao Shen
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Xudong Fu
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Maogeng Li
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Yuliang Feng
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Shushan Zhang
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
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10
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Herman AL, de Havenon A, Falcone GJ, Prabhakaran S, Sheth KN. Racial/Ethnic Variation in White Matter Hyperintensity Progression in the ACCORDION MIND Study. Neurologist 2023; 28:157-159. [PMID: 35834785 DOI: 10.1097/nrl.0000000000000454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND White matter hyperintensities (WMHs) are linked to cognitive decline and stroke. We investigate the impact of race on WMH progression in the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORDION MIND) trial. MATERIALS AND METHODS The primary outcome is WMH progression in milliliters, evaluated by fitting linear regression to WMH volume on the month 80 magnetic resonance imaging (MRI) and including the WMH volume on the baseline MRI. The primary predictor is patient race, with the exclusion of patients defined as "other" race. We also derived predicted probabilities of our outcome for systolic blood pressure (SBP) levels. RESULTS We included 276 patients who completed the baseline and month 80 MRI, of which 207 (75%) were White, 48 (17%) Black, and 21 (8%) Hispanic. During follow-up, the mean number of SBP, low-density lipoprotein (LDL), and A1c measurements per patient was 21, 8, and 15. The median (IQR) WMH progression was 1.5 mL (0.5 to 3.9) for Black patients, 1.0 mL (0.4 to 4.0) for Hispanics, and 1.3 mL (0.5 to 2.7) for Whites (Kruskal-Wallis test, P =0.59). In the multivariate regression model, Black, compared with White, patients had significantly more WMH progression (β Coefficient 1.26, 95% confidence interval 0.45 to 2.06, P =0.002). Hispanic, compared with White, patients neither have significantly different WMH progression ( P =0.392), nor was there a difference when comparing Hispanic to Black patients ( P =0.162). The predicted WMH progression was significantly higher for Black compared with White patients across a mean SBP of 117 to 139 mm Hg. CONCLUSIONS Black diabetic patients in Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORDION MIND) have a higher risk of WMH progression than White patients across a normal range of SBP.
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Affiliation(s)
- Alison L Herman
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Adam de Havenon
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Guido J Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | | | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT
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11
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Cabrera JÁ, Urmeneta Ulloa J, Jímenez de la Peña M, Rubio Alonso M, López Gavilán M, Bayona Horta S, Pizarro G, Simon K, Migoya T, Martínez de Vega V. White-Matter Lesions and Cortical Cerebral Blood Flow Evaluation by 3D Arterial Spin-Labeled Perfusion MRI in Asymptomatic Divers: Correlation with Patent Foramen Ovale Ocurrence. J Clin Med 2023; 12:jcm12082866. [PMID: 37109204 PMCID: PMC10141148 DOI: 10.3390/jcm12082866] [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: 02/21/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Cerebral white-matter lesions (cWML) can be caused by dilation of Virchow-Robin spaces or may correspond to true lacunar ischemic lesions. The aim of our study was to evaluate in asymptomatic divers the relationship between the presence of patent foramen ovale (PFO) and cWML, as well as their possible effects on cortical cerebral blood flow (CBF) by magnetic resonance (MRI) through the arterial spin labeling (ASL) sequence. Transthoracic echocardiography was performed for the identification of PFO, and cerebral magnetic resonance including the 3D-ASL sequence for CBF quantification. Thirty-eight divers, with a mean age 45.8 ± 8.6 years, were included. Nineteen healthy volunteers, mean age 41 ± 15.2 years, served as the control group. A total of 28.9% of divers had completed more than 1000 dives. It was found that 26.3% of divers presented with PFO in the echocardiographic study. cWML was evidenced in 10.5% of diver MRI studies. There was no statistically significant relationship between the presence of PFO and cWML (p = 0.95). We observed a lower blood flow in all brain areas assessed by the 3D-ASL sequence in the group of divers, compared with the control group. We did not find statistical differences in CBF as a function of the presence or absence of PFO, number of dives, or cWML evidence.
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Affiliation(s)
- José Ángel Cabrera
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain
| | - Javier Urmeneta Ulloa
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain
- Radiology Department, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain
| | | | - Margarita Rubio Alonso
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | | | - Silvia Bayona Horta
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain
| | - Gonzalo Pizarro
- Cardiology Department, Hospital Ruber Juan Bravo, Grupo Quirónsalud, 28006 Madrid, Spain
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12
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Li Z, Wang W, Sang F, Zhang Z, Li X. White matter changes underlie hypertension-related cognitive decline in older adults. Neuroimage Clin 2023; 38:103389. [PMID: 37004321 PMCID: PMC10102561 DOI: 10.1016/j.nicl.2023.103389] [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: 02/03/2023] [Revised: 03/18/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
Hypertension has been well recognized as a risk factor for cognitive impairment and dementia. Although the underlying mechanisms of hypertension-affected cognitive deterioration are not fully understood, white matter changes (WMCs) seem to play an important role. WMCs include low microstructural integrity and subsequent white matter macrostructural lesions, which are common on brain imaging in hypertensive patients and are critical for multiple cognitive domains. This article provides an overview of the impact of hypertension on white matter microstructural and macrostructural changes and its link to cognitive dysfunction. Hypertension may induce microstructural changes in white matter, especially for the long-range fibers such as anterior thalamic radiation (ATR) and inferior fronto-occipital fasciculus (IFOF), and then macrostructural abnormalities affecting different lobes, especially the periventricular area. Different regions' WMCs would further exert different effects to specific cognitive domains and accelerate brain aging. As a modifiable risk factor, hypertension might provide a new perspective for alleviating and delaying cognitive impairment.
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Affiliation(s)
- Zilin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China
| | - Wenxiao Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China
| | - Feng Sang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China
| | - Xin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China.
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13
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Fellows RP, Bangen KJ, Graves LV, Delano-Wood L, Bondi MW. Pathological functional impairment: Neuropsychological correlates of the shared variance between everyday functioning and brain volumetrics. Front Aging Neurosci 2022; 14:952145. [PMID: 36620766 PMCID: PMC9816390 DOI: 10.3389/fnagi.2022.952145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Given that several non-cognitive factors can contribute to difficulties with everyday functioning, examining the extent to which cognition is associated with brain-related changes in everyday functioning is critical to accurate characterization of cognitive disorders. In this study, we examined neuropsychological correlates of the shared variance between everyday functioning and pathological indicators of cognitive aging using MRI brain volumetrics. Participants and methods Participants were 600 adults aged 55 and older without dementia [432 cognitively normal; 168 mild cognitive impairment (MCI)] from the National Alzheimer's Coordinating Center cohort who underwent neuropsychological testing, informant-rated everyday functioning, and brain MRI scanning at baseline. The shared variance between everyday functioning and brain volumetrics (i.e., hippocampal volume, white matter hyperintensity volume) was extracted using the predicted value from multiple regression. The shared variance was used as an indicator of pathological everyday functional impairment. The residual variance from the regression analysis was used to examine functional reserve. Results Larger white matter hyperintensity volumes (p = 0.002) and smaller hippocampal volumes (p < 0.001) were significantly correlated with worse informant-rated everyday functioning. Among individuals with MCI, worse performances on delayed recall (p = 0.013) and category fluency (p = 0.012) were significantly correlated with pathological functional impairment in multiple regression analysis. In the cognitively normal group, only worse auditory working memory (i.e., digit span backward; p = 0.025) significantly correlated with pathological functioning. Functional reserve was inversely related to anxiety (p < 0.001) in the MCI group and was associated with depressive symptoms (p = 0.003) and apathy (p < 0.001) in the cognitively normal group. Conclusion Subtle brain-related everyday functioning difficulties are evident in MCI and track with expected preclinical Alzheimer's disease cognitive phenotypes in this largely amnestic sample. Our findings indicate that functional changes occur early in the disease process and that interventions to target neuropsychiatric symptoms may help to bolster functional reserve in those at risk.
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Affiliation(s)
- Robert P. Fellows
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,*Correspondence: Robert P. Fellows, ✉
| | - Katherine J. Bangen
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Lisa V. Graves
- Department of Psychology, California State University, San Marcos, CA, United States
| | - Lisa Delano-Wood
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Mark W. Bondi
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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14
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Lahna D, Roese N, Woltjer R, Boespflug EL, Schwartz D, Grinstead J, Dodge HH, Wall R, Kaye JA, Rooney WD, Silbert LC. Postmortem 7T MRI for guided histopathology and evaluation of cerebrovascular disease. J Neuropathol Exp Neurol 2022; 82:57-70. [PMID: 36343095 PMCID: PMC9764082 DOI: 10.1093/jnen/nlac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Postmortem (PM) magnetic resonance imaging (MRI) can serve as a bridge between in vivo imaging and histology by connecting MRI observed macrostructural findings to histological staining and microstructural changes. Data were acquired from 20 formalin-fixed brains including T2, T1, PD, and T2*-weighted images of left hemispheres and 6-mm-thick coronal slices. Tissue slices were bisected, aligned to MR images and used to guide histological sampling. Markers of myelin and oligodendroglia alterations were semiquantitatively rated and compared within white matter hyperintensities (WMHs) and normal-appearing white matter. Tissue priors were created from 3T in vivo data and used to guide segmentation of WMH. PM WMH and hemisphere volumes were compared to volumes derived from in vivo data. PM T2 WMH and T1 hemisphere volumes were correlated with in vivo 3T FLAIR WMH and T1 hemisphere volumes. WMH showed significant myelin loss, decreased GFAP expression and increased vimentin expression. MR-visible perivascular spaces and cortical microvascular lesions were successfully captured on histopathological sections. PM MRI can quantify cerebrovascular disease burden and guide tissue sampling, allowing for more comprehensive characterization of cerebrovascular disease that may be used to study etiologies of age-related cognitive change.
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Affiliation(s)
- David Lahna
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Natalie Roese
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Randy Woltjer
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Erin L Boespflug
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Schwartz
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Hiroko H Dodge
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Wall
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Jeffrey A Kaye
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Lisa C Silbert
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
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15
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Heterogeneity of White Matter Hyperintensity and Cognitive Impairment in Patients with Acute Lacunar Stroke. Brain Sci 2022; 12:brainsci12121674. [PMID: 36552134 PMCID: PMC9776102 DOI: 10.3390/brainsci12121674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Background: The severity of white matter hyperintensity (WMH) in patients with acute lacunar stroke (ALS) may be not completely parallel to cognitive impairment. Controversies persist about the effects of WMH on cognitive dysfunction. It is vital to explore whether the association may be affected by certain factors and whether a subsequent subgroup analysis is necessary. The aim of this study was to evaluate the relationship between WMH and cognitive impairment in acute lacunar stroke patients and the possible causal factors. Methods: We continuously enrolled patients with ALS who were hospitalized at the First Affiliated Hospital of Soochow University between October 2017 and June 2022. The cognitive function of all patients was assessed by using the Montreal Cognitive Assessment (MoCA) scale 14 ± 2 days after the onset of AIS, and the results were adjusted to the education level. The MoCA scale was reevaluated at the 6-month (day 182 ± 7) follow-up by outpatient visit or video. Demographic and clinical data were collected. The manifestations of chronic cerebral small-vessel disease (CSVD), including the total Fazekas score and total CSVD burden score, were assessed with an MRI scan. A mismatch refers to an inconsistency between the severity of WMH and cognitive dysfunction. A Type 1 mismatch refers to cognitive impairment with mild WMH (total Fazekas score = 0−1), and a Type 2 mismatch refers to severe WMH (total Fazekas score = 5−6) in patients with normal cognitive function. Results: Among 213 enrolled ALS patients, 66 patients (31.0%) had cognitive dysfunction, and 40 patients (18.8%) had mismatches. Twenty-seven cases (12.7%) were Type 1 mismatched, and seventeen cases (8.0%) were Type 2 mismatched. Age, gender, fibrinogen and cerebral infarction history were independent risk factors for cognitive impairment in ALS patients. Imaging features, including moderate to severe WMH, deep WMH and the total CSVD burden score, were also independently associated with cognitive impairment. The patients in the mismatched group were older, had more severe deep WMH and had a higher occurrence of depression (p < 0.05). The NIHSS score, depression and microbleeds were significantly different between the Type 1 mismatched group and the matched group (p = 0.018, p = 0.012 and p = 0.047). Patients in the Type 2 mismatched group were male (p = 0.04), had a lower level of fibrinogen (p = 0.005), a lower incidence of CMBs (p = 0.003), a lower total CSVD burden score (p = 0.017), more severe paraventricular WMH (p = 0.035) and milder deep WMH (p = 0.026). Conclusions: Our study examined a homogeneous study cohort of recruited patients with symptomatic ALS. We found heterogeneity between WMH and cognitive function in ALS patients. Despite a similar WMH severity, some baseline clinical features and other conventional CSVD imaging characteristics may account for this heterogeneity phenomenon. Our findings provide data for the early diagnosis and prevention of cognitive impairment in ALS patients and suggest that the severity of WMH is not completely parallel to cognitive impairment. The white matter microstructural injury and remote WMH effects may account for the mismatch phenomenon. More attention should be paid to understanding the underlying mechanisms and finding new imaging markers.
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16
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Lahna D, Schwartz DL, Woltjer R, Black SE, Roese N, Dodge H, Boespflug EL, Keith J, Gao F, Ramirez J, Silbert LC. Venous Collagenosis as Pathogenesis of White Matter Hyperintensity. Ann Neurol 2022; 92:992-1000. [PMID: 36054513 PMCID: PMC9671829 DOI: 10.1002/ana.26487] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/05/2022] [Accepted: 08/13/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Periventricular white matter hyperintensities (pvWMHs) are commonly observed on MRI in older individuals and are associated with cognitive and motor decline. The etiology of pvWMH remains unknown. Venous collagenosis has been implicated, which may also interfere with perivascular fluid flow leading to dilation of perivascular spaces (PVS). Here, we examine relationships between in vivo pvWMH volume and ex vivo morphological quantification of collagenosis and the PVS in veins and arteries. METHODS Brain tissue from 25 Oregon Alzheimer's Disease Research Center subjects was selected to cover the full range of WMH burden. Tissue from white matter abutting the ventricle was stained with Masson's trichrome and smooth muscle actin. An automated hue based algorithm identified and segmented vessel into collagenized vessel walls, lumen, and PVS. Multiple linear regressions with pvWMH volume as the dependent variable and either collagen thickness or PVS width were performed with covariates of vessel diameter, age at death, sex, and interval between MRI and death. RESULTS PVS width and collagen thickness were significantly correlated in both arteries (r = 0.21, p = 0.001) and veins (r = 0.23, p = 0.001). Increased venous collagen (p = 0.017) was a significant predictor of higher pvWMH burden while arterial collagen was not (p = 0.128). Neither PVS width in arteries (p = 0.937) nor veins (p = 0.133) predicted pvWMH burden. INTERPRETATION These findings are consistent with a model in which venous collagenosis mediates the relationship between vascular risk factors and pvWMH. This study confirms the importance of changes to the venous system in contributing to MRI white matter lesions commonly observed with advanced age. ANN NEUROL 2022;92:992-1000.
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Affiliation(s)
- David Lahna
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
| | - Daniel L Schwartz
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon,Advanced Imaging Research Center, OHSUPortlandOregon
| | | | - Sandra E Black
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, LC Campbell Cognitive NeurologySunnybrook Research Institute, University of TorontoTorontoOntario (ON)Canada,Heart & Stroke FoundationCanadian Partnership for Stroke RecoveryTorontoOntarioCanada,Department of Medicine (Neurology)Sunnybrook Health Sciences Centre and University of TorontoOntarioCanada
| | - Natalie Roese
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
| | - Hiroko Dodge
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
| | - Erin L Boespflug
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
| | - Julia Keith
- Department of Anatomic Pathology, Sunnybrook Health Sciences CenterUniversity of TorontoTorontoOntarioCanada
| | - Fuqiang Gao
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, LC Campbell Cognitive NeurologySunnybrook Research Institute, University of TorontoTorontoOntario (ON)Canada,Heart & Stroke FoundationCanadian Partnership for Stroke RecoveryTorontoOntarioCanada
| | - Joel Ramirez
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, LC Campbell Cognitive NeurologySunnybrook Research Institute, University of TorontoTorontoOntario (ON)Canada,Heart & Stroke FoundationCanadian Partnership for Stroke RecoveryTorontoOntarioCanada
| | - Lisa C Silbert
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
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17
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Song S, Gaynor AM, Gazes Y, Lee S, Xu Q, Habeck C, Stern Y, Gu Y. Physical activity moderates the association between white matter hyperintensity burden and cognitive change. Front Aging Neurosci 2022; 14:945645. [PMID: 36313016 PMCID: PMC9610117 DOI: 10.3389/fnagi.2022.945645] [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: 05/16/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023] Open
Abstract
Objective Greater physical activity (PA) could delay cognitive decline, yet the underlying mechanisms remain unclear. White matter hyperintensity (WMH) burden is one of the key brain pathologies that have been shown to predict faster cognitive decline at a late age. One possible pathway is that PA may help maintain cognition by mitigating the detrimental effects of brain pathologies, like WMH, on cognitive change. This study aims to examine whether PA moderates the association between WMH burden and cognitive change. Materials and methods This population-based longitudinal study included 198 dementia-free adults aged 20-80 years. Leisure-time physical activity (LTPA) was assessed by a self-reported questionnaire. Occupational physical activity (OPA) was a factor score measuring the physical demands of each job. Total physical activity (TPA) was operationalized as the average of z-scores of LTPA and OPA. Outcome variables included 5-year changes in global cognition and in four reference abilities (fluid reasoning, processing speed, memory, and vocabulary). Multivariable linear regression models were used to estimate the moderation effect of PA on the association between white matter hyperintensities and cognitive change, adjusting for age, sex, education, and baseline cognition. Results Over approximately 5 years, global cognition (p < 0.001), reasoning (p < 0.001), speed (p < 0.001), and memory (p < 0.05) scores declined, and vocabulary (p < 0.001) increased. Higher WMH burden was correlated with more decline in global cognition (Spearman's rho = -0.229, p = 0.001), reasoning (rho = -0.402, p < 0.001), and speed (rho = -0.319, p < 0.001), and less increase in vocabulary (rho = -0.316, p < 0.001). Greater TPA attenuated the association between WMH burden and changes in reasoning (βTPA^*WMH = 0.029, 95% CI = 0.006-0.052, p = 0.013), speed (βTPA^*WMH = 0.035, 95% CI = -0.004-0.065, p = 0.028), and vocabulary (βTPA^*WMH = 0.034, 95% CI = 0.004-0.065, p = 0.029). OPA seemed to be the factor that exerted a stronger moderation on the relationship between WMH burden and cognitive change. Conclusion Physical activity may help maintain reasoning, speed, and vocabulary abilities in face of WMH burden. The cognitive reserve potential of PA warrants further examination.
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Affiliation(s)
- Suhang Song
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, United States
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, United States
| | - Alexandra M. Gaynor
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, United States
| | - Yunglin Gazes
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, United States
- Division of Cognitive Neuroscience, Department of Neurology, Columbia University, New York, NY, United States
- Gertrude H. Sergievsky Center, Columbia University, New York, NY, United States
| | - Seonjoo Lee
- Department of Psychiatry and Biostatistics, Columbia University, New York, NY, United States
- Mental Health Data Science, New York State Psychiatric Institute, New York, NY, United States
| | - Qianhui Xu
- Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christian Habeck
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, United States
- Division of Cognitive Neuroscience, Department of Neurology, Columbia University, New York, NY, United States
- Gertrude H. Sergievsky Center, Columbia University, New York, NY, United States
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, United States
- Division of Cognitive Neuroscience, Department of Neurology, Columbia University, New York, NY, United States
- Gertrude H. Sergievsky Center, Columbia University, New York, NY, United States
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Yian Gu
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, United States
- Division of Cognitive Neuroscience, Department of Neurology, Columbia University, New York, NY, United States
- Gertrude H. Sergievsky Center, Columbia University, New York, NY, United States
- Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, United States
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18
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Apor A, Bartykowszki A, Szilveszter B, Varga A, Suhai FI, Manouras A, Molnár L, Jermendy ÁL, Panajotu A, Turáni MF, Papp R, Karády J, Kolossváry M, Kováts T, Maurovich-Horvat P, Merkely B, Nagy AI. Subclinical leaflet thrombosis after transcatheter aortic valve implantation is associated with silent brain injury on brain magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2022; 23:1584-1595. [PMID: 36168113 DOI: 10.1093/ehjci/jeac191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Whether hypoattenuated leaflet thickening (HALT) following transcatheter aortic valve implantation (TAVI) carries a risk of subclinical brain injury (SBI) is unknown. We investigated whether HALT is associated with SBI detected on magnetic resonance imaging (MRI), and whether post-TAVI SBI impacts the patients' cognition and outcome. METHODS AND RESULTS We prospectively enrolled 153 patients (age: 78.1 ± 6.3 years; female 44%) who underwent TAVI. Brain MRI was performed shortly post-TAVI and 6 months later to assess the occurrence of acute silent cerebral ischaemic lesions (SCIL) and chronic white matter hyperintensities (WMH). HALT was screened by cardiac computed tomography (CT) angiography (CTA) 6 months post-TAVI. Neurocognitive evaluation was performed before, shortly after and 6 months following TAVI. At 6 months, 115 patients had diagnostic CTA and 10 had HALT. HALT status, baseline, and follow-up MRIs were available in 91 cases. At 6 months, new SCIL was evident in 16%, new WMH in 66%. New WMH was more frequent (100 vs. 62%; P = 0.047) with higher median volume (319 vs. 50 mm3; P = 0.039) among HALT-patients. In uni- and multivariate analysis, HALT was associated with new WMH volume (beta: 0.72; 95%CI: 0.2-1.39; P = 0.009). The patients' cognitive trajectory from pre-TAVI to 6 months showed significant association with the 6-month SCIL volume (beta: -4.69; 95%CI: -9.13 to 0.27; P = 0.038), but was not related to the presence or volume of new WMH. During a 3.1-year follow-up, neither HALT [hazard ratio (HR): 0.86; 95%CI: 0.202-3.687; P = 0.84], nor the related WMH burden (HR: 1.09; 95%CI: 0.701-1.680; P = 0.71) was related with increased mortality. CONCLUSIONS At 6 months post-TAVI, HALT was linked with greater WMH burden, but did not carry an increased risk of cognitive decline or mortality over a 3.1-year follow-up (NCT02826200).
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Affiliation(s)
- Astrid Apor
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary
| | - Andrea Bartykowszki
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary.,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary.,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Andrea Varga
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary
| | - Ferenc I Suhai
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary
| | - Aristomenis Manouras
- Department of Medicine, Karolinska Institute, 14186 Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Levente Molnár
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary
| | - Ádám L Jermendy
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary
| | - Alexisz Panajotu
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary
| | | | - Roland Papp
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Tímea Kováts
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary.,Medical Imaging Center, Semmelweis University, 1082 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary
| | - Anikó Ilona Nagy
- Heart and Vascular Center, Semmelweis University, 68, Városmajor Street, 1122 Budapest, Hungary.,Department of Medicine, Karolinska Institute, 14186 Stockholm, Sweden
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19
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Song S, Gaynor AM, Cruz E, Lee S, Gazes Y, Habeck C, Stern Y, Gu Y. Mediterranean Diet and White Matter Hyperintensity Change over Time in Cognitively Intact Adults. Nutrients 2022; 14:3664. [PMID: 36079921 PMCID: PMC9460774 DOI: 10.3390/nu14173664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Current evidence on the impact of Mediterranean diet (MeDi) on white matter hyperintensity (WMH) trajectory is scarce. This study aims to examine whether greater adherence to MeDi is associated with less accumulation of WMH. This population-based longitudinal study included 183 cognitively intact adults aged 20−80 years. The MeDi score was obtained from a self-reported food frequency questionnaire; WMH was assessed by 3T MRI. Multivariable linear regression was used to estimate the effect of MeDi on WMH change. Covariates included socio-demographic factors and brain markers. Moderation effects by age, gender, and race/ethnicity were examined, followed by stratification analyses. Among all participants, WMH increased from baseline to follow-up (mean difference [follow-up-baseline] [standard deviation] = 0.31 [0.48], p < 0.001). MeDi adherence was negatively associated with the increase in WMH (β = −0.014, 95% CI = −0.026−−0.001, p = 0.034), adjusting for all covariates. The association between MeDi and WMH change was moderated by age (young group = reference, p-interaction[middle-aged × MeDi] = 0.075, p-interaction[older × MeDi] = 0.037). The association between MeDi and WMH change was observed among the young group (β = −0.035, 95% CI = −0.058−−0.013, p = 0.003), but not among other age groups. Moderation effects by gender and race/ethnicity did not reach significance. Greater adherence to MeDi was associated with a lesser increase in WMH over time. Following a healthy diet, especially at younger age, may help to maintain a healthy brain.
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Affiliation(s)
- Suhang Song
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA 30602, USA
| | - Alexandra M. Gaynor
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
| | - Emily Cruz
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
| | - Seonjoo Lee
- Department of Psychiatry and Biostatistics, Columbia University, New York, NY 10032, USA
- Mental Health Data Science, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Yunglin Gazes
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA
| | - Christian Habeck
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA
| | - Yaakov Stern
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Yian Gu
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA
- Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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20
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Guo W, Shi J. White matter hyperintensities volume and cognition: A meta-analysis. Front Aging Neurosci 2022; 14:949763. [PMID: 36118701 PMCID: PMC9476945 DOI: 10.3389/fnagi.2022.949763] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cerebral small vessel disease (CSVD) is prevalent in the elderly and leads to an increased risk of cognitive impairment and dementia. The volume of white matter hyperintensities (WMHs) increases with age, which affects cognition. Objective To explore the relationship between WMH volume and cognitive decline in patients with CSVD. Methods We performed a systematic search of PubMed, Embase, and the Web of Science databases from their respective creation dates to the 5 May 2022 to identify all the clinical studies on either mild cognitive impairment (MCI) or dementia in regards to WMH volume in CSVD. Results White matter hyperintensities was associated with the risk of both the MCI and dementia, with a 35% increased risk [relative risk (RR) = 1.35; (95% CI: 1.01-1.81)] of progression from cognitively unimpaired (CU) to MCI (six studies, n = 2,278) and a 49% increased risk [RR = 1.49; (95% CI: 1.21-1.84)] of progression to dementia (six studies, n = 6,330). In a subgroup analysis, a follow-up period of over 5 years increased the risk of MCI by 40% [RR = 1.40; (95% CI: 1.07-1.82)] and dementia by 48% [RR = 1.48; (95% CI: 1.15-1.92)]. Conclusion White matter hyperintensities was found to be substantially correlated with the risk of cognitive impairment. Furthermore, cognitive decline was found to be a chronic process, such that WMH predicted the rate of cognitive decline in CSVD beyond 5 years. The cognitive decline observed in patients with WMH may, therefore, be minimized by early intervention.
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Affiliation(s)
| | - Jing Shi
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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21
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Werhane ML, Thomas KR, Bangen KJ, Weigand AJ, Edmonds EC, Nation DA, Sundermann EE, Bondi MW, Delano-Wood L. Arterial Stiffening Moderates the Relationship Between Type-2 Diabetes Mellitus and White Matter Hyperintensity Burden in Older Adults With Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:716638. [PMID: 34759811 PMCID: PMC8574966 DOI: 10.3389/fnagi.2021.716638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebrovascular dysfunction has been proposed as a possible mechanism underlying cognitive impairment in the context of type 2 diabetes mellitus (DM). Although magnetic resonance imaging (MRI) evidence of cerebrovascular disease, such as white matter hyperintensities (WMH), is often observed in DM, the vascular dynamics underlying this pathology remain unclear. Thus, we assessed the independent and combined effects of DM status and different vascular hemodynamic measures (i.e., systolic, diastolic, and mean arterial blood pressure and pulse pressure index [PPi]) on WMH burden in cognitively unimpaired (CU) older adults and those with mild cognitive impairment (MCI). Methods: 559 older adults (mean age: 72.4 years) from the Alzheimer's Disease Neuroimaging Initiative were categorized into those with diabetes (DM+; CU = 43, MCI = 34) or without diabetes (DM-; CU = 279; MCI = 203). Participants underwent BP assessment, from which all vascular hemodynamic measures were derived. T2-FLAIR MRI was used to quantify WMH burden. Hierarchical linear regression, adjusting for age, sex, BMI, intracranial volume, CSF amyloid, and APOE ε4 status, examined the independent and interactive effects of DM status and each vascular hemodynamic measure on total WMH burden. Results: The presence of DM (p = 0.046), but not PPi values (p = 0.299), was independently associated with greater WMH burden overall after adjusting for covariates. Analyses stratified by cognitive status revealed a significant DM status x PPi interaction within the MCI group (p = 0.001) such that higher PPi values predicted greater WMH burden in the DM + but not DM- group. No significant interactions were observed in the CU group (all ps > 0.05). Discussion: Results indicate that higher PPi values are positively associated with WMH burden in diabetic older adults with MCI, but not their non-diabetic or CU counterparts. Our findings suggest that arterial stiffening and reduced vascular compliance may have a role in development of cerebrovascular pathology within the context of DM in individuals at risk for future cognitive decline. Given the specificity of these findings to MCI, future exploration of the sensitivity of earlier brain markers of vascular insufficiency (i.e., prior to macrostructural white matter changes) to the effects of DM and arterial stiffness/reduced vascular compliance in CU individuals is warranted.
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Affiliation(s)
- Madeleine L. Werhane
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Alexandra J. Weigand
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, United States
| | - Emily C. Edmonds
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Daniel A. Nation
- Department of Psychological Sciences, University of California, Irvine, Irvine, CA, United States
| | - Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Mark W. Bondi
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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22
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Porcu M, Cocco L, Cocozza S, Pontillo G, Operamolla A, Defazio G, Suri JS, Brunetti A, Saba L. The association between white matter hyperintensities, cognition and regional neural activity in healthy subjects. Eur J Neurosci 2021; 54:5427-5443. [PMID: 34327745 DOI: 10.1111/ejn.15403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 07/03/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
White matter hyperintensities (WMH) are common findings that can be found in physiological ageing. Several studies suggest that the disruption of white matter tracts included in WMH could induce abnormal functioning of the respective linked cortical structures, with consequent repercussion on the cerebral functions, included the cognitive sphere. In this cross-sectional research, we analysed the effects of the total WMH burden (tWMHb) on resting-state functional magnetic resonance imaging (rs-fMRI) and cognition. Functional and structural MR data, as well as the scores of the trail making test subtests A (TMT-A) and B (TMT-B) of 75 healthy patients, were extracted from the public available Leipzig Study for Mind-Body-Emotion Interactions dataset. tWMHb was extracted from structural data. Spearman's correlation analyses were made for investigating correlations between WMHb and the scores of the cognitive tests. The fractional amplitude of low-frequency fluctuations (fALFF) method was applied for analysing the rs-fMRI data, adopting a multiple regression model for studying the effects of tWMHb on brain activity. Three different subanalyses were conducted using different statistical methods. We observed statistically significant correlations between WMHb and the scores of the cognitive tests. The fALFF analysis revealed that tWMHb is associated with the reduction of regional neural activity of several brain areas (in particular the prefrontal cortex, precuneus and cerebellar crus I/II). We conclude that our findings clarify better the relationships between WMH and cognitive impairment, evidencing that tWMHb is associated with impairments of the neurocognitive function in healthy subjects by inducing a diffuse reduction of the neural activity.
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Affiliation(s)
- Michele Porcu
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Luigi Cocco
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Sirio Cocozza
- Department of Neuroradiology, University of Napoli "Federico II", Napoli, Italy
| | - Giuseppe Pontillo
- Department of Neuroradiology, University of Napoli "Federico II", Napoli, Italy
| | | | - Giovanni Defazio
- Department of Neurology, University of Cagliari, Cagliari, Italy
| | - Jasjit S Suri
- Stroke Diagnosis and Monitoring Division, AtheroPoint™, Roseville, California, USA
| | - Arturo Brunetti
- Department of Neuroradiology, University of Napoli "Federico II", Napoli, Italy
| | - Luca Saba
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
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23
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Yamasaki T, Ikawa F, Hidaka T, Kuwabara M, Matsuda S, Ozono I, Chiku M, Kitamura N, Hamano T, Akishita M, Yamaguchi S, Tomimoto H, Suzuki M. Prevalence and risk factors for brain white matter changes in young and middle-aged participants with Brain Dock (brain screening): a registry database study and literature review. Aging (Albany NY) 2021; 13:9496-9509. [PMID: 33820872 PMCID: PMC8064194 DOI: 10.18632/aging.202933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to determine the prevalence and risk factors for brain white matter changes in normal young and middle-aged participants who underwent Brain Dock (brain screening). We analyzed 5,000 consecutive healthy participants from the Brain Dock registry between August to December 2018. Age, sex, body mass index (BMI), medical history, deep subcortical white matter high intensity (DSWMH), periventricular high intensity (PVH), and enlargement of perivascular space (EPVS) were investigated in relation to age. The prevalence of DSWMH, PVH, and EPVS were 35.3%, 14.0%, and 17.8%, respectively. Multivariate logistic regression analyses for brain white matter changes were conducted. The significant risk factors in participants aged < 50 years were: age (OR:1.09, 95% CI:1.07-1.12), the female sex (1.29, 1.03-1.60), BMI obesity (1.86, 1.12-3.08), and hypertension (1.67, 1.18-2.35) for DSWMH; age (1.08, 1.04-1.13) and the female sex (1.56, 1.03-2.36) for PVH; and age (1.07, 1.05-1.10) and the female sex (0.77, 0.60-1.00) for EPVS. In conclusion, age was consistently identified as a significant risk factor in young and middle-aged participants. Some risk factors for brain white matter changes were identified even in young and middle-aged participants in this study. Further longitudinal studies should be done in the future.
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Affiliation(s)
- Tomohiro Yamasaki
- Postgraduate Clinical Training Center, Shimane University Hospital, Shimane, Japan
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Masashi Kuwabara
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Masaaki Chiku
- Department of Cardiovascular Medicine, Medical Check Studio Tokyo Ginza Clinic, Tokyo, Japan
| | - Naoyuki Kitamura
- Department of Diagnostic Radiology, Kasumi Clinic, Hiroshima, Japan
| | | | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Michiyasu Suzuki
- Department of Advanced ThermoNeuroBiology, Yamaguchi University School of Medicine, Yamaguchi, Japan
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24
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Jayachandran M, Lahr BD, Bailey KR, Miller VM, Kantarci K. Menopausal hormone therapy, blood thrombogenicity, and development of white matter hyperintensities in women of the Kronos Early Estrogen Prevention Study. ACTA ACUST UNITED AC 2021; 27:305-310. [PMID: 31934946 PMCID: PMC7050795 DOI: 10.1097/gme.0000000000001465] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Supplemental Digital Content is available in the text Objective: Development of white matter hyperintensities (WMH) in the brain is associated with blood thrombogenicity in recently menopausal women. This study examined the influence of menopausal hormone treatments (MHTs) on this association. Methods: Measures of blood thrombogenicity were examined in women of the Kronos Early Estrogen Prevention Study (n = 95) who had brain magnetic resonance imaging before and during the 48 months of randomization to transdermal 17β-estradiol (n = 30), oral conjugated equine estrogen (n = 29) both with progesterone for 12 days per month or placebo pills and patch (n = 36). Principal components (PCs) analysis was used to reduce the dimensionality of 14 markers of platelet activation and blood thrombogenicity. The first 5 PCs were assessed for association with treatment and changes in WMH. Within-person slopes were obtained to capture the extent of WMH change for each woman. Results: WMH increased in all groups over the 48 months (P = 0.044). The partial effect of PC1, representing an average of six thrombogenicity variables (microvesicles derived from endothelium, leukocytes, and monocytes, and positive for tissue factor and adhesion molecules) on WMH was significant (P = 0.003). PC3, reflecting a contrast of platelet microaggregates and adenosine triphosphate secretion versus total platelet count, differed across groups (P = 0.006) with higher scores in the oral conjugated equine estrogen group. The global association between PCs and WMH increase, however, did not differ significantly by MHT (P = 0.207 for interaction between MHT and PC's). Conclusion: In recently menopausal women, the type of MHT did not significantly influence the association of markers of blood thrombogenicity with development of WMH in the brain.
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Affiliation(s)
- Muthuvel Jayachandran
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.,Department of Surgery, Mayo Clinic, Rochester, MN
| | - Brian D Lahr
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.,Department of Surgery, Mayo Clinic, Rochester, MN
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25
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Melazzini L, Vitali P, Olivieri E, Bolchini M, Zanardo M, Savoldi F, Di Leo G, Griffanti L, Baselli G, Sardanelli F, Codari M. White Matter Hyperintensities Quantification in Healthy Adults: A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2020; 53:1732-1743. [PMID: 33345393 DOI: 10.1002/jmri.27479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although white matter hyperintensities (WMH) volumetric assessment is now customary in research studies, inconsistent WMH measures among homogenous populations may prevent the clinical usability of this biomarker. PURPOSE To determine whether a point estimate and reference standard for WMH volume in the healthy aging population could be determined. STUDY TYPE Systematic review and meta-analysis. POPULATION In all, 9716 adult subjects from 38 studies reporting WMH volume were retrieved following a systematic search on EMBASE. FIELD STRENGTH/SEQUENCE 1.0T, 1.5T, or 3.0T/fluid-attenuated inversion recovery (FLAIR) and/or proton density/T2 -weighted fast spin echo sequences or gradient echo T1 -weighted sequences. ASSESSMENT After a literature search, sample size, demographics, magnetic field strength, MRI sequences, level of automation in WMH assessment, study population, and WMH volume were extracted. STATISTICAL TESTS The pooled WMH volume with 95% confidence interval (CI) was calculated using the random-effect model. The I2 statistic was calculated as a measure of heterogeneity across studies. Meta-regression analysis of WMH volume on age was performed. RESULTS Of the 38 studies analyzed, 17 reported WMH volume as the mean and standard deviation (SD) and were included in the meta-analysis. Mean and SD of age was 66.11 ± 10.92 years (percentage of men 50.45% ± 21.48%). Heterogeneity was very high (I2 = 99%). The pooled WMH volume was 4.70 cm3 (95% CI: 3.88-5.53 cm3 ). At meta-regression analysis, WMH volume was positively associated with subjects' age (β = 0.358 cm3 per year, P < 0.05, R2 = 0.27). DATA CONCLUSION The lack of standardization in the definition of WMH together with the high technical variability in assessment may explain a large component of the observed heterogeneity. Currently, volumes of WMH in healthy subjects are not comparable between studies and an estimate and reference interval could not be determined. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Luca Melazzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Paolo Vitali
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emanuele Olivieri
- Medicine and Surgery Medical School, Università degli Studi di Milano, Milano, Italy
| | - Marco Bolchini
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Moreno Zanardo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Filippo Savoldi
- Postgraduate School in Radiology, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ludovica Griffanti
- Department of Psychiatry, Wellcome Centre for Integrative Neuroimaging (WIN), University of Oxford, Oxford, UK
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marina Codari
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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White matter hyperintensities and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 36 prospective studies. Neurosci Biobehav Rev 2020; 120:16-27. [PMID: 33188821 DOI: 10.1016/j.neubiorev.2020.11.007] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/20/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND White matter hyperintensities of presumed vascular origin (WMH) are one of the imaging features of cerebral small vessel disease. Controversies persist about the effects of WMH on cognitive dysfunction. This meta-analysis aimed to identify the associations of WMH with risks of cognitive impairment and dementia. METHODS We searched PubMed, EMBASE and Cochrane Library for prospective studies. Primary analyses of cognitive dysfunction and sub-analyses of specific outcomes and study characteristics were conducted using random-effect models. RESULTS Thirty-six prospective studies with 19,040 participants were included. WMH at baseline conferred a 14 % elevated risk of cognitive impairment and all-cause dementia (ACD). WMH also conferred 25 % elevated risk of Alzheimer's disease and 73 % elevated risk of vascular dementia. Risk effects of high-grade WMH and continually increasing WMH (in volume or severity) on ACD were revealed. Periventricular WMH conferred a 1.51-fold excess risk for dementia. CONCLUSIONS WMH were associated with increased risk of cognitive dysfunction and could become a neuroimaging indicator of dementia.
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Metabolic syndrome is associated with cognitive impairment after transient ischemic attack/mild stroke, but does not affect cognitive recovery in short term. Neuroreport 2020; 31:918-922. [PMID: 32658124 DOI: 10.1097/wnr.0000000000001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The metabolic syndrome (MetS) is a cluster of risk factors for cognitive impairment. We aimed to investigate the association between MetS and risk of persistent cognitive impairment in patients with a transient ischemic attack (TIA) or mild ischemic stroke. This is a prospective and observational study in consecutive patients with first-ever TIA or mild stroke (National Institutes of Health Stroke Scale score ≤ 6). Patients underwent Montreal cognitive assessment (MoCA) at hospital admission and day 30 after discharge. We defined cognitive impairment as a MoCA score of ≤26. Persistent cognitive impairment was defined as baseline cognitive impairment and an increase of <2 point or decrease in MoCA score at 1 month after discharge. Three hundred eleven eligible patients were enrolled, aged 21-80 years, and mean age was 61.87 ± 9.643 years and 211 patients were males (70.1%). Cognitive impairments were present in 166 (53.4%) patients at admission. The cognitive impairment rate was significantly higher in MetS patients than those without MetS both at admission and day 30 after discharge (66.1% vs 33.6%, P < 0.001 and 56.6% vs 27.9%, P < 0.001). In logistic regression analysis, MetS, hyperglycemia, hypertension, dyslipidemia, and obesity had no significant interaction with persistent cognitive impairment. However, hypertension had a tendency to be a predictor of persistent cognitive impairment, although this tendency had no statistical significance (odds ratio = 2.545, 95% confidence interval 0.872, 7.430, P = 0.0874). Baseline MetS is associated with the risk of cognitive impairment, but MetS does not affect short-term cognitive recovery from cognitively impaired in patients with TIA/mild stroke.
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Roseborough AD, Langdon KD, Hammond R, Cipriano LE, Pasternak SH, Whitehead SN, Khan AR. Post-mortem 7 Tesla MRI detection of white matter hyperintensities: A multidisciplinary voxel-wise comparison of imaging and histological correlates. Neuroimage Clin 2020; 27:102340. [PMID: 32679554 PMCID: PMC7364158 DOI: 10.1016/j.nicl.2020.102340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/31/2022]
Abstract
White matter hyperintensities (WMH) occur in normal aging and across diagnostic categories of neurodegeneration. Ultra-high field imaging (UHF) MRI machines offer the potential to improve our understanding of WMH. Post-mortem imaging using UHF magnetic resonance imaging (MRI) is a useful way of assessing WMH, however, the responsiveness of UHF-MRI to pathological changes within the white matter has not been characterized. In this study we report post-mortem MRI sequences of white matter hyperintensities in normal aging, Alzheimer's disease, and cerebrovascular disease. Seven Tesla post-mortem MRI reliably detected periventricular WMH using both FLAIR and T2 sequences and reflects underlying pathology of myelin and axon density despite prolonged fixation time. Co-registration of histological images to MRI allowed for direct voxel- wise comparison of imaging findings and pathological changes. Myelin content and cerebrovascular pathology were the most significant predictors of MRI white matter intensity as revealed by linear mixed models. Future work investigating the utility of UHF- MRI in studying cell-specific changes within WMH is required to better understand radio-pathologic correlations.
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Affiliation(s)
- Austyn D Roseborough
- Department of Anatomy and Cell Biology, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kristopher D Langdon
- Department of Pathology and Laboratory Medicine, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lauren E Cipriano
- Ivey Business School and Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
| | - Stephen H Pasternak
- Department of Clinical Neurological Sciences, Robarts Research Institute, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shawn N Whitehead
- Department of Anatomy and Cell Biology, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Ali R Khan
- Department of Medical Biophysics, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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Maniwa K, Yano S, Sheikh AM, Onoda K, Mitaki S, Isomura M, Mishima S, Yamaguchi S, Nabika T, Nagai A. Association between cystatin C gene polymorphism and the prevalence of white matter lesion in elderly healthy subjects. Sci Rep 2020; 10:4688. [PMID: 32170118 PMCID: PMC7069982 DOI: 10.1038/s41598-020-61383-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/28/2020] [Indexed: 12/26/2022] Open
Abstract
Cystatin C (CST3) is a cysteine protease inhibitor abundant in the central nervous system, and demonstrated to have roles in several pathophysiological processes including vascular remodeling and inflammation. Previously, we showed a relation of CST3 gene polymorphisms with deep and subcortical white matter hyperintensity (DSWMH) in a small case-control study. In this study, we aimed to investigate the relation in a larger cross-sectional study. Participants of a brain health examination program were recruited (n = 1795) in the study, who underwent routine blood tests and cognitive function tests. Cerebral white matter changes were analyzed by MRI. Additionally, 7 single nucleotide polymorphisms (SNPs) (−82G/C, −78T/G, −5G/A, +4A/C, +87C/T, +148G/A and +213G/A) in the promoter and coding regions of CST3 gene were examined. Among them, carriers of the minor allele haplotype −82C/+4C/+148A were significantly associated with decreased CST3 concentration in the plasma. Unadjusted analysis did not show significant relation between carriers of the minor allele haplotype and periventricular hyperintensity (PVH), but DSWMH was marginally (p < 0.054) increased in this group. After adjusting the effects of other variables like age and kidney function, logistic regression analysis revealed that carriers of the minor allele haplotype were at a significantly increased risk of developing both PVH and DSWMH. Thus, our results suggest that carriers of the minor allele haplotype −82C/+4C/+148A of CST3 gene could be at an increased risk to develop cerebral white matter disturbance.
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Affiliation(s)
- Kyohei Maniwa
- Central Clinical Laboratory Division, Shimane University Hospital, Izumo, Japan
| | - Shozo Yano
- Department of Laboratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Abdullah Md Sheikh
- Department of Laboratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Keiichi Onoda
- Department of Neurology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Shingo Mitaki
- Department of Neurology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Minoru Isomura
- Shimane University Faculty of Human Sciences, Matsue, Japan
| | - Seiji Mishima
- Central Clinical Laboratory Division, Shimane University Hospital, Izumo, Japan
| | | | - Toru Nabika
- Department of Functional Pathology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Atsushi Nagai
- Department of Neurology, Shimane University Faculty of Medicine, Izumo, Japan.
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Shinto L, Lahna D, Murchison CF, Dodge H, Hagen K, David J, Kaye J, Quinn JF, Wall R, Silbert LC. Oxidized Products of Omega-6 and Omega-3 Long Chain Fatty Acids Are Associated with Increased White Matter Hyperintensity and Poorer Executive Function Performance in a Cohort of Cognitively Normal Hypertensive Older Adults. J Alzheimers Dis 2020; 74:65-77. [DOI: 10.3233/jad-191197] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Lynne Shinto
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - David Lahna
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Charles F. Murchison
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hiroko Dodge
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Kirsten Hagen
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Jason David
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Neurology, Veterans Affairs Medical Center, Portland, OR, USA
| | - Joseph F. Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Neurology, Veterans Affairs Medical Center, Portland, OR, USA
| | - Rachel Wall
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Neurology, Veterans Affairs Medical Center, Portland, OR, USA
| | - Lisa C. Silbert
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Neurology, Veterans Affairs Medical Center, Portland, OR, USA
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31
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Soldan A, Pettigrew C, Zhu Y, Wang MC, Moghekar A, Gottesman RF, Singh B, Martinez O, Fletcher E, DeCarli C, Albert M. White matter hyperintensities and CSF Alzheimer disease biomarkers in preclinical Alzheimer disease. Neurology 2019; 94:e950-e960. [PMID: 31888969 DOI: 10.1212/wnl.0000000000008864] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/30/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Recent studies suggest that white matter hyperintensities (WMH) on MRI, which primarily reflect small vessel cerebrovascular disease, may play a role in the evolution of Alzheimer disease (AD). In a longitudinal study, we investigated whether WMH promote the progression of AD pathology, or alter the association between AD pathology and risk of progression from normal cognition to mild cognitive impairment (MCI). METHODS Two sets of analyses were conducted. The relationship between whole brain WMH load, based on fluid-attenuated inversion recovery MRI, obtained in initially cognitively normal participants (n = 274) and time to onset of symptoms of MCI (n = 60) was examined using Cox regression models. In a subset of the participants with both MRI and CSF data (n = 204), the interaction of WMH load and CSF AD biomarkers was also evaluated. RESULTS Baseline WMH load interacted with CSF total tau (t-tau) with respect to symptom onset, but not with CSF β-amyloid 1-42 or phosphorylated tau (p-tau) 181. WMH volume was associated with time to symptom onset of MCI among individuals with low t-tau (hazard ratio [HR] 1.35, confidence interval [CI] 1.06-1.73, p = 0.013), but not those with high t-tau (HR 0.86, CI 0.56-1.32, p = 0.47). The rate of change in the CSF biomarkers over time was not associated with the rate of change in WMH volumes. CONCLUSION These results suggest that WMH primarily affect the risk of progression when CSF measures of neurodegeneration or neuronal injury (as reflected by t-tau) are low. However, CSF biomarkers of amyloid and p-tau and WMH appear to have largely independent and nonsynergistic effects on the risk of progression to MCI.
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Affiliation(s)
- Anja Soldan
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis.
| | - Corinne Pettigrew
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
| | - Yuxin Zhu
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
| | - Mei-Cheng Wang
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
| | - Abhay Moghekar
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
| | - Rebecca F Gottesman
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
| | - Baljeet Singh
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
| | - Oliver Martinez
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
| | - Evan Fletcher
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
| | - Charles DeCarli
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
| | - Marilyn Albert
- From the Department of Neurology (A.S., C.P., A.M., R.F.G., M.A.), The Johns Hopkins University School of Medicine; Department of Biostatistics (Y.Z., M.-C.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and Department of Neurology (B.S., O.M., E.F., C.D.), School of Medicine, University of California, Davis
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Baseline White Matter Hyperintensities and Hippocampal Volume are Associated With Conversion From Normal Cognition to Mild Cognitive Impairment in the Framingham Offspring Study. Alzheimer Dis Assoc Disord 2019; 32:50-56. [PMID: 28984639 DOI: 10.1097/wad.0000000000000215] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION We examined associations between magnetic resonance imaging (MRI) markers of cerebrovascular disease and neurodegeneration with mild cognitive impairment (MCI) diagnosis at baseline and conversion from normal cognition to MCI at follow-up. METHODS Framingham Offspring participants underwent brain MRI and neuropsychological assessment at baseline (n=1049) and follow-up (n=561). Participants were classified at baseline and at follow-up as cognitively normal or MCI using sensitive neuropsychological criteria. White matter hyperintensity (WMH) volume, covert brain infarcts, hippocampal volume, and total cerebral brain volume were quantified. RESULTS Baseline measures of WMH and hippocampal volume were associated with MCI status cross-sectionally and also with conversion from normal cognition to MCI at 6.5-year follow-up. Annualized change rates in total cerebral brain volume and hippocampal volume were associated with conversion from normal cognition to MCI to follow-up. DISCUSSION Baseline WMH and hippocampal volume are markers that are both associated with conversion from normal cognition to MCI, highlighting the role of both vascular lesions and neurodegeneration in MCI.
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Das AS, Regenhardt RW, Vernooij MW, Blacker D, Charidimou A, Viswanathan A. Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies. J Stroke 2019; 21:121-138. [PMID: 30991799 PMCID: PMC6549070 DOI: 10.5853/jos.2018.03608] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 02/28/2019] [Indexed: 12/28/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. In most cases, CSVD is only recognized in its advanced stages once its symptomatic sequelae develop. However, its significance in asymptomatic healthy populations remains poorly defined. In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. While the presence of these imaging markers may reflect unique mechanisms at play, there are likely shared pathways underlying CSVD. Herein, we aim to assess the etiology and significance of these individual biomarkers by focusing in asymptomatic populations at an epidemiological level. By primarily examining population-based studies, we explore the risk factors that are involved in the formation and progression of these biomarkers. Through a critical semi-systematic review, we aim to characterize “asymptomatic” CSVD, review screening modalities, and draw associations from observational studies in clinical populations. Lastly, we highlight areas of research (including therapeutic approaches) in which further investigation is needed to better understand asymptomatic CSVD.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Alber J, Alladi S, Bae HJ, Barton DA, Beckett LA, Bell JM, Berman SE, Biessels GJ, Black SE, Bos I, Bowman GL, Brai E, Brickman AM, Callahan BL, Corriveau RA, Fossati S, Gottesman RF, Gustafson DR, Hachinski V, Hayden KM, Helman AM, Hughes TM, Isaacs JD, Jefferson AL, Johnson SC, Kapasi A, Kern S, Kwon JC, Kukolja J, Lee A, Lockhart SN, Murray A, Osborn KE, Power MC, Price BR, Rhodius-Meester HF, Rondeau JA, Rosen AC, Rosene DL, Schneider JA, Scholtzova H, Shaaban CE, Silva NC, Snyder HM, Swardfager W, Troen AM, van Veluw SJ, Vemuri P, Wallin A, Wellington C, Wilcock DM, Xie SX, Hainsworth AH. White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): Knowledge gaps and opportunities. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2019; 5:107-117. [PMID: 31011621 PMCID: PMC6461571 DOI: 10.1016/j.trci.2019.02.001] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
White matter hyperintensities (WMHs) are frequently seen on brain magnetic resonance imaging scans of older people. Usually interpreted clinically as a surrogate for cerebral small vessel disease, WMHs are associated with increased likelihood of cognitive impairment and dementia (including Alzheimer's disease [AD]). WMHs are also seen in cognitively healthy people. In this collaboration of academic, clinical, and pharmaceutical industry perspectives, we identify outstanding questions about WMHs and their relation to cognition, dementia, and AD. What molecular and cellular changes underlie WMHs? What are the neuropathological correlates of WMHs? To what extent are demyelination and inflammation present? Is it helpful to subdivide into periventricular and subcortical WMHs? What do WMHs signify in people diagnosed with AD? What are the risk factors for developing WMHs? What preventive and therapeutic strategies target WMHs? Answering these questions will improve prevention and treatment of WMHs and dementia.
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Affiliation(s)
- Jessica Alber
- Department of Biomedical and Pharmaceutical Sciences, George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hee-Joon Bae
- Cerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - David A. Barton
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Laurel A. Beckett
- Department of Public Health Sciences, School of Medicine University of California, Davis, CA, USA
| | | | - Sara E. Berman
- Wisconsin Alzheimer's Disease Research Center, Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra E. Black
- Department of Medicine, University of Toronto, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Isabelle Bos
- Department of Psychiatry & Neuropsychology, Alzheimer Centre Limburg, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Gene L. Bowman
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Adam M. Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Brandy L. Callahan
- Department of Psychology, University of Calgary & Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Roderick A. Corriveau
- Department of Psychology, University of Calgary & Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Silvia Fossati
- Departments of Neurology and Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Rebecca F. Gottesman
- Division of Cerebrovascular Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deborah R. Gustafson
- Section for NeuroEpidemiology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
| | | | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alex M. Helman
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
| | - Timothy M. Hughes
- Department of Internal Medicine – Section of Gerontology and Geriatric Medicine, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeremy D. Isaacs
- St George's University of London and Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Angela L. Jefferson
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sterling C. Johnson
- Department of Medicine-Geriatrics, Institute on Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - Alifiya Kapasi
- Department of Pathology (Neuropathology), Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - Silke Kern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jay C. Kwon
- Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Athene Lee
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Samuel N. Lockhart
- Department of Internal Medicine – Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anne Murray
- Berman Center for Outcomes and Clinical Research, 20298 Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Katie E. Osborn
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Brittani R. Price
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Hanneke F.M. Rhodius-Meester
- Alzheimer Center, Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Allyson C. Rosen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Douglas L. Rosene
- Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Julie A. Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago IL, USA
| | | | - C. Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health & Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Narlon C.B.S. Silva
- School of Kinesiology, Western Centre for Public Health & Family Medicine, London, ON, Canada
| | - Heather M. Snyder
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Walter Swardfager
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Aron M. Troen
- Institute of Biochemistry Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture Food and Environment, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susanne J. van Veluw
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Anders Wallin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Donna M. Wilcock
- Sanders-Brown Center on Aging, Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Sharon Xiangwen Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Atticus H. Hainsworth
- Molecular & Clinical Sciences Research Institute, St George's University of London and Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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Randomized Trial of Marine n-3 Polyunsaturated Fatty Acids for the Prevention of Cerebral Small Vessel Disease and Inflammation in Aging (PUFA Trial): Rationale, Design and Baseline Results. Nutrients 2019; 11:nu11040735. [PMID: 30934894 PMCID: PMC6521224 DOI: 10.3390/nu11040735] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022] Open
Abstract
Vascular risk factors for age-related cognitive decline are significant, and their management may ultimately prove the most successful strategy for reducing risk and sustaining cognitive health. This randomized, double-blinded, placebo-controlled trial with parallel group allocation to either marine n-3 polyunsaturated fatty acids (n-3 PUFA) or soybean oil placebo assesses the effects on the total volume of accumulation in cerebral white matter hyperintensities (WMH), a potentially modifiable neurovascular component of age-related cognitive decline. Total WMH accumulation over 3 years is the primary endpoint. The safety and efficacy of n-3 PUFA is evaluated in older adults with significant WMH and suboptimum plasma n-3 PUFA as inclusion criteria. One hundred and two non-demented older adults were enrolled with a mean age of 81.1 (±4.4) years, WMH of 19.4 (±16.1) cm3, and a plasma n-3 PUFA of 86.64 (±29.21) µg/mL. 61% were female, 28% were apolipoprotein E epsilon 4 carriers, and the mean mini-mental state exam (MMSE) was 27.9 (±1.7). This trial provides an initial evaluation of n-3 PUFA effects on WMH, a reproducible and valid risk biomarker for cognitive decline, as well as on inflammatory biomarkers thought to play a role in WMH accumulation. We present the baseline results and operational experience of enriching a study population on advanced age, blood n-3 PUFA, and magnetic resonance imaging (MRI) derived WMH with biomarker outcomes (WMH, inflammation markers) in a dementia prevention paradigm.
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Jiménez-Balado J, Riba-Llena I, Abril O, Garde E, Penalba A, Ostos E, Maisterra O, Montaner J, Noviembre M, Mundet X, Ventura O, Pizarro J, Delgado P. Cognitive Impact of Cerebral Small Vessel Disease Changes in Patients With Hypertension. Hypertension 2019; 73:342-349. [DOI: 10.1161/hypertensionaha.118.12090] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joan Jiménez-Balado
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Iolanda Riba-Llena
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Oscar Abril
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Edurne Garde
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Anna Penalba
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Elena Ostos
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Olga Maisterra
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Joan Montaner
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Maria Noviembre
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Xavier Mundet
- Primary Healthcare University Research Institute IDIAP Jordi Gol (X.M.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Oriol Ventura
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Jesus Pizarro
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Pilar Delgado
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
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Naqvi I, Hitomi E, Leigh R. Sustained Opening of the Blood-Brain Barrier with Progressive Accumulation of White Matter Hyperintensities Following Ischemic Stroke. Brain Sci 2019; 9:brainsci9010016. [PMID: 30669616 PMCID: PMC6356213 DOI: 10.3390/brainsci9010016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/07/2019] [Accepted: 01/17/2019] [Indexed: 01/02/2023] Open
Abstract
Objective: To report a patient in whom an acute ischemic stroke precipitated chronic blood-brain barrier (BBB) disruption and expansion of vascular white matter hyperintensities (WMH) into regions of normal appearing white matter (NAWM) during the following year. Background: WMH are a common finding in patients with vascular risk factors such as a history of stroke. The pathophysiology of WMH is not fully understood; however, there is growing evidence to suggest that the development of WMH may be preceded by the BBB disruption in the NAWM. Methods: We studied a patient enrolled in the National Institutes of Health Natural History of Stroke Study who was scanned with magnetic resonance imaging (MRI) after presenting to the emergency room with an acute stroke. After a treatment with IV tPA, she underwent further MRI scanning at 2 h, 24 h, 5 days, 30 days, 90 days, 6 months, and 1-year post stroke. BBB permeability images were generated from the perfusion weighted imaging (PWI) source images. MRIs from each time point were co-registered to track changes in BBB disruption and WMH over time. Results: An 84-year-old woman presented after acute onset right hemiparesis, right-sided numbness and aphasia with an initial NIHSS of 13. MRI showed diffusion restriction in the left frontal lobe and decreased blood flow on perfusion imaging. Fluid attenuated inversion recovery (FLAIR) imaging showed bilateral confluent WMH involving the deep white matter and periventricular regions. She was treated with IV tPA without complication and her NIHSS improved initially to 3 and ultimately to 0. Permeability maps identified multiple regions of chronic BBB disruption remote from the acute stroke, predominantly spanning the junction of WMH and NAWM. The severity of BBB disruption was greatest at 24 h after the stroke but persisted on subsequent MRI scans. Progression of WMH into NAWM over the year of observation was detected bilaterally but was most dramatic in the regions adjacent to the initial stroke. Conclusions: WMH-associated BBB disruption may be exacerbated by an acute stroke, even in the contralateral hemisphere, and can persist for months after the initial event. Transformation of NAWM to WMH may be evident in areas of BBB disruption within a year after the stroke. Further studies are needed to investigate the relationship between chronic BBB disruption and progressive WMH in patients with a history of cerebrovascular disease and the potential for acute stroke to trigger or exacerbate the process leading to the development of WMH.
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Affiliation(s)
- Imama Naqvi
- Neuro Vascular Brain Imaging Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Emi Hitomi
- Neuro Vascular Brain Imaging Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Richard Leigh
- Neuro Vascular Brain Imaging Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
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Meguro K, Dodge HH. Vascular Mild Cognitive Impairment: Identifying Disease in Community-Dwelling Older Adults, Reducing Risk Factors, and Providing Support. The Osaki-Tajiri and Kurihara Projects. J Alzheimers Dis 2019; 70:S293-S302. [PMID: 30909215 PMCID: PMC6699913 DOI: 10.3233/jad-180899] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/15/2023]
Abstract
Vascular mild cognitive impairment (MCI) is a critical disease. Its prognosis includes not only onset of vascular dementia, but also death by cardiovascular disease. The vascular risk factors for vascular MCI are treatable, and appropriate treatment can prevent or delay the progression to dementia. Therefore, this group is an excellent candidate for secondary prevention. However, community-dwelling older adults with vascular MCI are often undetected and are not clinically identified until they develop frank dementia. Furthermore, older adults with undetected vascular MCI often have decreased ability to follow their medication regimens and this poor medication adherence worsens their vascular comorbidities. This vicious cycle needs to be prevented through community-based interventions. There is evidence that treatment of hypertension or diabetes mellitus could lead to a reduced incidence of vascular MCI and dementia. In this review article, we first explain the background and etiology of vascular MCI. We then summarize phenotype of subcortical vascular dementia which is often unrecognized or "hidden" in the community. Then we introduce the Osaki-Tajiri and Kurihara Projects which have been conducted in Northern Japan, as an example of prevention projects aimed to identify early-stage vascular MCI in the community, reduce the risk factors and facilitate their treatment. Early identification of vascular MCI in the community could lead to a large reduction in the dementia burden worldwide. The outreach efforts presented here could be useful in developing secondary prevention strategies targeted to vascular MCI.
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Affiliation(s)
- Kenichi Meguro
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center (NICHe), Tohoku University, Sendai, Japan
- The Osaki-Tajiri SKIP Center, Osaki, Japan
| | - Hiroko H. Dodge
- Department of Neurology, Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, Layton Aging and Alzheimer’s Disease Center, Oregon Health and Science University, Portland, OR, USA
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van Loenhoud AC, Groot C, Vogel JW, van der Flier WM, Ossenkoppele R. Is intracranial volume a suitable proxy for brain reserve? Alzheimers Res Ther 2018; 10:91. [PMID: 30205838 PMCID: PMC6134772 DOI: 10.1186/s13195-018-0408-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Brain reserve is a concept introduced to explain why Alzheimer's disease (AD) patients with a greater brain volume prior to onset of pathology generally have better clinical outcomes. In this review, we provide a historical background of the emergence of brain reserve and discuss several aspects that need further clarification, including the dynamic or static nature of the concept and its underlying mechanisms and clinical effect. We then describe how brain reserve has been operationalized over the years, and critically evaluate the use of intracranial volume (ICV) as the most widely used proxy for brain reserve. Furthermore, we perform a meta-analysis showing that ICV is associated with higher cognitive performance after adjusting for the presence and amount of pathology. Although we acknowledge its imperfections, we conclude that the use of ICV as a proxy for brain reserve is currently warranted. However, further development of more optimal measures of brain reserve as well as a more clearly defined theoretical framework is essential.
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Affiliation(s)
- Anna Catharina van Loenhoud
- Department of Neurology and Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Colin Groot
- Department of Neurology and Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacob William Vogel
- Department of Neurology and Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Montreal Neurological Institute, McGill University, Montreal, QC Canada
| | - Wiesje Maria van der Flier
- Department of Neurology and Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Neurology and Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Clinical Memory Research, Lund University, Lund, Sweden
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Madureira S, Verdelho A, Moleiro C, Santos C, Scheltens P, Gouw A, Ferro J. White Matter Changes and Cognitive Decline in a Ten-Year Follow-Up Period: A Pilot Study on a Single-Center Cohort from the Leukoaraiosis and Disability Study. Dement Geriatr Cogn Disord 2018; 41:303-13. [PMID: 27380560 DOI: 10.1159/000447121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS To describe the contribution of white matter lesions to the long-term neuropsychological profiles of different groups of clinical diagnoses, and to identify neuropsychological predictors of cognitive impairment in a 10-year follow-up. METHODS The Lisbon subcohort of the Leukoaraiosis and Disability (LADIS) study was re-evaluated performing a clinical, functional and cognitive evaluation [including Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) and ADAS-Cog with the extension for vascular impairment (VADAS-Cog), the 9-word version of the California Verbal Learning Test (CVLT-9), the Trail-Making test and the Stroop test] as well as an MRI scan. Using clinical diagnostic criteria, participants were identified as having no cognitive impairment (NI), cognitive impairment but no dementia (CIND) or dementia (DEM), and the effect of time on clinical diagnosis and neuropsychological profiles was analyzed. RESULTS From the initial group of 66 participants, 37 out of 41 survivors (90%) were re-evaluated (mean age 81.40 years, 57% women). Fifteen patients (41%) had DEM, 12 (32%) CIND and 10 (27%) NI. Over time, the three groups presented distinct profiles in the MMSE [F2, 62 = 15.85, p = 0.000], ADAS [F2, 62 = 15.85, p = 0.000] and VADAS [F2, 48 = 5.87, p = 0.008]. Logistic regression analysis identified higher scores on MMSE (β = 1.14, p = 0.03, OR = 3.13, 95% CI 1.09-8.97) as predictors of NI after 10 years of follow-up. CONCLUSION Higher scores on baseline MMSE were the only neuropsychological predictors of NI after 10 years.
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Affiliation(s)
- Sofia Madureira
- Department of Neurosciences, Santa Maria Hospital, University of Lisbon, Lisbon, Portugal
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Ding D, Xiong Y, Zhao Q, Guo Q, Chu S, Chu WW, Luo J, Liang X, Zheng L, Hong Z, Wong LK, Mok VC. White Matter Hyperintensity Predicts the Risk of Incident Cognitive Decline in Community Dwelling Elderly. J Alzheimers Dis 2018; 61:1333-1341. [PMID: 29376875 DOI: 10.3233/jad-170876] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunyun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qihao Guo
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuguang Chu
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Winnie W.C. Chu
- Department of Radiology and Organ Imaging, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Xiaoniu Liang
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Zheng
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhen Hong
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lawrence K.S. Wong
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Vincent C.T. Mok
- Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Wang Q, Guo L, Thompson PM, Jack CR, Dodge H, Zhan L, Zhou J. The Added Value of Diffusion-Weighted MRI-Derived Structural Connectome in Evaluating Mild Cognitive Impairment: A Multi-Cohort Validation1. J Alzheimers Dis 2018; 64:149-169. [PMID: 29865049 PMCID: PMC6272125 DOI: 10.3233/jad-171048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
T1-weighted MRI has been extensively used to extract imaging biomarkers and build classification models for differentiating Alzheimer's disease (AD) patients from healthy controls, but only recently have brain connectome networks derived from diffusion-weighted MRI been used to model AD progression and various stages of disease such as mild cognitive impairment (MCI). MCI, as a possible prodromal stage of AD, has gained intense interest recently, since it may be used to assess risk factors for AD. Little work has been done to combine information from both white matter and gray matter, and it is unknown how much classification power the diffusion-weighted MRI-derived structural connectome could provide beyond information available from T1-weighted MRI. In this paper, we focused on investigating whether diffusion-weighted MRI-derived structural connectome can improve differentiating healthy controls subjects from those with MCI. Specifically, we proposed a novel feature-ranking method to build classification models using the most highly ranked feature variables to classify MCI with healthy controls. We verified our method on two independent cohorts including the second stage of Alzheimer's Disease Neuroimaging Initiative (ADNI2) database and the National Alzheimer's Coordinating Center (NACC) database. Our results indicated that 1) diffusion-weighted MRI-derived structural connectome can complement T1-weighted MRI in the classification task; 2) the feature-rank method is effective because of the identified consistent T1-weighted MRI and network feature variables on ADNI2 and NACC. Furthermore, by comparing the top-ranked feature variables from ADNI2, NACC, and combined dataset, we concluded that cross-validation using independent cohorts is necessary and highly recommended.
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Affiliation(s)
- Qi Wang
- Computer Science and Engineering, Michigan State University, East Lansing, MI
| | - Lei Guo
- Mathematics, Statistics & Computer Science Department, University of Wisconsin-Stout, Menomonie, WI
| | - Paul M. Thompson
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA
| | | | - Hiroko Dodge
- Michigan Alzheimer's Disease Center and Department of Neurology, University of Michigan, Ann Arbor, MI
- Layton Aging and Alzheimer's Disease Center and Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Liang Zhan
- Computer Engineering Program, University of Wisconsin-Stout, Menomonie, WI
| | - Jiayu Zhou
- Computer Science and Engineering, Michigan State University, East Lansing, MI
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Role of Cerebrovascular Disease in Cognition. NEURODEGENER DIS 2018. [DOI: 10.1007/978-3-319-72938-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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45
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Ghanem A, Dörner J, Schulze-Hagen L, Müller A, Wilsing M, Sinning JM, Lütkens J, Frerker C, Kuck KH, Gräff I, Schild H, Werner N, Grube E, Nickenig G. Subacute Subclinical Brain Infarctions after Transcatheter Aortic Valve Implantation Negatively Impact Cognitive Function in Long-Term Follow-Up. PLoS One 2017; 12:e0168852. [PMID: 28056466 PMCID: PMC5215955 DOI: 10.1371/journal.pone.0168852] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 10/19/2016] [Indexed: 11/19/2022] Open
Abstract
Aims To date every post-procedural cerebrovascular embolic event (CVE) is dreaded for its potential to accelerate cognitive decline after transcatheter aortic valve implantation (TAVI). This study differentiates the impact of acute (procedural) and post-acute cerebrovascular embolic events (CVEs) on cognitive performance. Methods Magnetic resonance imaging (MRI) before, early and late after TAVI was performed to quantify embolic burden. Quantification of diffusion- and T1-weighted lesions, as well as white-matter and total brain volumes, as well as cognitive function testing (MMSE) were assessed in 28 patients with a medium follow-up period of 34 months. Results Procedural diffusion-weighted lesions were observed in 17 patients (61%), but demonstrated locoregional remnants only in a minority of patients in long-term follow-up (6.5%). Acute CVEs did not impact the trajectory of late silent brain infarctions (SBI), white-matter hyperintensities, and cerebral atrophy. Functionally, early CVEs did not affect cognitive function. In contrast, patients with “new” SBIs after TAVI had a trend to cognitive deterioration in long-term follow-up (“new”SBI: MMSE -1.4 / no “new”SBI: MMSE +1.5, p = 0.067). Interestingly, only a fraction of these “new” SBIs evolved from procedural CVEs (22.2%). Conclusions Aquired SBIs after TAVI, but not DW-CVE per se are associated with functional impairment long-term after TAVI. In the context of subacute thrombosis seen in TAVI prostheses, these findings set the stage for tailored stroke prevention and comprehensive surrogate endpoint definitions in neuroprotective trials.
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Affiliation(s)
- Alexander Ghanem
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiology, University Hospital Bonn, Germany
- * E-mail: (AG); (GN)
| | - Jonas Dörner
- Department of Radiology, University Hospital Cologne, Germany
- Department of Radiology, University Hospital Bonn, Germany
| | | | - Andreas Müller
- Department of Radiology, University Hospital Bonn, Germany
| | - Marius Wilsing
- Department of Cardiology, University Hospital Bonn, Germany
| | | | - Julian Lütkens
- Department of Radiology, University Hospital Bonn, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Ingo Gräff
- Emergency Department, University Hospital Bonn, Bonn, Germany
| | - Hans Schild
- Department of Radiology, University Hospital Bonn, Germany
| | - Nikos Werner
- Department of Cardiology, University Hospital Bonn, Germany
| | - Eberhard Grube
- Department of Cardiology, University Hospital Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology, University Hospital Bonn, Germany
- * E-mail: (AG); (GN)
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Shibata K, Nishimura Y, Otsuka K, Sakura H. Influence of cerebral white matter hyperintensities on cognitive impairment in elderly medical patients. Geriatr Gerontol Int 2016; 17:1488-1493. [PMID: 27680506 DOI: 10.1111/ggi.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/28/2016] [Accepted: 07/24/2016] [Indexed: 11/28/2022]
Abstract
AIM We investigated the characteristics of elderly medical patients with white matter hyperintensities on magnetic resonance imaging. METHODS A total of 213 patients (123 men and 90 women; mean age 74.8 years) reported their history of hypertension, diabetes, dyslipidemia, previous stroke, coronary heart disease and chronic kidney disease (CKD). All patients completed the Mini-Mental State Examination and Geriatric Depression Scale. White matter hyperintensities were evaluated for the periventricular region, basal ganglia (BGH), deep white matter and infratentorial region, and brain atrophy was calculated as bicaudate ratios. RESULTS Patients with cognitive impairment (Mini-Mental State Examination score < 24) were significantly older (P = 0.001), had periventricular region hyperintensities (P = 0.029) and BGH (P = 0.0015), and showed atrophy (P < 0.0001). Logistic regression showed that cognitive impairment was predicted by stroke (OR 2.5, 95% CI 0.033-0.894, P = 0.036) and atrophy (OR 8.43, 95% CI 5.71-37.0, P = 0.0109). Multiple regressions showed that BGH was associated with CKD (β = 0.213; P = 0.003), and infratentorial region was associated with stroke (β = 0.157; P =0.035) and CKD (β = 0.172; P = 0.016). Periventricular region was associated with age (β = 0.2; P = 0.011) and Geriatric Depression Scale (β = 0.151; P = 0.037), and deep white matter hyperintensities with age (β = 0.189; P = 0.016). CONCLUSIONS Although cognitive impairment in elderly medical patients is associated with stroke and brain atrophy, white matter hyperintensities, especially BGH and infratentorial region, are associated with cognitive decline in relation to CKD. Geriatr Gerontol Int 2017; 17: 1488-1493.
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Affiliation(s)
- Koichi Shibata
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yoshiko Nishimura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kuniaki Otsuka
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hiroshi Sakura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Boyle PA, Yu L, Fleischman DA, Leurgans S, Yang J, Wilson RS, Schneider JA, Arvanitakis Z, Arfanakis K, Bennett DA. White matter hyperintensities, incident mild cognitive impairment, and cognitive decline in old age. Ann Clin Transl Neurol 2016; 3:791-800. [PMID: 27752514 PMCID: PMC5048389 DOI: 10.1002/acn3.343] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/27/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022] Open
Abstract
Objective Examine the association of white matter hyperintensities (WMH) with risk of incident mild cognitive impairment (MCI) and rate of decline in multiple cognitive systems in community‐based older persons. Methods Participants (n = 354) were older persons initially free of cognitive impairment from two ongoing longitudinal epidemiologic studies of aging. All underwent brain magnetic resonance imaging (MRI) for quantification of WMH and gray matter volumes and detailed annual clinical evaluations including 17 cognitive tests. Proportional hazards models were used to examine the relationship between WMH and incident MCI, and mixed‐effects models were used to examine the relationship between WMH and decline in global cognition and five specific cognitive systems. Results During up to about 6 years of follow‐up (mean = 4.1), 106 (30% of 354) persons developed MCI. In a proportional hazards model adjusted for age, gender, and education, WMH volume was associated with a substantially increased risk of MCI (P < 0.001). Thus, a person with a high WMH volume (90th percentile) was about 2.7 times more likely to develop MCI compared to a person with a low volume (10th percentile). WMH volume also was associated with an increased rate of decline in global cognition (P < 0.001), perceptual speed, working memory, episodic memory, and semantic memory. Associations persisted after adjustment for total gray matter volume, vascular risk factors, and vascular diseases. Interpretation WMH contribute to the development of MCI and are associated with progressive decline in multiple cognitive systems in old age.
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Affiliation(s)
- Patricia A Boyle
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Behavioral Sciences Rush University Medical Center Chicago Illinois
| | - Lei Yu
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Neurological Sciences Rush University Medical Center Chicago Illinois
| | - Debra A Fleischman
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Behavioral Sciences Rush University Medical Center Chicago Illinois; Department of Neurological Sciences Rush University Medical Center Chicago Illinois
| | - Sue Leurgans
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Neurological Sciences Rush University Medical Center Chicago Illinois
| | - Jingyun Yang
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Neurological Sciences Rush University Medical Center Chicago Illinois
| | - Robert S Wilson
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Behavioral Sciences Rush University Medical Center Chicago Illinois; Department of Neurological Sciences Rush University Medical Center Chicago Illinois
| | - Julie A Schneider
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Neurological Sciences Rush University Medical Center Chicago Illinois; Department of Pathology Rush University Medical Center Chicago Illinois
| | - Zoe Arvanitakis
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Neurological Sciences Rush University Medical Center Chicago Illinois
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Biomedical Engineering Illinois Institute of Technology Chicago Illinois; Department of Diagnostic Radiology and Nuclear Medicine Rush University Medical Center Chicago Illinois
| | - David A Bennett
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois; Department of Neurological Sciences Rush University Medical Center Chicago Illinois
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Promjunyakul NO, Lahna DL, Kaye JA, Dodge HH, Erten-Lyons D, Rooney WD, Silbert LC. Comparison of cerebral blood flow and structural penumbras in relation to white matter hyperintensities: A multi-modal magnetic resonance imaging study. J Cereb Blood Flow Metab 2016; 36:1528-36. [PMID: 27270266 PMCID: PMC5010096 DOI: 10.1177/0271678x16651268] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
Normal-appearing white matter (NAWM) surrounding WMHs is associated with decreased structural integrity and perfusion, increased risk of WMH growth, and is referred to as the WMH penumbra. Studies comparing structural and cerebral blood flow (CBF) penumbras within the same individuals are lacking, however, and would facilitate our understanding of mechanisms resulting in WM damage. This study aimed to compare both CBF and structural WMH penumbras in non-demented aging. Eighty-two elderly volunteers underwent 3T-MRI including fluid attenuated inversion recovery (FLAIR), pulsed arterial spin labeling and diffusion tensor imaging (DTI). A NAWM layer mask was generated for periventricular and deep WMHs. Mean CBF, DTI-fractional anisotropy (DTI-FA), DTI-mean diffusivity (DTI-MD) and FLAIR intensity for WMHs and its corresponding NAWM layer masks were computed and compared against its mean within total brain NAWM using mixed effects models. For both periventricular and deep WMHs, DTI-FA, DTI-MD and FLAIR intensity changes extended 2-9 mm surrounding WMHs (p ≤ 0.05), while CBF changes extended 13-14 mm (p ≤ 0.05). The CBF penumbra is more extensive than structural penumbras in relation to WMHs and includes WM tissue both with and without microstructural changes. Findings implicate CBF as a potential target for the prevention of both micro and macro structural WM damage.
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Affiliation(s)
| | - David L Lahna
- Department of Neurology, Oregon Health & Science University, Portland, USA
| | - Jeffrey A Kaye
- Department of Neurology, Oregon Health & Science University, Portland, USA Department of Neurology, Veterans Affairs Medical Center, Portland, USA
| | - Hiroko H Dodge
- Department of Neurology, Oregon Health & Science University, Portland, USA
| | - Deniz Erten-Lyons
- Department of Neurology, Oregon Health & Science University, Portland, USA Department of Neurology, Veterans Affairs Medical Center, Portland, USA
| | - William D Rooney
- Department of Neurology, Oregon Health & Science University, Portland, USA Advanced Imaging Research Center, Oregon Health & Science University, Portland, USA
| | - Lisa C Silbert
- Department of Neurology, Oregon Health & Science University, Portland, USA Department of Neurology, Veterans Affairs Medical Center, Portland, USA
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Clark AL, Sorg SF, Schiehser DM, Luc N, Bondi MW, Sanderson M, Werhane ML, Delano-Wood L. Deep white matter hyperintensities affect verbal memory independent of PTSD symptoms in veterans with mild traumatic brain injury. Brain Inj 2016; 30:864-71. [DOI: 10.3109/02699052.2016.1144894] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alexandra L. Clark
- San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
| | - Norman Luc
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Mark W. Bondi
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
| | - Mark Sanderson
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Madeleine L. Werhane
- San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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Parathyroid Hormone and Subclinical Cerebrovascular Disease: The Atherosclerosis Risk in Communities Brain Magnetic Resonance Imaging Study. J Stroke Cerebrovasc Dis 2016; 25:883-93. [PMID: 26825350 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/22/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Elevated parathyroid hormone (PTH) levels have been associated with cardiovascular disease risk factors and events. We hypothesized that elevated PTH levels would also be associated with subclinical cerebrovascular disease. We examined the relationship between elevated PTH level and white matter hyperintensities (WMHs) and subclinical infarcts measured on brain magnetic resonance imaging (MRI). METHODS PTH was measured at baseline (1993-1994) among participants free of prior clinical stroke who underwent a brain MRI at baseline (n = 1703) and a second brain MRI 10 years later (n = 948). PTH levels of 65 pg/mL or higher were considered elevated (n = 204). Participants who did not return for a follow-up MRI had, at baseline, higher PTH and a greater prevalence of cardiovascular risk factors (P < .05 for all); therefore, multiple imputation was used. The cross-sectional and prospective associations of PTH levels with WMH and MRI-defined infarcts (and their progression) were investigated using multivariable regression models. RESULTS At baseline, the participants had a mean age of 62 years and were 60% female and 49% black. Cross-sectionally, after adjusting for demographic and lifestyle factors, elevated PTH level was associated with higher WMH score (β = .19, 95% confidence interval [CI] .04-.35) and increased odds of prevalent infarcts (odds ratio 1.56, 95% CI 1.02-2.36). Results were attenuated after adjustment for potential mediators of this association (i.e., hypertension). No prospective associations were found between PTH and incident infarcts or change in estimated WMH volume, although estimates were imprecise. CONCLUSIONS Although associated cross-sectionally, we did not confirm any association between elevated PTH level and progression of cerebrovascular changes on brain MRIs obtained 10 years apart. The relationship of PTH with subclinical brain disease warrants further study.
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