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Zheng C, Cao Y, Li Y, Ye Z, Jia X, Li M, Yu Y, Liu W. Long-term table tennis training alters dynamic functional connectivity and white matter microstructure in large scale brain regions. Brain Res 2024; 1838:148889. [PMID: 38552934 DOI: 10.1016/j.brainres.2024.148889] [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: 01/03/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 05/12/2024]
Abstract
Table tennis training has been employed as an exercise treatment to enhance cognitive brain functioning in patients with mental illnesses. However, research on its underlying mechanisms remains limited. In this study, we investigated functional and structural changes in large-scale brain regions between 20 table tennis players (TTPs) and 21 healthy controls (HCs) using 7-Tesla magnetic resonance imaging (MRI) techniques. Compared with those of HCs, TTPs exhibited significantly greater fractional anisotropy (FA) and axial diffusivity (AD) values in multiple fiber tracts. We used the locations with the most significant structural changes in white matter as the seed areas and then compared static and dynamic functional connectivity (sFC and dFC). Brodmann 11, located in the orbitofrontal cortex, showed altered dFC values to large-scale brain regions, such as the occipital lobe, thalamus, and cerebellar hemispheres, in TTPs. Brodmann 48, located in the temporal lobe, showed altered dFC to the parietal lobe, frontal lobe, cerebellum, and occipital lobe. Furthermore, the AD values of the forceps minor (Fmi) and right anterior thalamic radiations (ATRs) were negatively correlated with useful field of view (UFOV) test scores in TTPs. Our results suggest that table tennis players exhibit a unique pattern of dynamic neural activity, this provides evidence for potential mechanisms through which table tennis interventions can enhance attention and other cognitive functions.
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Affiliation(s)
- Chanying Zheng
- Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yuting Cao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yuyang Li
- Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Xize Jia
- School of Psychology, Zhejiang Normal University, Jinhua, China
| | - Mengting Li
- School of Psychology, Zhejiang Normal University, Jinhua, China.
| | - Yang Yu
- Psychiatry Department, the Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, Hangzhou, China.
| | - Wenming Liu
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou, China.
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2
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Rajeev V, Tabassum NI, Fann DY, Chen CP, Lai MK, Arumugam TV. Intermittent Metabolic Switching and Vascular Cognitive Impairment. J Obes Metab Syndr 2024; 33:92-107. [PMID: 38736362 PMCID: PMC11224924 DOI: 10.7570/jomes24010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/25/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024] Open
Abstract
Intermittent fasting (IF), a dietary pattern alternating between eating and fasting periods within a 24-hour cycle, has garnered recognition for its potential to enhance both healthspan and lifespan in animal models and humans. It also shows promise in alleviating age-related diseases, including neurodegeneration. Vascular cognitive impairment (VCI) spans a severity range from mild cognitive deficits to severe cognitive deficits and loss of function in vascular dementia. Chronic cerebral hypoperfusion has emerged as a significant contributor to VCI, instigating vascular pathologies such as microbleeds, blood-brain barrier dysfunction, neuronal loss, and white matter lesions. Preclinical studies in rodents strongly suggest that IF has the potential to attenuate pathological mechanisms, including excitotoxicity, oxidative stress, inflammation, and cell death pathways in VCI models. Hence, this supports evaluating IF in clinical trials for both existing and at-risk VCI patients. This review compiles existing data supporting IF's potential in treating VCI-related vascular and neuronal pathologies, emphasizing the mechanisms by which IF may mitigate these issues. Hence providing a comprehensive overview of the available data supporting IF's potential in treating VCI by emphasizing the underlying mechanisms that make IF a promising intervention for VCI.
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Affiliation(s)
- Vismitha Rajeev
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nishat I. Tabassum
- Centre for Cardiovascular Biology and Disease Research, Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, Australia
| | - David Y. Fann
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher P. Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Mitchell K.P. Lai
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Thiruma V. Arumugam
- Centre for Cardiovascular Biology and Disease Research, Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, Australia
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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3
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Lissek S, Schlaffke L, Tegenthoff M. Microstructural properties of attention-related white matter tracts are associated with the renewal effect of extinction. Behav Brain Res 2024; 471:115125. [PMID: 38936425 DOI: 10.1016/j.bbr.2024.115125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 06/10/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024]
Abstract
The tendency to show the renewal effect of extinction appears as an intra-individually stable, reproducible processing strategy associated with differential patterns of BOLD activation in hippocampus, iFG and vmPFC, as well as differential resting-state functional connectivity between prefrontal regions and the dorsal attention network. Also, pharmacological modulations of the noradrenergic system that influence attentional processing have partially different effects upon individuals with (REN) and without (NoREN) a propensity for renewal. However, it is as yet unknown whether REN and NoREN individuals differ regarding microstructural properties in attention-related white matter (WM) regions, and whether such differences are related to noradrenergic processing. In this diffusion tensor imaging (DTI) analysis we investigated the relation between microstructural properties of attention-related WM tracts and ABA renewal propensity, under conditions of noradrenergic stimulation by means of the noradrenergic reuptake inhibitor atomoxetine, compared to placebo. Fractional anisotropy (FA) was higher in participants with noradrenergic stimulation (ATO) compared to placebo (PLAC), the effect was predominantly left-lateralized and based on the comparison of ATO REN and PLAC REN participants. In REN participants of both treatment groups, FA in several WM tracts showed a positive correlation with the ABA renewal level, suggesting higher renewal levels were associated with higher microstructural integrity. These findings point towards a relation between microstructural properties of attention-related WM tracts and the propensity for renewal that is not specifically dependent on noradrenergic processing.
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Affiliation(s)
- Silke Lissek
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Lara Schlaffke
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
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Coenen M, de Kort FA, Weaver NA, Kuijf HJ, Aben HP, Bae HJ, Bordet R, Chen CP, Dewenter A, Doeven T, Dondaine T, Duering M, Fang R, van der Giessen RS, Kim J, Kim BJ, de Kort PL, Koudstaal PJ, Lee M, Lim JS, Lopes R, van Oostenbrugge RJ, Staals J, Yu KH, Biessels GJ, Biesbroek JM. Strategic white matter hyperintensity locations associated with post-stroke cognitive impairment: A multicenter study in 1568 stroke patients. Int J Stroke 2024:17474930241252530. [PMID: 38651756 DOI: 10.1177/17474930241252530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) occurs in up to 50% of stroke survivors. Presence of pre-existing vascular brain injury, in particular the extent of white matter hyperintensities (WMH), is associated with worse cognitive outcome after stroke, but the role of WMH location in this association is unclear. AIMS We determined if WMH in strategic white matter tracts explain cognitive performance after stroke. METHODS Individual patient data from nine ischemic stroke cohorts with magnetic resonance imaging (MRI) were harmonized through the Meta VCI Map consortium. The association between WMH volumes in strategic tracts and domain-specific cognitive functioning (attention and executive functioning, information processing speed, language and verbal memory) was assessed using linear mixed models and lasso regression. We used a hypothesis-driven design, primarily addressing four white matter tracts known to be strategic in memory clinic patients: the left and right anterior thalamic radiation, forceps major, and left inferior fronto-occipital fasciculus. RESULTS The total study sample consisted of 1568 patients (39.9% female, mean age = 67.3 years). Total WMH volume was strongly related to cognitive performance on all four cognitive domains. WMH volume in the left anterior thalamic radiation was significantly associated with cognitive performance on attention and executive functioning and information processing speed and WMH volume in the forceps major with information processing speed. The multivariable lasso regression showed that these associations were independent of age, sex, education, and total infarct volume and had larger coefficients than total WMH volume. CONCLUSION These results show tract-specific relations between WMH volume and cognitive performance after ischemic stroke, independent of total WMH volume. This implies that the concept of strategic lesions in PSCI extends beyond acute infarcts and also involves pre-existing WMH. DATA ACCESS STATEMENT The Meta VCI Map consortium is dedicated to data sharing, following our guidelines.
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Affiliation(s)
- Mirthe Coenen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floor As de Kort
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo P Aben
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Régis Bordet
- Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France
| | - Christopher Plh Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Ageing and Cognition Center, National University Health System, Singapore
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Thomas Doeven
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thibaut Dondaine
- Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Rong Fang
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Jonguk Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Department of Neurology, School of Medicine, Inha University, Incheon, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Paul Lm de Kort
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Renaud Lopes
- Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France
| | | | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
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5
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Ramirez-Garcia G, Escutia-Macedo X, Cook DJ, Moreno-Andrade T, Villarreal-Garza E, Campos-Coy M, Elizondo-Riojas G, Gongora-Rivera F, Garza-Villarreal EA, Fernandez-Ruiz J. Consistent spatial lesion-symptom patterns: A comprehensive analysis using triangulation in lesion-symptom mapping in a cohort of stroke patients. Magn Reson Imaging 2024; 109:286-293. [PMID: 38531463 DOI: 10.1016/j.mri.2024.03.031] [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: 02/08/2024] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The relationship between brain lesions and stroke outcomes is crucial for advancing patient prognosis and developing effective therapies. Stroke is a leading cause of disability worldwide, and it is important to understand the neurological basis of its varied symptomatology. Lesion-symptom mapping (LSM) methods provide a means to identify brain areas that are strongly associated with specific symptoms. However, inner variations in LSM methods can yield different results. To address this, our study aimed to characterize the lesion-symptom mapping variability using three different LSM methods. Specifically, we sought to determine a lesion symptom core across LSM approaches enhancing the robustness of the analysis and removing potential spatial bias. MATERIAL & METHODS A cohort consisting of 35 patients with either right- or left-sided middle cerebral artery strokes were enrolled and evaluated using the NIHSS at 24 h post-stroke. Anatomical T1w MRI scans were also obtained 24 h post-stroke. Lesion masks were segmented manually and three distinctive LSM methods were implemented: ROI correlation-based, univariate, and multivariate approaches. RESULTS The results of the LSM analyses showed substantial spatial differences in the extension of each of the three lesion maps. However, upon overlaying all three lesion-symptom maps, a consistent lesion core emerged, corresponding to the territory associated with elevated NIHSS scores. This finding not only enhances the spatial accuracy of the lesion map but also underscores its clinical relevance. CONCLUSION This study underscores the significance of exploring complementary LSM approaches to investigate the association between brain lesions and stroke outcomes. By utilizing multiple methods, we can increase the robustness of our results, effectively addressing and neutralizing potential spatial bias introduced by each individual method. Such an approach holds promise for enhancing our understanding of stroke pathophysiology and optimizing patient care strategies.
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Affiliation(s)
- Gabriel Ramirez-Garcia
- Laboratorio de Neuropsicologia, Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico; Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Ximena Escutia-Macedo
- Laboratorio de Neuropsicologia, Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada; Translational Stroke Research Lab, Department of Surgery, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Talia Moreno-Andrade
- Departamento de Neurologia, Hospital Universitario Dr. Jose Eleuterio Gonzalez Universidad Autonoma de Nuevo León, Monterrey, Nuevo Leon, Mexico; Unidad de Neuromodulacion y Plasticidad Cerebral, Centro de Investigacion y Desarrollo en Ciencias de la Salud, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Estefania Villarreal-Garza
- Departamento de Neurologia, Hospital Universitario Dr. Jose Eleuterio Gonzalez Universidad Autonoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Mario Campos-Coy
- Unidad de Neuromodulacion y Plasticidad Cerebral, Centro de Investigacion y Desarrollo en Ciencias de la Salud, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico; Departamento de Imagen Diagnostica, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Guillermo Elizondo-Riojas
- Unidad de Neuromodulacion y Plasticidad Cerebral, Centro de Investigacion y Desarrollo en Ciencias de la Salud, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico; Departamento de Imagen Diagnostica, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Fernando Gongora-Rivera
- Departamento de Neurologia, Hospital Universitario Dr. Jose Eleuterio Gonzalez Universidad Autonoma de Nuevo León, Monterrey, Nuevo Leon, Mexico; Unidad de Neuromodulacion y Plasticidad Cerebral, Centro de Investigacion y Desarrollo en Ciencias de la Salud, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Eduardo A Garza-Villarreal
- Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Juriquilla, Queretaro, Mexico; Departamento de Neurologia, Hospital Universitario Dr. Jose Eleuterio Gonzalez Universidad Autonoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Juan Fernandez-Ruiz
- Laboratorio de Neuropsicologia, Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico; Facultad de Psicologia, Universidad Veracruzana, Xalapa, Veracruz, Mexico.
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Taghvaei M, Mechanic-Hamilton DJ, Sadaghiani S, Shakibajahromi B, Dolui S, Das S, Brown C, Tackett W, Khandelwal P, Cook P, Shinohara RT, Yushkevich P, Bassett DS, Wolk DA, Detre JA. Impact of white matter hyperintensities on structural connectivity and cognition in cognitively intact ADNI participants. Neurobiol Aging 2024; 135:79-90. [PMID: 38262221 PMCID: PMC10872454 DOI: 10.1016/j.neurobiolaging.2023.10.012] [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: 04/24/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 01/25/2024]
Abstract
We used indirect brain mapping with virtual lesion tractography to test the hypothesis that the extent of white matter tract disconnection due to white matter hyperintensities (WMH) is associated with corresponding tract-specific cognitive performance decrements. To estimate tract disconnection, WMH masks were extracted from FLAIR MRI data of 481 cognitively intact participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI) and used as regions of avoidance for fiber tracking in diffusion MRI data from 50 healthy young participants from the Human Connectome Project. Estimated tract disconnection in the right inferior fronto-occipital fasciculus, right frontal aslant tract, and right superior longitudinal fasciculus mediated the effects of WMH volume on executive function. Estimated tract disconnection in the left uncinate fasciculus mediated the effects of WMH volume on memory and in the right frontal aslant tract on language. In a subset of ADNI control participants with amyloid data, positive status increased the probability of periventricular WMH and moderated the relationship between WMH burden and tract disconnection in executive function performance.
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Affiliation(s)
- Mohammad Taghvaei
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Sudipto Dolui
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandhitsu Das
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Brown
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - William Tackett
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Pulkit Khandelwal
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Philip Cook
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Biesbroek JM, Verhagen MG, van der Stigchel S, Biessels GJ. When the central integrator disintegrates: A review of the role of the thalamus in cognition and dementia. Alzheimers Dement 2024; 20:2209-2222. [PMID: 38041861 PMCID: PMC10984498 DOI: 10.1002/alz.13563] [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: 06/22/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 12/04/2023]
Abstract
The thalamus is a complex neural structure with numerous anatomical subdivisions and intricate connectivity patterns. In recent decades, the traditional view of the thalamus as a relay station and "gateway to the cortex" has expanded in recognition of its role as a central integrator of inputs from sensory systems, cortex, basal ganglia, limbic systems, brain stem nuclei, and cerebellum. As such, the thalamus is critical for numerous aspects of human cognition, mood, and behavior, as well as serving sensory processing and motor functions. Thalamus pathology is an important contributor to cognitive and functional decline, and it might be argued that the thalamus has been somewhat overlooked as an important player in dementia. In this review, we provide a comprehensive overview of thalamus anatomy and function, with an emphasis on human cognition and behavior, and discuss emerging insights on the role of thalamus pathology in dementia.
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Affiliation(s)
- J. Matthijs Biesbroek
- Department of NeurologyUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of NeurologyDiakonessenhuis HospitalUtrechtThe Netherlands
| | - Marieke G. Verhagen
- VIB Center for Brain and DiseaseLeuvenBelgium
- Department of NeurosciencesKatholieke Universiteit (KU) LeuvenLeuvenBelgium
| | - Stefan van der Stigchel
- Department of Experimental PsychologyHelmholtz InstituteUtrecht UniversityUtrechtThe Netherlands
| | - Geert Jan Biessels
- Department of NeurologyUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
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8
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Huang XL, Gao J, Wang YM, Zhu F, Qin J, Yao QN, Zhang XB, Sun HY. Neuropathological characteristics of abnormal white matter functional signaling in adolescents with major depression. World J Psychiatry 2024; 14:276-286. [PMID: 38464765 PMCID: PMC10921285 DOI: 10.5498/wjp.v14.i2.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Major depression disorder (MDD) constitutes a significant mental health concern. Epidemiological surveys indicate that the lifetime prevalence of depression in adolescents is much higher than that in adults, with a corresponding increased risk of suicide. In studying brain dysfunction associated with MDD in adole-scents, research on brain white matter (WM) is sparse. Some researchers even mistakenly regard the signals generated by the WM as noise points. In fact, studies have shown that WM exhibits similar blood oxygen level-dependent signal fluctuations. The alterations in WM signals and their relationship with disease severity in adolescents with MDD remain unclear. AIM To explore potential abnormalities in WM functional signals in adolescents with MDD. METHODS This study involved 48 adolescent patients with MDD and 31 healthy controls (HC). All participants were assessed using the Patient Health Questionnaire-9 Scale and the mini international neuropsychiatric interview (MINI) suicide inventory. In addition, a Siemens Skyra 3.0T magnetic resonance scanner was used to obtain the subjects' image data. The DPABI software was utilized to calculate the WM signal of the fractional amplitude of low frequency fluctuations (fALFF) and regional homogeneity, followed by a two-sample t-test between the MDD and HC groups. Independent component analysis (ICA) was also used to evaluate the WM functional signal. Pearson's correlation was performed to assess the relationship between statistical test results and clinical scales. RESULTS Compared to HC, individuals with MDD demonstrated a decrease in the fALFF of WM in the corpus callosum body, left posterior limb of the internal capsule, right superior corona radiata, and bilateral posterior corona radiata [P < 0.001, family-wise error (FWE) voxel correction]. The regional homogeneity of WM increased in the right posterior limb of internal capsule and left superior corona radiata, and decreased in the left superior longitudinal fasciculus (P < 0.001, FWE voxel correction). The ICA results of WM overlapped with those of regional homo-geneity. The fALFF of WM signal in the left posterior limb of the internal capsule was negatively correlated with the MINI suicide scale (P = 0.026, r = -0.32), and the right posterior corona radiata was also negatively correlated with the MINI suicide scale (P = 0.047, r = -0.288). CONCLUSION Adolescents with MDD involves changes in WM functional signals, and these differences in brain regions may increase the risk of suicide.
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Affiliation(s)
- Xin-Lin Huang
- Imaging and Nuclear Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang Province, China
| | - Ju Gao
- Department of Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Yong-Ming Wang
- School of Biology & Basic Medical Sciences, Medical College of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Feng Zhu
- Department of Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Jing Qin
- Department of Radiology, Shanghai Anting Hospital, Shanghai 20000, China
| | - Qian-Nan Yao
- Imaging and Nuclear Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang Province, China
| | - Xiao-Bin Zhang
- Department of Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hong-Yan Sun
- Department of Radiology, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
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9
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Ribeiro M, Yordanova YN, Noblet V, Herbet G, Ricard D. White matter tracts and executive functions: a review of causal and correlation evidence. Brain 2024; 147:352-371. [PMID: 37703295 DOI: 10.1093/brain/awad308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023] Open
Abstract
Executive functions are high-level cognitive processes involving abilities such as working memory/updating, set-shifting and inhibition. These complex cognitive functions are enabled by interactions among widely distributed cognitive networks, supported by white matter tracts. Executive impairment is frequent in neurological conditions affecting white matter; however, whether specific tracts are crucial for normal executive functions is unclear. We review causal and correlation evidence from studies that used direct electrical stimulation during awake surgery for gliomas, voxel-based and tract-based lesion-symptom mapping, and diffusion tensor imaging to explore associations between the integrity of white matter tracts and executive functions in healthy and impaired adults. The corpus callosum was consistently associated with all executive processes, notably its anterior segments. Both causal and correlation evidence showed prominent support of the superior longitudinal fasciculus to executive functions, notably to working memory. More specifically, strong evidence suggested that the second branch of the superior longitudinal fasciculus is crucial for all executive functions, especially for flexibility. Global results showed left lateralization for verbal tasks and right lateralization for executive tasks with visual demands. The frontal aslant tract potentially supports executive functions, however, additional evidence is needed to clarify whether its involvement in executive tasks goes beyond the control of language. Converging evidence indicates that a right-lateralized network of tracts connecting cortical and subcortical grey matter regions supports the performance of tasks assessing response inhibition, some suggesting a role for the right anterior thalamic radiation. Finally, correlation evidence suggests a role for the cingulum bundle in executive functions, especially in tasks assessing inhibition. We discuss these findings in light of current knowledge about the functional role of these tracts, descriptions of the brain networks supporting executive functions and clinical implications for individuals with brain tumours.
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Affiliation(s)
- Monica Ribeiro
- Service de neuro-oncologie, Hôpital La Pitié-Salpêtrière, Groupe Hospitalier Universitaire Pitié Salpêtrière-Charles Foix, Sorbonne Université, 75013 Paris, France
- Université Paris Saclay, ENS Paris Saclay, Service de Santé des Armées, CNRS, Université Paris Cité, INSERM, Centre Borelli UMR 9010, 75006 Paris, France
| | - Yordanka Nikolova Yordanova
- Service de neurochirurgie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, 92140 Clamart, France
| | - Vincent Noblet
- ICube, IMAGeS team, Université de Strasbourg, CNRS, UMR 7357, 67412 Illkirch, France
| | - Guillaume Herbet
- Praxiling, UMR 5267, CNRS, Université Paul Valéry Montpellier 3, 34090 Montpellier, France
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34295 Montpellier, France
- Institut Universitaire de France
| | - Damien Ricard
- Université Paris Saclay, ENS Paris Saclay, Service de Santé des Armées, CNRS, Université Paris Cité, INSERM, Centre Borelli UMR 9010, 75006 Paris, France
- Département de neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, 92140 Clamart, France
- Ecole du Val-de-Grâce, 75005 Paris, France
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10
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Jühling D, Rajashekar D, Cheng B, Hilgetag CC, Forkert ND, Werner R. Spatial normalization for voxel-based lesion symptom mapping: impact of registration approaches. Front Neurosci 2024; 18:1296357. [PMID: 38298911 PMCID: PMC10828036 DOI: 10.3389/fnins.2024.1296357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
Background Voxel-based lesion symptom mapping (VLSM) assesses the relation of lesion location at a voxel level with a specific clinical or functional outcome measure at a population level. Spatial normalization, that is, mapping the patient images into an atlas coordinate system, is an essential pre-processing step of VLSM. However, no consensus exists on the optimal registration approach to compute the transformation nor are downstream effects on VLSM statistics explored. In this work, we evaluate four registration approaches commonly used in VLSM pipelines: affine (AR), nonlinear (NLR), nonlinear with cost function masking (CFM), and enantiomorphic registration (ENR). The evaluation is based on a standard VLSM scenario: the analysis of statistical relations of brain voxels and regions in imaging data acquired early after stroke onset with follow-up modified Rankin Scale (mRS) values. Materials and methods Fluid-attenuated inversion recovery (FLAIR) MRI data from 122 acute ischemic stroke patients acquired between 2 and 3 days after stroke onset and corresponding lesion segmentations, and 30 days mRS values from a European multicenter stroke imaging study (I-KNOW) were available and used in this study. The relation of the voxel location with follow-up mRS was assessed by uni- as well as multi-variate statistical testing based on the lesion segmentations registered using the four different methods (AR, NLR, CFM, ENR; implementation based on the ANTs toolkit). Results The brain areas evaluated as important for follow-up mRS were largely consistent across the registration approaches. However, NLR, CFM, and ENR led to distortions in the patient images after the corresponding nonlinear transformations were applied. In addition, local structures (for instance the lateral ventricles) and adjacent brain areas remained insufficiently aligned with corresponding atlas structures even after nonlinear registration. Conclusions For VLSM study designs and imaging data similar to the present work, an additional benefit of nonlinear registration variants for spatial normalization seems questionable. Related distortions in the normalized images lead to uncertainties in the VLSM analyses and may offset the theoretical benefits of nonlinear registration.
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Affiliation(s)
- Daniel Jühling
- Institute of Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Christian Hilgetag
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Rene Werner
- Institute of Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Squarcina L, Lucini Paioni S, Bellani M, Rossetti MG, Houenou J, Polosan M, Phillips ML, Wessa M, Brambilla P. White matter integrity in bipolar disorder investigated with diffusion tensor magnetic resonance imaging and fractal geometry. J Affect Disord 2024; 345:200-207. [PMID: 37863367 DOI: 10.1016/j.jad.2023.10.095] [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: 09/05/2022] [Revised: 09/14/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Growing evidence suggests the presence of white matter (WM) alterations in bipolar disorder (BD). In this study we aimed to investigate the state of WM structures, in terms of tissue integrity and morphological complexity, in BD patients compared to healthy controls (HC), in an attempt to better elucidate the microstructural changes associated with BD. METHODS We collected a dataset of 399 Diffusion Tensor Magnetic Resonance Imaging (167 BD and 232 healthy controls) images, acquired at five different sites, which was processed with Tract-Based Spatial Statistics (TBSS) and fractal analysis. RESULTS The TBSS analysis demonstrated significantly lower FA values in the BD group. Diffusion abnormalities were primarily located in the temporo-parietal network. The Fractal Dimension (FD) analysis did not reveal consistent significant differences in the morphological complexity of WM structures between the groups. When the FD values of patients were considered individually, it is possible to notice some localized significant deviations from the healthy population. LIMITATIONS DTI sequences have not been harmonized before acquisition, samples' sizes are heterogeneous. CONCLUSIONS This study, by applying both TBSS and FD analyses, allows to evaluate diffusion and structural alterations of WM at the same time. The evaluation of WM integrity from these two different perspectives could be useful to better understand the pathophysiological and morphological changes underpinning bipolar disorder.
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Affiliation(s)
- Letizia Squarcina
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Susanna Lucini Paioni
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Marcella Bellani
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Maria Gloria Rossetti
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Josselin Houenou
- APHP, Mondor Univ Hospitals, DMU IMPACT, INSERM U955, Translational NeuroPsychiatry Team, UPEC, Créteil, France & NeuroSpin, UNIACT Lab, PsyBrain Team, CEA Saclay, Gif-sur-Yvette, France
| | - Mircea Polosan
- Univ. Grenoble-Alpes, Grenoble Institut Neurosciences, Inserm U1216, CHU Grenoble Alpes, France
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Michèle Wessa
- Department of Clinical Psychology and Neuropsychology, Institute of Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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12
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Meade CS, Bell RP, Towe SL, Lascola CD, Al‐Khalil K, Gibson MJ. Cocaine use is associated with cerebral white matter hyperintensities in HIV disease. Ann Clin Transl Neurol 2023; 10:1633-1646. [PMID: 37475160 PMCID: PMC10502656 DOI: 10.1002/acn3.51854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND White matter hyperintensities (WMH), a marker of cerebral small vessel disease and predictor of cognitive decline, are observed at higher rates in persons with HIV (PWH). The use of cocaine, a potent central nervous system stimulant, is disproportionately common in PWH and may contribute to WMH. METHODS The sample included of 110 PWH on antiretroviral therapy. Fluid-attenuated inversion recovery (FLAIR) and T1-weighted anatomical MRI scans were collected, along with neuropsychological testing. FLAIR images were processed using the Lesion Segmentation Toolbox. A hierarchical regression model was run to investigate predictors of WMH burden [block 1: demographics; block 2: cerebrovascular disease (CVD) risk; block 3: lesion burden]. RESULTS The sample was 20% female and 79% African American with a mean age of 45.37. All participants had persistent HIV viral suppression, and the median CD4+ T-cell count was 750. Nearly a third (29%) currently used cocaine regularly, with an average of 23.75 (SD = 20.95) days in the past 90. In the hierarchical linear regression model, cocaine use was a significant predictor of WMH burden (β = .28). WMH burden was significantly correlated with poorer cognitive function (r = -0.27). Finally, higher WMH burden was significantly associated with increased serum concentrations of interferon-γ-inducible protein 10 (IP-10) but lower concentrations of myeloperoxidase (MPO); however, these markers did not differ by COC status. CONCLUSIONS WMH burden is associated with poorer cognitive performance in PWH. Cocaine use and CVD risk independently contribute to WMH, and addressing these conditions as part of HIV care may mitigate brain injury underlying neurocognitive impairment.
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Affiliation(s)
- Christina S. Meade
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth Carolina27710USA
| | - Ryan P. Bell
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
| | - Sheri L. Towe
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
| | - Christopher D. Lascola
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth Carolina27710USA
- Department of RadiologyDuke University School of MedicineDurhamNorth Carolina27710USA
| | - Kareem Al‐Khalil
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
| | - Matthew J. Gibson
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
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13
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Coenen M, Kuijf HJ, Huenges Wajer IMC, Duering M, Wolters FJ, Fletcher EF, Maillard PM, Barkhof F, Barnes J, Benke T, Boomsma JMF, Chen CPLH, Dal-Bianco P, Dewenter A, Enzinger C, Ewers M, Exalto LG, Franzmeier N, Groeneveld O, Hilal S, Hofer E, Koek DL, Maier AB, McCreary CR, Padilla CS, Papma JM, Paterson RW, Pijnenburg YAL, Rubinski A, Schmidt R, Schott JM, Slattery CF, Smith EE, Steketee RME, Sudre CH, van den Berg E, van der Flier WM, Venketasubramanian N, Vernooij MW, Xin X, DeCarli C, Biessels GJ, Biesbroek JM. Strategic white matter hyperintensity locations for cognitive impairment: A multicenter lesion-symptom mapping study in 3525 memory clinic patients. Alzheimers Dement 2023; 19:2420-2432. [PMID: 36504357 DOI: 10.1002/alz.12827] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Impact of white matter hyperintensities (WMH) on cognition likely depends on lesion location, but a comprehensive map of strategic locations is lacking. We aimed to identify these locations in a large multicenter study. METHODS Individual patient data (n = 3525) from 11 memory clinic cohorts were harmonized. We determined the association of WMH location with attention and executive functioning, information processing speed, language, and verbal memory performance using voxel-based and region of interest tract-based analyses. RESULTS WMH in the left and right anterior thalamic radiation, forceps major, and left inferior fronto-occipital fasciculus were significantly related to domain-specific impairment, independent of total WMH volume and atrophy. A strategic WMH score based on these tracts inversely correlated with performance in all domains. DISCUSSION The data show that the impact of WMH on cognition is location-dependent, primarily involving four strategic white matter tracts. Evaluation of WMH location may support diagnosing vascular cognitive impairment. HIGHLIGHTS We analyzed white matter hyperintensities (WMH) in 3525 memory clinic patients from 11 cohorts The impact of WMH on cognition depends on location We identified four strategic white matter tracts A single strategic WMH score was derived from these four strategic tracts The strategic WMH score was an independent determinant of four cognitive domains.
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Affiliation(s)
- Mirthe Coenen
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene M C Huenges Wajer
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frank J Wolters
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evan F Fletcher
- Department of Neurology, University of California at Davis, Davis, California, USA
| | - Pauline M Maillard
- Department of Neurology, University of California at Davis, Davis, California, USA
| | - Frederik Barkhof
- Radiology & Nuclear Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
- UCL Institute of Neurology, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Jooske M F Boomsma
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Christopher P L H Chen
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - Peter Dal-Bianco
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Christian Enzinger
- Division of General Neurology, Department of Neurology, Medical University Graz, Graz, Austria
- Division of Neuroradiology, Interventional and Vascular Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Lieza G Exalto
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Onno Groeneveld
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Department of Neurology, Isala MS Centre, Isala Hospital, Meppel, The Netherlands
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Edith Hofer
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Dineke L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea B Maier
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheryl R McCreary
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Catarina S Padilla
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
| | - Janne M Papma
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ross W Paterson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anna Rubinski
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Reinhold Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Catherine F Slattery
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca M E Steketee
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing, the Centre for Medical Image Computing, UCL, London, UK
| | - Esther van den Berg
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Raffles Neuroscience Center, Raffles Hospital, Singapore, Singapore
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Xu Xin
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis, California, USA
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
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Botz J, Lohner V, Schirmer MD. Spatial patterns of white matter hyperintensities: a systematic review. Front Aging Neurosci 2023; 15:1165324. [PMID: 37251801 PMCID: PMC10214839 DOI: 10.3389/fnagi.2023.1165324] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background White matter hyperintensities are an important marker of cerebral small vessel disease. This disease burden is commonly described as hyperintense areas in the cerebral white matter, as seen on T2-weighted fluid attenuated inversion recovery magnetic resonance imaging data. Studies have demonstrated associations with various cognitive impairments, neurological diseases, and neuropathologies, as well as clinical and risk factors, such as age, sex, and hypertension. Due to their heterogeneous appearance in location and size, studies have started to investigate spatial distributions and patterns, beyond summarizing this cerebrovascular disease burden in a single metric-its volume. Here, we review the evidence of association of white matter hyperintensity spatial patterns with its risk factors and clinical diagnoses. Design/methods We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. We used the standards for reporting vascular changes on neuroimaging criteria to construct a search string for literature search on PubMed. Studies written in English from the earliest records available until January 31st, 2023, were eligible for inclusion if they reported on spatial patterns of white matter hyperintensities of presumed vascular origin. Results A total of 380 studies were identified by the initial literature search, of which 41 studies satisfied the inclusion criteria. These studies included cohorts based on mild cognitive impairment (15/41), Alzheimer's disease (14/41), Dementia (5/41), Parkinson's disease (3/41), and subjective cognitive decline (2/41). Additionally, 6 of 41 studies investigated cognitively normal, older cohorts, two of which were population-based, or other clinical findings such as acute ischemic stroke or reduced cardiac output. Cohorts ranged from 32 to 882 patients/participants [median cohort size 191.5 and 51.6% female (range: 17.9-81.3%)]. The studies included in this review have identified spatial heterogeneity of WMHs with various impairments, diseases, and pathologies as well as with sex and (cerebro)vascular risk factors. Conclusion The results show that studying white matter hyperintensities on a more granular level might give a deeper understanding of the underlying neuropathology and their effects. This motivates further studies examining the spatial patterns of white matter hyperintensities.
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Affiliation(s)
- Jonas Botz
- Computational Neuroradiology, Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, Germany
| | - Valerie Lohner
- Cardiovascular Epidemiology of Aging, Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Markus D. Schirmer
- Computational Neuroradiology, Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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15
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Ferris J, Greeley B, Yeganeh NM, Rinat S, Ramirez J, Black S, Boyd L. Exploring biomarkers of processing speed and executive function: The role of the anterior thalamic radiations. Neuroimage Clin 2022; 36:103174. [PMID: 36067614 PMCID: PMC9460835 DOI: 10.1016/j.nicl.2022.103174] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/08/2022] [Accepted: 08/27/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Processing speed and executive function are often impaired after stroke and in typical aging. However, there are no reliable neurological markers of these cognitive impairments. The trail making test (TMT) is a common index of processing speed and executive function. Here, we tested candidate MRI markers of TMT performance in a cohort of older adults and individuals with chronic stroke. METHODS In 61 older adults and 32 individuals with chronic stroke, we indexed white matter structure with region-specific lesion load (of white matter hyperintensities (WMHs) and stroke lesions) and diffusion tensor imaging (DTI) from four regions related to TMT performance: the anterior thalamic radiations (ATR), superior longitudinal fasciculus (SLF), forceps minor, and cholinergic pathways. Regression modelling was used to identify the marker(s) that explained the most variance in TMT performance. RESULTS DTI metrics of the ATR related to processing speed in both the older adult (TMT A: β = -3.431, p < 0.001) and chronic stroke (TMT A: β = 11.282, p < 0.001) groups. In the chronic stroke group executive function was best predicted by a combination of ATR and forceps minor DTI metrics (TMT B: adjustedR2 = 0.438, p < 0.001); no significant predictors of executive function (TMT B) emerged in the older adult group. No imaging metrics related to set shifting (TMT B-A). Regional DTI metrics predicted TMT performance above and beyond whole-brain stroke and WMH volumes and removing whole-brain lesion volumes improved model fits. CONCLUSIONS In this comprehensive assessment of candidate imaging markers, we demonstrate an association between ATR microstructure and processing speed and executive function performance. Regional DTI metrics provided better predictors of cognitive performance than whole-brain lesion volumes or regional lesion load, emphasizing the importance of lesion location in understanding cognition. We propose ATR DTI metrics as novel candidate imaging biomarker of post-stroke cognitive impairment.
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Affiliation(s)
- Jennifer Ferris
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Brian Greeley
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Negin Motamed Yeganeh
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Shie Rinat
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Dr Sandra Black Centre for Brain Resilience and Recovery, Toronto, Canada,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Sandra Black
- LC Campbell Cognitive Neurology Research Unit, Dr Sandra Black Centre for Brain Resilience and Recovery, Toronto, Canada,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Lara Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada,Corresponding author at: University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada.
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Association of Serum GFAP with Functional and Neurocognitive Outcome in Sporadic Small Vessel Disease. Biomedicines 2022; 10:biomedicines10081869. [PMID: 36009416 PMCID: PMC9405121 DOI: 10.3390/biomedicines10081869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022] Open
Abstract
Cerebrospinal fluid (CSF) and serum biomarkers are critical for clinical decision making in neurological diseases. In cerebral small vessel disease (CSVD), white matter hyperintensities (WMH) are an important neuroimaging biomarker, but more blood-based biomarkers capturing different aspects of CSVD pathology are needed. In 42 sporadic CSVD patients, we prospectively analysed WMH on magnetic resonance imaging (MRI) and the biomarkers neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), chitinase3-like protein 1 (CHI3L1), Tau and Aβ1-42 in CSF and NfL and GFAP in serum. GFAP and CHI3L1 expression was studied in post-mortem brain tissue in additional cases. CSVD cases with higher serum NfL and GFAP levels had a higher modified Rankin Scale (mRS) and NIHSS score and lower CSF Aβ1-42 levels, whereas the CSF NfL and CHI3L1 levels were positively correlated with the WMH load. Moreover, the serum GFAP levels significantly correlated with the neurocognitive functions. Pathological analyses in CSVD revealed a high density of GFAP-immunoreactive fibrillary astrocytic processes in the periventricular white matter and clusters of CHI3L1-immunoreactive astrocytes in the basal ganglia and thalamus. Thus, besides NfL, serum GFAP is a highly promising fluid biomarker of sporadic CSVD, because it does not only correlate with the clinical severity but also correlates with the cognitive function in patients.
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Deng X, Liu L, Luo J, Liu L, Hui X, Feng H. Research on the Mechanism of Cognitive Decline in Patients With Acoustic Neuroma. Front Neurosci 2022; 16:933825. [PMID: 35860298 PMCID: PMC9289464 DOI: 10.3389/fnins.2022.933825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Little is known about neuropsychological research on patients with acoustic neuroma (AN), especially cognitive neuropsychology. We aim to compare the cognitive function of patients with AN and healthy controls (HCs) and explore possible underlying mechanisms. Various neuropsychological assessments were performed on all participants. Tract-based spatial statistics (TBSS) was used to compare DTI metrics such as fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). Correlation analysis was analyzed between DTI metrics and cognitive scales. Compared with the HC group, the AN group performed worse in the neuropsychological evaluations, and TBSS analysis showed widespread alteration of the FA, AD, RD, and MD, which correlated with the cognitive function. These white matter tracts include minor forceps, major forceps, anterior thalamic radiation, superior longitudinal fasciculus, corticospinal tract, and right inferior fronto-occipital fasciculus. Meanwhile, we found for the first time that cognitive decline was related to the decrease of FA in minor forceps, which can be used as a neurobiological marker of cognitive impairment in patients with AN. The occurrence of cognition impairment is common in patients with AN. Including neuropsychological evaluation in the routine clinical assessment and appropriate treatment may strengthen clinical management and improve the quality of life of patients.
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Affiliation(s)
- Xueyun Deng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
- Department of Neurosurgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Lizhen Liu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
| | - Jun Luo
- Department of Radiology, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
| | - Lihua Liu
- Department of Geriatrics, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Xuhui Hui
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
- *Correspondence: Hua Feng
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Mock N, Balzer C, Gutbrod K, De Haan B, Jäncke L, Ettlin T, Trost W. Lesion-symptom mapping corroborates lateralization of verbal and nonverbal memory processes and identifies distributed brain networks responsible for memory dysfunction. Cortex 2022; 153:178-193. [DOI: 10.1016/j.cortex.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/10/2021] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
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Jiang J, Yao K, Huang X, Zhang Y, Shen F, Weng S. Longitudinal white matter hyperintensity changes and cognitive decline in patients with minor stroke. Aging Clin Exp Res 2022; 34:1047-1054. [PMID: 35084664 PMCID: PMC9135882 DOI: 10.1007/s40520-021-02024-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
Background and objective As reported, both minor stroke and white matter hyperintensities (WMHs) are associated with an increased risk of cognitive impairment and dementia. The underlying factors for dynamic changes in WMH volume and cognitive performances in patients with minor stroke remain poorly understood. A 2-year longitudinal study was designed to investigate the factors associated with the changes in white matter hyperintensity (WMH) volume on brain MRI and cognitive decline in patients with minor stroke. Methods A group of eligible patients with minor ischemic stroke was recruited in a row. At the initial and 2-year follow-up visits, all the participants underwent routine examinations, multimodal MRI, and cognitive assessment. Using a lesion prediction algorithm tool, we were able to automate the measurement of the change in WMH volume. During the 2-year follow-up, cognitive function was evaluated using Telephone Interview for Cognitive Status-Modified (TICS-m). Participants’ demographic, clinical, and therapeutic data were collected and statistically analyzed. Regression analyses were used to test the relationships between risk factors and changes in WMH volume and cognitive decline. Results Finally, we followed up with 225/261 participants for 2 years, with a mean age of 65.67 ± 10.73 years (65.6% men). WMH volume was observed to be increased in 113 patients, decreased in 74 patients, and remained stable in 58 patients. Patients with WMH progression were more often had a history of hypertension (p = 0.006) and a higher CSVD burden both at baseline and follow-up visit (p < 0.05). Longitudinally, the proportion of patients taking antihypertension medications on a regular basis in the regression group was higher than in the stable group (p = 0.01). When compared to the stable group, the presence of lacunes (OR 9.931, 95% CI 1.597–61.77, p = 0.014) was a stronger predictor of progression in WMH volume. 87 subjects (38.6%) displayed incident cognitive impairment. The progression of WMH volume was a significant risk factor for cognitive decline (p < 0.001). Conclusions The longitudinal change of WMH is dynamic. The regressive WMH volume was associated with the use of antihypertensive medications on a regular basis. The presence of lacunes at the initial visit of the study was a stronger predictor of WMH progression. The progression of WMH volume could be useful in predicting cognitive decline in patients with minor stroke.
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Affiliation(s)
- Jingwen Jiang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kanmin Yao
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Huang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fanxia Shen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Suiqing Weng
- Department of Neurology, Shanghai Minhang Hospital, Shanghai Fu Dan University, Shanghai, China.
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Leijenaar JF, Ingala S, Sudre CH, Mutsaerts HJMM, Leeuwis AE, van der Flier WM, Scheltens P, Weinstein HC, Barkhof F, van Gerven J, Groeneveld GJ, Prins ND. Decreased integrity of the monoaminergic tract is associated with a positive response to MPH in patients with vascular cognitive impairment - proof of principle study STREAM-VCI. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100128. [PMID: 36324417 PMCID: PMC9616323 DOI: 10.1016/j.cccb.2022.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
Abstract
Background Patients with vascular cognitive impairment (VCI) are very heterogeneous in both symptoms and type of cerebrovascular pathology. This might be an important reason why there is no symptomatic treatment available for VCI patients. In this study, we investigated in patients with VCI, whether there was an association between a positive response to methylphenidate and galantamine and the type of cerebrovascular disease, structural damage to specific neurotransmitter systems, cerebral perfusion, and presence of co-morbid Alzheimer (AD) pathology. Methods We included 27 VCI patients (mean age 67 years ± 8,30% female) from the STREAM-VCI trial who received placebo, methylphenidate(10 mg), and galantamine(16 mg) in a single challenge, cross-over design. In this study, we classified patients improving on a task for executive functioning after methylphenidate compared to placebo as methylphenidate responders (MPH+; resp. non-responders, MPH-) and patients improving on a task for memory after galantamine compared to placebo as galantamine responders (GAL+; resp. non-responders, GAL-). On baseline MRI, we visually assessed measures of cerebrovascular disease, automatically segmented white matter hyperintensities, used diffusion tensor imaging to visualize the integrity of monoaminergic and cholinergic neurotransmitter systems with mean diffusivity (MD) and fractional anisotropy (FA). Comorbid AD pathology was assessed using CSF or amyloid-PET. We tested differences between responders and non-responders using ANOVA, adjusting for age and sex. Results Nine patients were MPH+ vs 18 MPH-. MPH+ had higher MD (1.22 ± 0.07 vs 0.94 ± 0.05); p = .001) and lower FA (0.38 ± .01 vs 0.43 ± .01); p = .04) in the monoaminergic tract compared to MPH-. Eight patients were GAL+ and 18 GAL-. We found no differences between GAL+ and GAL- in any of the MRI measures. Information on co-morbid AD pathology was present in 17 patients. AD pathology tended to be more frequent in GAL+ vs GAL- (5(71%) vs 2(20%); p = .06). Conclusions In patients with VCI, we found that decreased integrity of the monoaminergic tract is associated with a positive response to MPH. Responsiveness to galantamine may be related to co-morbid AD pathology.
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Affiliation(s)
- Jolene F Leijenaar
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherland
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Henk-Jan MM Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherland
- Department of Radiology and Nuclear Medicine, University Hospital Ghent, Ghent, Belgium
| | - Anna E. Leeuwis
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
| | - Wiesje M van der Flier
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
- Department of Epidemiology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherland
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
| | - Henry C Weinstein
- Department of Neurology, Onze Lieve Vrouwe Gasthuis West, Amsterdam, the Netherland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherland
- Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom
| | | | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, the Netherland
- Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherland
| | - Niels D Prins
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
- Brain Research Center, Amsterdam, the Netherland
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Zhang D, Zhu P, Yin B, Zhao P, Wang S, Ye L, Bai L, Yan Z, Bai G. Frontal White Matter Hyperintensities Effect on Default Mode Network Connectivity in Acute Mild Traumatic Brain Injury. Front Aging Neurosci 2022; 13:793491. [PMID: 35250532 PMCID: PMC8890121 DOI: 10.3389/fnagi.2021.793491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
The functional connectivity of the brain depends not only on the structural integrity of the cortex but also on the white matter pathways between cortical areas. White matter hyperintensities (WMH), caused by chronic hypoperfusion in the white matter, play a role in the outcome of traumatic brain injury (TBI) and other neurodegenerative disorders. Herein, we investigate how the location and volume of WMH affect the default-mode network (DMN) connectivity in acute mild TBI (mTBI) patients. Forty-six patients with acute mTBI and 46 matched healthy controls were enrolled in the study. All participants underwent T2-weighted fluid-attenuated inversion recovery magnetic resonance imaging (MRI), resting-state functional MRI (fMRI),and neuropsychological assessments. The volume and location of WMH were recorded. The relationships between the WMH volume and clinical assessments were evaluated using Spearman’s correlation. Patients with higher frontal lobe WMH volume had more severe post-concussion symptoms and poorer information processing speed. Moreover, these patients had significantly lower functional connectivity in the right middle temporal gyrus, left middle frontal gyrus, right superior frontal gyrus, and left anterior cingulate cortex, compared with patients with low frontal lobe WMH volume. Compared to the controls, the patients with high frontal WMH volume exhibited significantly lower functional connectivity in the right inferior temporal gyrus, left anterior cingulate cortex, and right superior frontal gyrus. These findings suggest that frontal lobe WMH volume may modulate the functional connectivity within the DMN. Therefore, the WMH volume in specific regions of the brain, particularly the frontal and parietal lobes, may accelerate the process of aging and cognitive impairment may be a useful biomarker for the diagnosis and prognosis of acute mTBI.
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Affiliation(s)
- Danbin Zhang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pingyi Zhu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
| | - Pinghui Zhao
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Limei Ye
- Department of Radiology, Jinhua Municipal Central Hospital and Jinhua Hospital of Zhejiang University, Jinhua, China
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Zhihan Yan,
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
- Wenzhou Key Laboratory of Basic Science and Translational Research of Radiation Oncology, Wenzhou, China
- Guanghui Bai,
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22
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Automatic quantification of perivascular spaces in T2-weighted images at 7 T MRI. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100142. [PMID: 36324395 PMCID: PMC9616283 DOI: 10.1016/j.cccb.2022.100142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/21/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
Abstract
Fully automated detection of perivascular spaces on 7T MRI. Good correlation with manual assessments of perivascular spaces. Quantitative measurements of PVS characteristics: density, length, and tortuosity.
Perivascular spaces (PVS) are believed to be involved in brain waste disposal. PVS are associated with cerebral small vessel disease. At higher field strengths more PVS can be observed, challenging manual assessment. We developed a method to automatically detect and quantify PVS. A machine learning approach identified PVS in an automatically positioned ROI in the centrum semiovale (CSO), based on -resolution T2-weighted TSE scans. Next, 3D PVS tracking was performed in 50 subjects (mean age 62.9 years (range 27–78), 19 male), and quantitative measures were extracted. Maps of PVS density, length, and tortuosity were created. Manual PVS annotations were available to train and validate the automatic method. Good correlation was found between the automatic and manual PVS count: ICC (absolute/consistency) is 0.64/0.75, and Dice similarity coefficient (DSC) is 0.61. The automatic method counts fewer PVS than the manual count, because it ignores the smallest PVS (length <2 mm). For 20 subjects manual PVS annotations of a second observer were available. Compared with the correlation between the automatic and manual PVS, higher inter-observer ICC was observed (0.85/0.88), but DSC was lower (0.49 in 4 persons). Longer PVS are observed posterior in the CSO compared with anterior in the CSO. Higher PVS tortuosity are observed in the center of the CSO compared with the periphery of the CSO. Our fully automatic method can detect PVS in a 2D slab in the CSO, and extract quantitative PVS parameters by performing 3D tracking. This method enables automated quantitative analysis of PVS.
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Liu M, Wang Y, Zhang H, Yang Q, Shi F, Zhou Y, Shen D. OUP accepted manuscript. Cereb Cortex 2022; 32:4641-4656. [PMID: 35136966 PMCID: PMC9627024 DOI: 10.1093/cercor/bhab507] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/12/2022] Open
Abstract
Subcortical ischemic vascular disease could induce subcortical vascular cognitive impairments (SVCIs), such as amnestic mild cognitive impairment (aMCI) and non-amnestic MCI (naMCI), or sometimes no cognitive impairment (NCI). Previous SVCI studies focused on focal structural lesions such as lacunes and microbleeds, while the functional connectivity networks (FCNs) from functional magnetic resonance imaging are drawing increasing attentions. Considering remarkable variations in structural lesion sizes, we expect that seeking abnormalities in the multiscale hierarchy of brain FCNs could be more informative to differentiate SVCI patients with varied outcomes (NCI, aMCI, and naMCI). Driven by this hypothesis, we first build FCNs based on the atlases at multiple spatial scales for group comparisons and found distributed FCN differences across different spatial scales. We then verify that combining multiscale features in a prediction model could improve differentiation accuracy among NCI, aMCI, and naMCI. Furthermore, we propose a graph convolutional network to integrate the naturally emerged multiscale features based on the brain network hierarchy, which significantly outperforms all other competing methods. In addition, the predictive features derived from our method consistently emphasize the limbic network in identifying aMCI across the different scales. The proposed analysis provides a better understanding of SVCI and may benefit its clinical diagnosis.
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Affiliation(s)
| | | | - Han Zhang
- School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China
| | - Qing Yang
- School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai 200232, China
| | - Yan Zhou
- Address correspondence to Dinggang Shen, School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China. . Yan Zhou, Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - Dinggang Shen
- Address correspondence to Dinggang Shen, School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China. . Yan Zhou, Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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Ji L, Jiang W, Liu D, Hou K. Effect of SIRT1 on white matter neural network in adolescent patients with depression. Front Psychiatry 2022; 13:966315. [PMID: 36177213 PMCID: PMC9513552 DOI: 10.3389/fpsyt.2022.966315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to explore the correlation between the rs12415800 polymorphism of the silent information regulator 1 (SIRT1) gene and the white matter neural circuit in adolescent patients with depression. METHODS We enrolled 119 participants, comprising 59 adolescent patients with depression and 60 matched healthy controls for analysis. Patients were further subdivided based on genotype; GG, AG, and AA, with G representing the wild type gene, and A representing the A allele at rs12415800. RESULTS We found that: (1) lower anisotropy fraction (FA) values in the left cingulate fasciculus and left anterior thalamus radiation in the AG/AA genotype were more likely to be affected by depression. (2) The FA values of the right inferior occipital-frontal fasciculus, right corticospinal tract, right inferior longitudinal fasciculus, and right superior longitudinal fasciculus regions in the depression (AG/AA) group were lower than in the depression (GG) group. (3) FA values of the right inferior occipital-frontal fasciculus left corticospinal tract, right inferior longitudinal fasciculus, left anterior thalamus radiation, right superior longitudinal fasciculus, left inferior longitudinal fasciculus, left uncinate fasciculus, and right anterior thalamus radiation in the depression (GG) group were lower than the control (GG) group. CONCLUSIONS The polymorphism locus of the SIRT1 gene rs12415800 may be related to changes in the microstructure of white matter fiber tracts, and patients carrying the A allele (AG/AA) have more changes in the white matter than those with the non-A allele (GG).
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Affiliation(s)
- Ling Ji
- Department of Clinical Psychology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Wen Jiang
- Outpatient Department, The General Hospital of Western Theater Command, Chengdu, China
| | - Daiyan Liu
- People's Liberation Army of China (PLA) Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Kaiwen Hou
- Outpatient Department, The General Hospital of Western Theater Command, Chengdu, China
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25
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Rundek T, Tolea M, Ariko T, Fagerli EA, Camargo CJ. Vascular Cognitive Impairment (VCI). Neurotherapeutics 2022; 19:68-88. [PMID: 34939171 PMCID: PMC9130444 DOI: 10.1007/s13311-021-01170-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 01/03/2023] Open
Abstract
Vascular cognitive impairment (VCI) is predominately caused by vascular risk factors and cerebrovascular disease. VCI includes a broad spectrum of cognitive disorders, from mild cognitive impairment to vascular dementia caused by ischemic or hemorrhagic stroke, and vascular factors alone or in a combination with neurodegeneration including Alzheimer's disease (AD) and AD-related dementia. VCI accounts for at least 20-40% of all dementia diagnosis. Growing evidence indicates that cerebrovascular pathology is the most important contributor to dementia, with additive or synergistic interactions with neurodegenerative pathology. The most common underlying mechanism of VCI is chronic age-related dysregulation of CBF, although other factors such as inflammation and cardiovascular dysfunction play a role. Vascular risk factors are prevalent in VCI and if measured in midlife they predict cognitive impairment and dementia in later life. Particularly, hypertension, high cholesterol, diabetes, and smoking at midlife are each associated with a 20 to 40% increased risk of dementia. Control of these risk factors including multimodality strategies with an inclusion of lifestyle modification is the most promising strategy for treatment and prevention of VCI. In this review, we present recent developments in age-related VCI, its mechanisms, diagnostic criteria, neuroimaging correlates, vascular risk determinants, and current intervention strategies for prevention and treatment of VCI. We have also summarized the most recent and relevant literature in the field of VCI.
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Affiliation(s)
- Tatjana Rundek
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Magdalena Tolea
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Taylor Ariko
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric A Fagerli
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian J Camargo
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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26
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Guo Q, Duan J, Cai S, Zhang J, Chen T, Yang H. Desynchronized white matter function and structure in drug-naive first-episode major depressive disorder patients. Front Psychiatry 2022; 13:1082052. [PMID: 36713909 PMCID: PMC9874158 DOI: 10.3389/fpsyt.2022.1082052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a highly prevalent mental disease. Using magnetic resonance imaging (MRI), although numerous studies have revealed the alterations in structure and function of grey matter (GM), few studies focused on the synchronization of white matter (WM) structure and function in MDD. The aim of this study was to investigate whether functional and structural abnormalities of WM play an essential role in the neurobiological mechanisms of MDD. METHODS Gradient-echo imaging sequences at 3.0T were used to gather resting state functional MRI (rsfMRI) data, which were performed on 33 drug-naive first-episode MDD patients and 34 healthy controls (HCs). After data preprocessed, amplitude of low frequency fluctuation (ALFF) of WM was calculated. ALFF values in different frequency bands were analyzed, including typical (0.01-0.15 Hz) band, slow-4 (0.027-0.073 Hz) and slow-5 (0.01-0.027 Hz) bands. In addition, the fractional anisotropy (FA) values in WM in 23 patients and 26 HCs were examined using tract-based spatial statistics (TBSS) and tractography based on diffusion tensor imaging (DTI). Pearson correlation analysis was applied to analyze the relationships between ALFF values and Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). RESULTS Compared with the HCs, MDD patients showed decreased ALFF values in posterior thalamic radiation (PTR) and superior longitudinal fasciculus (SLF) in slow-5 frequency band, no significant differences of ALFF values were found in typical and slow-4 frequency bands. In addition, there were no significant differences in FA values with TBSS analysis as well as the number of fibers in PTR and SLF with tractography analysis between two groups. Further correlation analysis showed that the ALFF value in SLF was negatively correlated with HAMA-2 score (r = -0.548, p FDR = 0.037) in patients. CONCLUSION Our results indicated that WM dysfunction may be associated with the pathophysiological mechanism of depression. Our study also suggested that the functional damage of the WM may precedes the structural damage in first-episode MDD patients. Furthermore, for mental disorders, slow-5 frequency band may be a more sensitive functional indicator for early detection of abnormal spontaneous brain activity in WM.
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Affiliation(s)
- Qinger Guo
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jingfeng Duan
- Department of Psychiatry, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shuyang Cai
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jiaxi Zhang
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.,Key Laboratory of Intelligent Education Technology and Application of Zhejiang, Zhejiang Normal University, Jinhua, China
| | - Tao Chen
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Yang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Jung Y, Viviano RP, van Rooden S, van der Grond J, Rombouts SARB, Damoiseaux JS. White Matter Hyperintensities and Apolipoprotein E Affect the Association Between Mean Arterial Pressure and Objective and Subjective Cognitive Functioning in Older Adults. J Alzheimers Dis 2021; 84:1337-1350. [PMID: 34657884 DOI: 10.3233/jad-210695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND White matter hyperintensities (WMH) show a robust relationship with arterial pressure as well as objective and subjective cognitive functioning. In addition, APOE ɛ4 carriership may influence how arterial pressure affects cognitive functioning. OBJECTIVE To determine the role of region-specific WMH burden and APOE ɛ4 carriership on the relationship between mean arterial pressure (MAP) and cognitive function as well as subjective cognitive decline (SCD). METHODS The sample consisted of 87 cognitively unimpaired middle-aged to older adults aged 50-85. We measured WMH volume for the whole brain, anterior thalamic radiation (ATR), forceps minor, and superior longitudinal fasciculus (SLF). We examined whether WMH burden mediated the relationship between MAP and cognition (i.e., TMT-A score for processing speed; Stroop performance for executive function) as well as SCD (i.e., Frequency of Forgetting (FoF)), and whether APOE ɛ4 carriership moderated that mediation. RESULTS WMH burden within SLF mediated the effect of MAP on Stroop performance. Both whole brain and ATR WMH burden mediated the effect of MAP on FoF score. In the MAP-WMH-Stroop relationship, the mediation effect of SLF WMH and the effect of MAP on SLF WMH were significant only in APOE ɛ4 carriers. In the MAP-WMH-FoF relationship, the effect of MAP on whole brain WMH burden was significant only in ɛ4 carriers. CONCLUSION WMH burden and APOE genotype explain the link between blood pressure and cognitive function and may enable a more accurate assessment of the effect of high blood pressure on cognitive decline and risk for dementia.
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Affiliation(s)
- Youjin Jung
- Department of Psychology, Wayne State University, Detroit, MI, USA.,Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Raymond P Viviano
- Department of Psychology, Wayne State University, Detroit, MI, USA.,Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Sanneke van Rooden
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Serge A R B Rombouts
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.,Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Jessica S Damoiseaux
- Department of Psychology, Wayne State University, Detroit, MI, USA.,Institute of Gerontology, Wayne State University, Detroit, MI, USA
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Sundaresan V, Zamboni G, Rothwell PM, Jenkinson M, Griffanti L. Triplanar ensemble U-Net model for white matter hyperintensities segmentation on MR images. Med Image Anal 2021; 73:102184. [PMID: 34325148 PMCID: PMC8505759 DOI: 10.1016/j.media.2021.102184] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/10/2021] [Accepted: 07/16/2021] [Indexed: 01/05/2023]
Abstract
White matter hyperintensities (WMHs) have been associated with various cerebrovascular and neurodegenerative diseases. Reliable quantification of WMHs is essential for understanding their clinical impact in normal and pathological populations. Automated segmentation of WMHs is highly challenging due to heterogeneity in WMH characteristics between deep and periventricular white matter, presence of artefacts and differences in the pathology and demographics of populations. In this work, we propose an ensemble triplanar network that combines the predictions from three different planes of brain MR images to provide an accurate WMH segmentation. In the loss functions the network uses anatomical information regarding WMH spatial distribution in loss functions, to improve the efficiency of segmentation and to overcome the contrast variations between deep and periventricular WMHs. We evaluated our method on 5 datasets, of which 3 are part of a publicly available dataset (training data for MICCAI WMH Segmentation Challenge 2017 - MWSC 2017) consisting of subjects from three different cohorts, and we also submitted our method to MWSC 2017 to be evaluated on the unseen test datasets. On evaluating our method separately in deep and periventricular regions, we observed robust and comparable performance in both regions. Our method performed better than most of the existing methods, including FSL BIANCA, and on par with the top ranking deep learning methods of MWSC 2017.
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Affiliation(s)
- Vaanathi Sundaresan
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
- Oxford-Nottingham Centre for Doctoral Training in Biomedical Imaging, University of Oxford, UK
- Oxford India Centre for Sustainable Development, Somerville College, University of Oxford, UK
| | - Giovanna Zamboni
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Universitá di Modena e Reggio Emilia, Italy
| | - Peter M. Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
- Australian Institute for Machine Learning (AIML), School of Computer Science, The University of Adelaide, Adelaide, Australia
| | - Ludovica Griffanti
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, UK
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29
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Tamura Y, Shimoji K, Ishikawa J, Matsuo Y, Watanabe S, Takahashi H, Zen S, Tachibana A, Omura T, Kodera R, Oba K, Toyoshima K, Chiba Y, Tokumaru AM, Araki A. Subclinical Atherosclerosis, Vascular Risk Factors, and White Matter Alterations in Diffusion Tensor Imaging Findings of Older Adults With Cardiometabolic Diseases. Front Aging Neurosci 2021; 13:712385. [PMID: 34489681 PMCID: PMC8417784 DOI: 10.3389/fnagi.2021.712385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
White matter abnormalities may reflect cerebral microvessel disease. Diffusion tensor imaging (DTI) can help detect early changes in white matter integrity in each tract. However, studies investigating the relationship between subclinical atherosclerosis markers and white matter alterations in DTI findings are limited. This study aimed to examine associations between cardiovascular risk factors and indices of subclinical atherosclerosis-ankle brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and carotid artery intima-media thickness (IMT)-and altered white matter integrity in older patients. A total of 224 patients (aged ≥65 years) with cardiometabolic disease who underwent magnetic resonance imaging (MRI) and either plethysmography or cervical ultrasound at the start of the 3-year observational study period were included in this study. We measured fractional anisotropy (FA) and mean diffusivity (MD), which are indices of white matter integrity in seven white matter tracts. In a univariate analysis, lower ABI and higher baPWV values were associated with FA or MD abnormalities in several tracts, whereas IMT was scarcely associated with such change. In addition, high blood pressure and glycoalbumin/glycohemoglobin ratio (GA/HbA1c) and low body mass index (BMI) and triglyceride (TG) levels were associated with FA or MD abnormalities. In a multivariate analysis adjusted for age, sex, BMI, diastolic blood pressure, TG, and GA/HbA1c, the associations between ABI and FA or MD remained in all of either side of the following tracts: anterior thalamic radiation, forceps minor, inferior frontooccipital fasciculus (p < 0.001 for all) and superior longitudinal fasciculus (SLF; p < 0.05), whereas most of those between baPWV and FA or MD disappeared except for SLF (p < 0.05). These results indicate that low ABI could be an indicator of white matter abnormalities.
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Affiliation(s)
- Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Keigo Shimoji
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Yoshinori Matsuo
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - So Watanabe
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hisae Takahashi
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Shugo Zen
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Aya Tachibana
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Takuya Omura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Remi Kodera
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kazuhito Oba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kenji Toyoshima
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Yuko Chiba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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30
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Wang Y, Lu P, Zhan Y, Wu X, Qiu Y, Wang Z, Xu Q, Zhou Y. The Contribution of White Matter Diffusion and Cortical Perfusion Pathology to Vascular Cognitive Impairment: A Multimode Imaging-Based Machine Learning Study. Front Aging Neurosci 2021; 13:687001. [PMID: 34426730 PMCID: PMC8379092 DOI: 10.3389/fnagi.2021.687001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Widespread impairments in white matter and cerebrovascular integrity have been consistently implicated in the pathophysiology of patients with small vessel disease (SVD). However, the neural circuit mechanisms that underlie the developing progress of clinical cognitive symptoms remain largely elusive. Here, we conducted cross-modal MRI scanning including diffusion tensor imaging and arterial spin labeling in a cohort of 113 patients with SVD, which included 74 patients with vascular mild cognitive impairment (vMCI) and 39 patients without vMCI symptoms, and hence developed multimode imaging-based machine learning models to identify markers that discriminated SVD subtypes. Diffusion and perfusion features, respectively, extracted from individual white matter and gray matter regions were used to train three sets of classifiers in a nested 10-fold fashion: diffusion-based, perfusion-based, and combined diffusion-perfusion-based classifiers. We found that the diffusion-perfusion combined classifier achieved the highest accuracy of 72.57% with leave-one-out cross-validation, with the diffusion features largely spanning the capsular lateral pathway of the cholinergic tracts, and the perfusion features mainly distributed in the frontal-subcortical-limbic areas. Furthermore, diffusion-based features within vMCI group were associated with performance on executive function tests. We demonstrated the superior accuracy of using diffusion-perfusion combined multimode imaging features for classifying vMCI subtype out of a cohort of patients with SVD. Disruption of white matter integrity might play a critical role in the progression of cognitive impairment in patients with SVD, while malregulation of coritcal perfusion needs further study.
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Affiliation(s)
- Yao Wang
- Department of Radiology, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peiwen Lu
- Department of Neurology, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yafeng Zhan
- Center for Excellence in Brain Science and Intelligence Technology, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Xiaowei Wu
- Department of Radiology, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yage Qiu
- Department of Radiology, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Wang
- Center for Excellence in Brain Science and Intelligence Technology, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Qun Xu
- Department of Neurology, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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31
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Aleksonis HA, Krishnamurthy LC, King TZ. White matter hyperintensity volumes are related to processing speed in long-term survivors of childhood cerebellar tumors. J Neurooncol 2021; 154:63-72. [PMID: 34231115 DOI: 10.1007/s11060-021-03799-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Across several clinical populations, higher white matter hyperintensity (WMH) burden is consistently associated with decreases in cognitive performance, especially processing speed. Research of childhood cancer survivors has not utilized WMH quantification methodology to better understand the impact of WMH burden and its relationship with core cognitive skills. The present study aimed to quantify WMH volumes in a sample of long-term survivors of childhood cerebellar tumor and investigate the relationships with performance on a measure of oral processing speed. To further explore brain-behavior relationships, multivariate sparse canonical correlations was employed to identify WMH areas that predict processing speed performance. METHODS Thirty-five survivors and 56 healthy controls underwent neuroimaging and completed a measure of oral processing speed. The survivor group was further divided based on treatment (i.e., chemoradiation therapy (n = 20) vs. surgery only (n = 15)) to better understand the impact of treatment. RESULTS Survivors, and especially those treated with chemoradiation therapy, showed higher total WMH volumes and slower processing speed. Higher total WMH volumes were significantly associated with poorer processing speed (r = - 0.492, p = 0.003). Multivariate brain-behavior relationships revealed that periventricular WMHs were significantly associated with slower processing speed performance (p < 0.05). CONCLUSION Results exemplify that long-term survivors treated with and without chemoradiation therapy are at increased risk of developing higher WMH volumes compared to healthy peers. In addition, processing speed was robustly shown to be related to periventricular WMHs using an automated neuroimaging pipeline. This methodology to monitor WMH burden has the potential to be implemented efficiently with routine clinical neuroimaging of cancer survivors.
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Affiliation(s)
- Holly A Aleksonis
- Department of Psychology and the Neuroscience Institute, Georgia State University, Urban Life Building, 11th Floor, 140 Decatur St, Atlanta, GA, 30303, USA
| | - Lisa C Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veteran's Affairs Medical Center, Decatur, GA, USA
- Department of Physics and Astronomy, Georgia State University, Atlanta, GA, USA
| | - Tricia Z King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Urban Life Building, 11th Floor, 140 Decatur St, Atlanta, GA, 30303, USA.
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32
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Chen C, Wang X, Cao S, Zhang J, Wang Z, Pan W, Yang J, Tian Y, Qiu B, Wei Q, Wang K. Thalamocortical Functional Connectivity in Patients With White Matter Hyperintensities. Front Aging Neurosci 2021; 13:632237. [PMID: 33815090 PMCID: PMC8012554 DOI: 10.3389/fnagi.2021.632237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/23/2021] [Indexed: 01/14/2023] Open
Abstract
Background: White matter hyperintensities (WMH)s is a very common neuroradiological manifestation in the elderly and is an increased risk of dementia and cognitive decline. As we all know, the thalamocortical circuit plays an important part in cognition regulation. However, the role of this circuit in WMHs and its related cognitive deficits is still unclear. Method: Eighty WMH patients and 37 healthy controls (HCs) were enrolled in the current study. WMH patients were divided into a mild WMH group (n = 33) and moderate-severe WMH group (n = 47) according to Fazekas scores. Resting-state functional magnetic resonance imaging (rs-fMRI) data of all participants were collected for thalamocortical functional connectivity (FC) analysis. The analysis was performed in two steps. First, the whole cerebral cortex was divided into six regions of interest (ROIs), which were used as seeds to investigate the changes of FC with the thalamus. Then, the subregion of the thalamus generated in the previous step was used as the seed for FC analysis with the whole brain. Results: In the first step of FC analysis, it was found that precentral gyrus (PrCG)-interthalamic adhesion (ITA) FC values in moderate-severe WMH group were higher than those in HC and mild WMH groups. However, when compared with the HC group, the increase of PrCG-ITA FC values in mild WMH group was not statistically significant. In the second step of FC analysis, the ITA was set as the seed, and compared with the HC group, the results showed that the FC values of the ITA-medial frontal gyrus (MFG) in mild group and moderate-severe WMH groups were significantly increased. In addition, the FC values in moderate-severe group were significantly higher than those in mild group. Finally, it was also found that FC values (PrCG-ITA and ITA-MFG) were significantly correlated with neuropsychological test results for multiple cognitive functions such as memory, execution and attention in WMH patients. Conclusion: Abnormal thalamocortical FC was closely related with cognitive impairments in WMH patients.
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Affiliation(s)
- Chen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Xiaojing Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Shanshan Cao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Jun Zhang
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhiqi Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Wen Pan
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Jinying Yang
- Laboratory Center for Information Science and Technology of China, Hefei, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
| | - Bensheng Qiu
- Hefei National Lab for Physical Sciences at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Qiang Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China.,The College of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
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33
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Nelson AJD. The anterior thalamic nuclei and cognition: A role beyond space? Neurosci Biobehav Rev 2021; 126:1-11. [PMID: 33737105 PMCID: PMC8363507 DOI: 10.1016/j.neubiorev.2021.02.047] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 12/25/2022]
Abstract
Anterior thalamic nuclei important for specific classes of temporal discriminations. Anterior thalamic nuclei required for hippocampal-dependent contextual processes. Critical role for anterior thalamic nuclei in selective attention. Significance of anterior thalamic – anterior cingulate interactions.
The anterior thalamic nuclei are a vital node within hippocampal-diencephalic-cingulate circuits that support spatial learning and memory. Reflecting this interconnectivity, the overwhelming focus of research into the cognitive functions of the anterior thalamic nuclei has been spatial processing. However, there is increasing evidence that the functions of the anterior thalamic nuclei extend beyond the spatial realm. This work has highlighted how these nuclei are required for certain classes of temporal discrimination as well as their importance for processing other contextual information; revealing parallels with the non-spatial functions of the hippocampal formation. Yet further work has shown how the anterior thalamic nuclei may be important for other forms of non-spatial learning, including a critical role for these nuclei in attentional mechanisms. This evidence signals the need to reconsider the functions of the anterior thalamic within the framework of their wider connections with sites including the anterior cingulate cortex that subserve non-spatial functions.
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Affiliation(s)
- Andrew J D Nelson
- School of Psychology, Cardiff University, 70 Park Place, Cardiff, CF10 3AT, Wales, UK.
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34
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Kim JS, Lee S, Kim GE, Oh DJ, Moon W, Bae JB, Han JW, Byun S, Suh SW, Choi YY, Choi KY, Lee KH, Kim JH, Kim KW. Construction and validation of a cerebral white matter hyperintensity probability map of older Koreans. NEUROIMAGE-CLINICAL 2021; 30:102607. [PMID: 33711622 PMCID: PMC7972979 DOI: 10.1016/j.nicl.2021.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/04/2022]
Abstract
We constructed WPM from healthy elderly Koreans. WPM may serve as a tool to study pathology and normal aging of distribution of WMH. WPM provides a prominent atlas of the age related distribution of WMH.
Background and purpose Although two white matter hyperintensity (WMH) probability maps of healthy older adults already exist, they have several limitations in representing the distribution of WMH in healthy older adults, especially Asian older adults. We constructed and validated a WMH probability map (WPM) of healthy older Koreans and examined the age-associated differences of WMH. Methods We constructed WPM using development dataset that consisted of high-resolution 3D fluid-attenuated inversion recovery images of 5 age groups (60–64 years, 65–69 years, 70–74 years, 75–79 years, and 80+ years). Each age group included 30 age-matched men and women each. We tested the validity of the WPM by comparing WMH ages estimated by the WPM and the chronological ages of 30 healthy controls, 30 hypertension patients, and 30 S patients. Results Older age groups showed a higher volume of WMH in both hemispheres (p < 0.001). About 90% of the WMH were periventricular in all age groups. With advancing age, the peak of the distance histogram from the ventricular wall of the periventricular WMH shifted away from the ventricular wall, while that of deep WMH shifted toward the ventricular wall. The estimated WMH ages were comparable to the chronological ages in the healthy controls, while being higher than the chronological ages in hypertension and stroke patients. Conclusions This WPM may serve as a standard atlas in research on WMH of older adults, especially Asians.
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Affiliation(s)
- Jun Sung Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Subin Lee
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Grace Eun Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Dae Jong Oh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Woori Moon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, National Medical Center, Seoul, South Korea
| | - Seung Wan Suh
- Department of Psychiatry, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Yu Yong Choi
- National Research Center for Dementia, Chosun University, Gwangju, South Korea; Biomedical Technology Center, Chosun University Hospital, Gwangju, South Korea
| | - Kyu Yeong Choi
- National Research Center for Dementia, Chosun University, Gwangju, South Korea
| | - Kun Ho Lee
- National Research Center for Dementia, Chosun University, Gwangju, South Korea; Department of Biomedical Science, Chosun University, Gwangju, South Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Ki Woong Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea; Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea.
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35
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Hilal S, Biesbroek JM, Vrooman H, Chong E, Kuijf HJ, Venketasubramanian N, Cheng CY, Wong TY, Biessels GJ, Chen C. The Impact of Strategic White Matter Hyperintensity Lesion Location on Language. Am J Geriatr Psychiatry 2021; 29:156-165. [PMID: 32651052 DOI: 10.1016/j.jagp.2020.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The impact of white matter hyperintensities (WMH) on language possibly depends on lesion location through disturbance of strategic white matter tracts. We examined the impact of WMH location on language in elderly Asians. DESIGN Cross-sectional. SETTING Population-based. PARTICIPANTS Eight-hundred nineteen residents of Singapore, ages (≥65 years). MEASUREMENTS Clinical, cognitive and 3T magnetic resonance imaging assessments were performed on all participants. Language was assessed using the Modified Boston Naming Test (MBNT) and Verbal Fluency (VF). Hypothesis-free region-of-interest-based (ROI) analyses based on major white matter tracts were used to determine the association between WMH location and language. Conditional dependencies between the regional WMH volumes and language were examined using Bayesian-network analysis. RESULTS ROI-based analyses showed that WMH located within the anterior thalamic radiation (mean difference: -0.12, 95% confidence interval [CI]: -0.22; -0.02, p = 0.019) and uncinate fasciculus (mean difference: -0.09, 95% CI: -0.18; -0.01, p = 0.022) in the left hemisphere were significantly associated with worse VF but did not survive multiple testing. Conversely, WMH volume in the left cingulum of cingulate gyrus was significantly associated with MBNT performance (mean difference: -0.09, 95% CI: -0.17; -0.02, p = 0.016). Bayesian-network analyses confirmed the left cingulum of cingulate gyrus as a direct determinant of MBNT performance. CONCLUSION Our findings identify the left cingulum of cingulate gyrus as a strategic white matter tract for MBNT, suggesting that language - is sensitive to subcortical ischemic damage. Future studies on the role of sporadic ischemic lesions and vascular cognitive impairment should not only focus on total WMH volume but should also take WMH lesion location into account when addressing language.
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Affiliation(s)
- Saima Hilal
- Memory Aging and Cognition Center, National University Health System (SH, EC, CC), Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore (SH, CC), Singapore; Saw Swee Hock School of Public Health, National University of Singapore (SH), Singapore.
| | - J Matthijs Biesbroek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht (JMB, GJB), the Netherlands
| | - Henri Vrooman
- Departments of Radiology & Medical Informatics, Erasmus University Medical Center (HV), Rotterdam, The Netherlands
| | - Eddie Chong
- Memory Aging and Cognition Center, National University Health System (SH, EC, CC), Singapore
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht (HJK), the Netherlands
| | | | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Center (CY, TYW), Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center (CY, TYW), Singapore
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht (JMB, GJB), the Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Center, National University Health System (SH, EC, CC), Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore (SH, CC), Singapore
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Richards E, Bayer A, Hanley C, Norris JE, Tree JJ, Tales A. Reaction Time and Visible White Matter Lesions in Subcortical Ischemic Vascular Cognitive Impairment. J Alzheimers Dis 2020; 72:859-865. [PMID: 31658059 PMCID: PMC6918906 DOI: 10.3233/jad-190823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Slowed behavioral reaction time is associated with pathological brain changes, including white matter lesions, the common clinical characteristic of subcortical ischemic vascular cognitive impairment (SIVCI). In the present study, reaction time (RT) employing Trails B of the Trail Making Test, with responses capped at 300 s, was investigated in SIVCI (n = 27) compared to cognitively healthy aging (CH) (n = 26). RT was significantly slowed in SIVCI compared to CH (Cohen’s d effect size = 1.26). Furthermore, failure to complete Trails B within 300 s was also a characteristic of SIVCI although some ostensibly cognitively healthy older adults also failed to complete within this time limit. Within the SIVCI group, RT did not differ significantly with respect to whether the patients were classified as having moderate/severe or mild, periventricular white matter changes visible on their diagnostic CT/MRI scans. This, together with the high degree of overlap in RT between the two SIVCI subgroups, raises the possibility that using visible ratings scales in isolation may lead to the underestimation of disease level.
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Affiliation(s)
- Emma Richards
- Centre for Innovative Ageing, Swansea University, Swansea, UK.,Department of Psychology, Swansea University, Swansea, UK
| | - Antony Bayer
- Department of Medicine, Cardiff University, Cardiff, UK
| | - Claire Hanley
- Department of Psychology, Swansea University, Swansea, UK
| | | | - Jeremy J Tree
- Department of Psychology, Swansea University, Swansea, UK
| | - Andrea Tales
- Centre for Innovative Ageing, Swansea University, Swansea, UK.,Department of Psychology, Swansea University, Swansea, UK
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Zeng M, Yu M, Qi G, Zhang S, Ma J, Hu Q, Zhang J, Li H, Wu H, Xu J. Concurrent alterations of white matter microstructure and functional activities in medication-free major depressive disorder. Brain Imaging Behav 2020; 15:2159-2167. [PMID: 33155171 DOI: 10.1007/s11682-020-00411-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/18/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023]
Abstract
Although numerous studies have revealed the structural and functional alterations in major depressive disorder (MDD) using unimodal diffusion magnetic resonance imaging (MRI) or functional MRI, however, the potential associations between changed microstructure and corresponding functional activities in the MDD has been largely uninvestigated. Herein, 27 medication-free MDD patients and 54 gender-, age-, and educational level-matched healthy controls (HC) were used to investigate the concurrent alterations of white matter microstructure and functional activities using tract-based spatial statistics (TBSS) analyses, fractional amplitude of low-frequency fluctuation (fALFF), and degree centrality (DC). The TBSS analyses revealed significantly decreased fractional anisotropy (FA) in the superior longitudinal fasciculus (SLF I) in the MDD patients compared to HC. Correlation analyses showed that decreased FA in the SLF I was significantly correlated with fALFF in left pre/postcentral gyrus and binary, weighted DC in right posterior cerebellum. Moreover, the fALFF in left pre/postcentral gyrus significantly reduced in MDD patients while binary and weighted DC in right posterior cerebellum significantly increased in MDD patients. Our results revealed concurrent structural and functional changes in MDD patients suggesting that the underlying structural disruptions are an important indicator of functional abnormalities.
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Affiliation(s)
- Min Zeng
- Department of Radiology, Pidu District People's Hospital, Chengdu, 625014, Chengdu, China
| | - Min Yu
- Department of Neonatology, Changzhou Children's Hospital, Changzhou, 213003, China
| | - Guiqiang Qi
- Department of Radiology, Pidu District People's Hospital, Chengdu, 625014, Chengdu, China
| | - Shaojin Zhang
- Department of Radiology, Pidu District People's Hospital, Chengdu, 625014, Chengdu, China
| | - Jijian Ma
- Department of Radiology, Pidu District People's Hospital, Chengdu, 625014, Chengdu, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 518055, Shenzhen, China.,CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 518055, Shenzhen, China
| | - Jinhuan Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 518055, Shenzhen, China.,The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 518000, Shenzhen, China
| | - Hongxing Li
- Department of Neonatology, Changzhou Children's Hospital, Changzhou, 213003, China.
| | - Huawang Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 510370, Guangzhou, China.
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 518055, Shenzhen, China.
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Richerson WT, Umfleet LG, Schmit BD, Wolfgram DF. Changes in Cerebral Volume and White Matter Integrity in Adults on Hemodialysis and Relationship to Cognitive Function. Nephron Clin Pract 2020; 145:35-43. [PMID: 33049742 DOI: 10.1159/000510614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/01/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients on hemodialysis (HD) have a significant burden of cognitive impairment. Characterizing the cerebral structural changes in HD patients compared to healthy controls and evaluating the relationship of cerebral structural integrity with cognitive performance in HD patients can help clarify the pathophysiology of the cognitive impairment in HD patients. METHODS In this cross-sectional study, in-center HD patients ≥50 years of age underwent brain structural and diffusion MRIs and cognitive assessment using the NIH Toolbox cognition battery. The cerebral imaging measures of the HD participants were compared to imaging from age-matched controls. Gray matter volume, white matter volume, and white matter integrity determined by diffusion tensor imaging parameters (including fractional anisotropy [FA]) were measured in both cohorts to determine differences in the cerebral structure between HD participants and healthy controls. The association between cognitive performance on the NIH Toolbox cognition battery and cerebral structural integrity was evaluated using multiple linear regression models. RESULTS We compared imaging measures form 23 HD participants and 15 age-matched controls. The HD participants had decreased gray matter volumes (526.8 vs. 589.5 cm3, p < 0.01) and worsened white matter integrity overall (FA values of 0.2864 vs. 0.3441, p < 0.01) within major white matter tracts compared to healthy controls. Decreases in white matter integrity in the left superior longitudinal fasciculus was associated with lower executive function scores (r2 = 0.24, p = 0.02) and inferior longitudinal fasciculus with lower memory scores (r = 0.25 and p = 0.03 for left and r2 = 0.21 and p = 0.03 for right). CONCLUSIONS HD patients have a pattern of decreased white matter integrity and gray matter atrophy compared to controls. Decreases in white matter integrity were associated with decreased cognitive performance in the HD population.
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Affiliation(s)
- Wesley T Richerson
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA,
| | - Laura G Umfleet
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dawn F Wolfgram
- Department of Medicine, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
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Tamura Y, Shimoji K, Ishikawa J, Tachibana A, Kodera R, Oba K, Toyoshima K, Chiba Y, Tokumaru AM, Araki A. Associations between sarcopenia and white matter alterations in older adults with diabetes mellitus: A diffusion tensor imaging study. J Diabetes Investig 2020; 12:633-640. [PMID: 32750745 PMCID: PMC8015831 DOI: 10.1111/jdi.13379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Aims/Introduction Older adults with diabetes mellitus are susceptible to sarcopenia. Diffusion tensor imaging studies have also shown that patients with diabetes have altered white matter integrity. However, the relationship between these structural changes in white matter and sarcopenia remains poorly understood. Materials and Methods The study included 284 older patients (aged ≥65 years) who visited the Tokyo Metropolitan Geriatric Hospital Frailty Clinic. We used diffusion tensor imaging to measure fractional anisotropy (FA) and mean diffusivity (MD) to evaluate changes in white matter integrity. We investigated the associations between sarcopenia, or its diagnostic components, and FA or MD in seven white matter tracts considered to be associated with sarcopenia according to the patients’ diabetes status. Results We found significantly low FA or high MD values in the bilateral anterior thalamic radiations (ATR) and right inferior fronto‐occipital fasciculus (IFOF) of patients with Asian Working Group for Sarcopenia 2019‐defined sarcopenia, in all patients and those with diabetes. Using binominal regression analyses, we associated low FA values in the left ATR and right IFOF with sarcopenia in all patients and those with diabetes, after adjusting for age, gender, HbA1c, blood pressure, cognitive function, physical activity, depression, nutritional status, and inflammation. Conclusions White matter alterations in left ATR and right IFOF are associated with the prevalence of sarcopenia in patients with diabetes. Specific changes to the left ATR and right IFOF tracts could play critical roles in the occurrence of sarcopenia in patients with diabetes.
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Affiliation(s)
- Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Keigo Shimoji
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Aya Tachibana
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Remi Kodera
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kazuhito Oba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kenji Toyoshima
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Yuko Chiba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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Chen Q, Wang Y, Qiu Y, Wu X, Zhou Y, Zhai G. A Deep Learning-Based Model for Classification of Different Subtypes of Subcortical Vascular Cognitive Impairment With FLAIR. Front Neurosci 2020; 14:557. [PMID: 32625048 PMCID: PMC7315844 DOI: 10.3389/fnins.2020.00557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
Deep learning methods have shown their great capability of extracting high-level features from image and have been used for effective medical imaging classification recently. However, training samples of medical images are restricted by the amount of patients as well as medical ethics issues, making it hard to train the neural networks. In this paper, we propose a novel end-to-end three-dimensional (3D) attention-based residual neural network (ResNet) architecture to classify different subtypes of subcortical vascular cognitive impairment (SVCI) with single-shot T2-weighted fluid-attenuated inversion recovery (FLAIR) sequence. Our aim is to develop a convolutional neural network to provide a convenient and effective way to assist doctors in the diagnosis and early treatment of the different subtypes of SVCI. The experiment data in this paper are collected from 242 patients from the Neurology Department of Renji Hospital, including 78 amnestic mild cognitive impairment (a-MCI), 70 nonamnestic MCI (na-MCI), and 94 no cognitive impairment (NCI). The accuracy of our proposed model has reached 98.6% on a training set and 97.3% on a validation set. The test accuracy on an untrained testing set reaches 93.8% with robustness. Our proposed method can provide a convenient and effective way to assist doctors in the diagnosis and early treatment.
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Affiliation(s)
- Qi Chen
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yage Qiu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaowei Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guangtao Zhai
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
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Biesbroek JM, Lam BY, Zhao L, Tang Y, Wang Z, Abrigo J, Chu WW, Wong A, Shi L, Kuijf HJ, Biessels GJ, Mok VC. High white matter hyperintensity burden in strategic white matter tracts relates to worse global cognitive performance in community-dwelling individuals. J Neurol Sci 2020; 414:116835. [DOI: 10.1016/j.jns.2020.116835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/29/2020] [Accepted: 04/10/2020] [Indexed: 11/26/2022]
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Dubost F, Bruijne MD, Nardin M, Dalca AV, Donahue KL, Giese AK, Etherton MR, Wu O, Groot MD, Niessen W, Vernooij M, Rost NS, Schirmer MD. Multi-atlas image registration of clinical data with automated quality assessment using ventricle segmentation. Med Image Anal 2020; 63:101698. [PMID: 32339896 PMCID: PMC7275913 DOI: 10.1016/j.media.2020.101698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/03/2019] [Accepted: 04/06/2020] [Indexed: 02/08/2023]
Abstract
Registration is a core component of many imaging pipelines. In case of clinical scans, with lower resolution and sometimes substantial motion artifacts, registration can produce poor results. Visual assessment of registration quality in large clinical datasets is inefficient. In this work, we propose to automatically assess the quality of registration to an atlas in clinical FLAIR MRI scans of the brain. The method consists of automatically segmenting the ventricles of a given scan using a neural network, and comparing the segmentation to the atlas ventricles propagated to image space. We used the proposed method to improve clinical image registration to a general atlas by computing multiple registrations - one directly to the general atlas and others via different age-specific atlases - and then selecting the registration that yielded the highest ventricle overlap. Finally, as an example application of the complete pipeline, a voxelwise map of white matter hyperintensity burden was computed using only the scans with registration quality above a predefined threshold. Methods were evaluated in a single-site dataset of more than 1000 scans, as well as a multi-center dataset comprising 142 clinical scans from 12 sites. The automated ventricle segmentation reached a Dice coefficient with manual annotations of 0.89 in the single-site dataset, and 0.83 in the multi-center dataset. Registration via age-specific atlases could improve ventricle overlap compared to a direct registration to the general atlas (Dice similarity coefficient increase up to 0.15). Experiments also showed that selecting scans with the registration quality assessment method could improve the quality of average maps of white matter hyperintensity burden, instead of using all scans for the computation of the white matter hyperintensity map. In this work, we demonstrated the utility of an automated tool for assessing image registration quality in clinical scans. This image quality assessment step could ultimately assist in the translation of automated neuroimaging pipelines to the clinic.
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Affiliation(s)
- Florian Dubost
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, The Netherlands.
| | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, The Netherlands; Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Marco Nardin
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Adrian V Dalca
- Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge, USA
| | - Kathleen L Donahue
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Anne-Katrin Giese
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Mark R Etherton
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Marius de Groot
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Wiro Niessen
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, The Netherlands; Department of Imaging Physics, Faculty of Applied Science, TU Delft, Delft, The Netherlands
| | - Meike Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Natalia S Rost
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Markus D Schirmer
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge, USA; Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Germany.
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Weaver NA, Zhao L, Biesbroek JM, Kuijf HJ, Aben HP, Bae HJ, Caballero MÁ, Chappell FM, Chen CP, Dichgans M, Duering M, Georgakis MK, van der Giessen RS, Gyanwali B, Hamilton OK, Hilal S, vom Hofe EM, de Kort PL, Koudstaal PJ, Lam BY, Lim JS, Makin SD, Mok VC, Shi L, Valdés Hernández MC, Venketasubramanian N, Wardlaw JM, Wollenweber FA, Wong A, Xin X, Biessels GJ. The Meta VCI Map consortium for meta-analyses on strategic lesion locations for vascular cognitive impairment using lesion-symptom mapping: Design and multicenter pilot study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:310-326. [PMID: 31011619 PMCID: PMC6465616 DOI: 10.1016/j.dadm.2019.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The Meta VCI Map consortium performs meta-analyses on strategic lesion locations for vascular cognitive impairment using lesion-symptom mapping. Integration of data from different cohorts will increase sample sizes, to improve brain lesion coverage and support comprehensive lesion-symptom mapping studies. METHODS Cohorts with available imaging on white matter hyperintensities or infarcts and cognitive testing were invited. We performed a pilot study to test the feasibility of multicenter data processing and analysis and determine the benefits to lesion coverage. RESULTS Forty-seven groups have joined Meta VCI Map (stroke n = 7800 patients; memory clinic n = 4900; population-based n = 14,400). The pilot study (six ischemic stroke cohorts, n = 878) demonstrated feasibility of multicenter data integration (computed tomography/magnetic resonance imaging) and achieved marked improvement of lesion coverage. DISCUSSION Meta VCI Map will provide new insights into the relevance of vascular lesion location for cognitive dysfunction. After the successful pilot study, further projects are being prepared. Other investigators are welcome to join.
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Affiliation(s)
- Nick A. Weaver
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lei Zhao
- BrainNow Medical Technology Limited, Hong Kong Science and Technology Park, Shatin, Hong Kong SAR, China
| | - J. Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo J. Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo P. Aben
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Miguel Á.A. Caballero
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Francesca M. Chappell
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom
| | - Christopher P.L.H. Chen
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Marios K. Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | | | - Bibek Gyanwali
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - Olivia K.L. Hamilton
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Departments of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Elise M. vom Hofe
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul L.M. de Kort
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Peter J. Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bonnie Y.K. Lam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Gerald Choa Neuroscience Centre, 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 SAR, China
| | - Jae-Sung Lim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Stephen D.J. Makin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Vincent C.T. Mok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Gerald Choa Neuroscience Centre, 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 SAR, China
| | - Lin Shi
- BrainNow Medical Technology Limited, Hong Kong Science and Technology Park, Shatin, Hong Kong SAR, China
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Maria C. Valdés Hernández
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom
| | | | - Joanna M. Wardlaw
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom
| | - Frank A. Wollenweber
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Adrian Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Gerald Choa Neuroscience Centre, 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 SAR, China
| | - Xu Xin
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Ten Brink AF, Fabius JH, Weaver NA, Nijboer TC, Van der Stigchel S. Trans-saccadic memory after right parietal brain damage. Cortex 2019; 120:284-297. [DOI: 10.1016/j.cortex.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/24/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
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Association between tumor location and neurocognitive functioning using tumor localization maps. J Neurooncol 2019; 144:573-582. [DOI: 10.1007/s11060-019-03259-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/30/2019] [Accepted: 08/03/2019] [Indexed: 12/20/2022]
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Zamboni G, Griffanti L, Mazzucco S, Pendlebury ST, Rothwell PM. Age-dependent association of white matter abnormality with cognition after TIA or minor stroke. Neurology 2019; 93:e272-e282. [PMID: 31201296 PMCID: PMC6656647 DOI: 10.1212/wnl.0000000000007772] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/04/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate if the association between MRI-detectable white matter hyperintensity (WMH) and cognitive status reported in previous studies persists at older ages (>80 years), when some white matter abnormality is almost universally reported in clinical practice. METHODS Consecutive eligible patients from a population-based cohort of all TIA/nondisabling stroke (Oxford Vascular Study) underwent multimodal MRI, including fluid-attenuated inversion recovery and diffusion-weighted imaging, allowing automated measurement of WMH volume, mean diffusivity (MD), and fractional anisotropy (FA) in normal-appearing white matter using FSL tools. These measures were related to cognitive status (Montreal Cognitive Assessment) at age ≤80 vs >80 years. RESULTS Of 566 patients (mean [range] age 66.7 [20-102] years), 107 were aged >80 years. WMH volumes and MD/FA were strongly associated with cognitive status in patients aged ≤80 years (all p < 0.001 for WMH, MD, and FA) but not in patients aged >80 years (not significant for WMH, MD, and FA), with age interactions for WMH volume (p interaction = 0.016) and MD (p interaction = 0.037). Voxel-wise analyses also showed that lower Montreal Cognitive Assessment scores were associated with frontal WMH in patients ≤80 years, but not >80 years. CONCLUSION MRI markers of white matter damage are strongly related to cognition in patients with TIA/minor stroke at younger ages, but not at age >80 years. Clinicians and patients should not overinterpret the significance of these abnormalities at older ages.
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Affiliation(s)
- Giovanna Zamboni
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy.
| | - Ludovica Griffanti
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
| | - Sara Mazzucco
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
| | - Sarah T Pendlebury
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
| | - Peter M Rothwell
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
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Altermatt A, Gaetano L, Magon S, Bauer L, Feurer R, Gnahn H, Hartmann J, Seifert CL, Poppert H, Wuerfel J, Radue EW, Kappos L, Sprenger T. Clinical associations of T2-weighted lesion load and lesion location in small vessel disease: Insights from a large prospective cohort study. Neuroimage 2019; 189:727-733. [DOI: 10.1016/j.neuroimage.2019.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 11/28/2022] Open
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Heaps-Woodruff JM, Joska J, Cabeen R, Baker LM, Salminen LE, Hoare J, Laidlaw DH, Wamser-Nanney R, Peng CZ, Engelbrecht S, Seedat S, Stein DJ, Paul RH. White matter fiber bundle lengths are shorter in cART naive HIV: an analysis of quantitative diffusion tractography in South Africa. Brain Imaging Behav 2019; 12:1229-1238. [PMID: 29110194 DOI: 10.1007/s11682-017-9769-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study examines white matter microstructure using quantitative tractography diffusion magnetic resonance imaging (qtdMRI) in HIV+ individuals from South Africa who were naïve or early in the initiation of antiretroviral therapy. Fiber bundle length (FBL) metrics, generated from qtdMRI, for whole brain and six white matter tracts of interest (TOI) were assessed for 135 HIV+ and 21 HIV- individuals. The association between FBL metrics, measures of disease burden, and neuropsychological performance were also investigated. Results indicate significantly reduced sum of whole brain fiber bundle lengths (FBL, p < 0.001), but not average whole brain FBL in the HIV+ group compared to the HIV- controls. The HIV+ group exhibited significantly shorter sum of FBL in all six TOIs examined: the anterior thalamic radiation, cingulum bundle, inferior and superior longitudinal fasciculi, inferior frontal occipital fasciculus, and the uncinate fasciculus. Additionally, average FBLs were significantly shorter select TOIs including the inferior longitudinal fasciculus, cingulum bundle, and the anterior thalamic radiation. Shorter whole brain FBL sum metrics were associated with poorer neuropsychological performance, but were not associated with markers of disease burden. Taken together these findings suggest HIV affects white matter architecture primarily through reductions in white matter fiber numbers and, to a lesser degree, the shortening of fibers along a bundle path.
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Affiliation(s)
| | - John Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ryan Cabeen
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Laurie M Baker
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Lauren E Salminen
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - David H Laidlaw
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.,Department of Computer Science, Brown University, Providence, RI, USA
| | | | - Chun-Zi Peng
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Services (NHLS), Cape Town, South Africa
| | - Soraya Seedat
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Services (NHLS), Cape Town, South Africa
| | - Dan J Stein
- MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Robert H Paul
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
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49
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Frey BM, Petersen M, Mayer C, Schulz M, Cheng B, Thomalla G. Characterization of White Matter Hyperintensities in Large-Scale MRI-Studies. Front Neurol 2019; 10:238. [PMID: 30972001 PMCID: PMC6443932 DOI: 10.3389/fneur.2019.00238] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/22/2019] [Indexed: 01/18/2023] Open
Abstract
Background: White matter hyperintensities of presumed vascular origin (WMH) are a common finding in elderly people and a growing social malady in the aging western societies. As a manifestation of cerebral small vessel disease, WMH are considered to be a vascular contributor to various sequelae such as cognitive decline, dementia, depression, stroke as well as gait and balance problems. While pathophysiology and therapeutical options remain unclear, large-scale studies have improved the understanding of WMH, particularly by quantitative assessment of WMH. In this review, we aimed to provide an overview of the characteristics, research subjects and segmentation techniques of these studies. Methods: We performed a systematic review according to the PRISMA statement. One thousand one hundred and ninety-six potentially relevant articles were identified via PubMed search. Six further articles classified as relevant were added manually. After applying a catalog of exclusion criteria, remaining articles were read full-text and the following information was extracted into a standardized form: year of publication, sample size, mean age of subjects in the study, the cohort included, and segmentation details like the definition of WMH, the segmentation method, reference to methods papers as well as validation measurements. Results: Our search resulted in the inclusion and full-text review of 137 articles. One hundred and thirty-four of them belonged to 37 prospective cohort studies. Median sample size was 1,030 with no increase over the covered years. Eighty studies investigated in the association of WMH and risk factors. Most of them focussed on arterial hypertension, diabetes mellitus type II and Apo E genotype and inflammatory markers. Sixty-three studies analyzed the association of WMH and secondary conditions like cognitive decline, mood disorder and brain atrophy. Studies applied various methods based on manual (3), semi-automated (57), and automated segmentation techniques (75). Only 18% of the articles referred to an explicit definition of WMH. Discussion: The review yielded a large number of studies engaged in WMH research. A remarkable variety of segmentation techniques was applied, and only a minority referred to a clear definition of WMH. Most addressed topics were risk factors and secondary clinical conditions. In conclusion, WMH research is a vivid field with a need for further standardization regarding definitions and used methods.
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Affiliation(s)
- Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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50
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Wu D, Albert M, Soldan A, Pettigrew C, Oishi K, Tomogane Y, Ye C, Ma T, Miller MI, Mori S. Multi-atlas based detection and localization (MADL) for location-dependent quantification of white matter hyperintensities. NEUROIMAGE-CLINICAL 2019; 22:101772. [PMID: 30927606 PMCID: PMC6444296 DOI: 10.1016/j.nicl.2019.101772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/05/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Abstract
The extent and spatial location of white matter hyperintensities (WMH) on brain MRI may be relevant to the development of cognitive decline in older persons. Here, we introduce a new method, known as the Multi-atlas based Detection and Localization (MADL), to evaluate WMH on fluid-attenuated inversion recovery (FLAIR) data. This method simultaneously parcellates the whole brain into 143 structures and labels hyperintense areas within each WM structure. First, a multi-atlas library was established with FLAIR data of normal elderly brains; and then a multi-atlas fusion algorithm was developed by which voxels with locally abnormal intensities were detected as WMH. At the same time, brain segmentation maps were generated from the multi-atlas fusion process to determine the anatomical location of WMH. Areas identified using the MADL method agreed well with manual delineation, with an interclass correlation of 0.97 and similarity index (SI) between 0.55 and 0.72, depending on the total WMH load. Performance was compared to other state-of-the-art WMH detection methods, such as BIANCA and LST. MADL-based analyses of WMH in an older population revealed a significant association between age and WMH load in deep WM but not subcortical WM. The findings also suggested increased WMH load in selective brain regions in subjects with mild cognitive impairment compared to controls, including the inferior deep WM and occipital subcortical WM. The proposed MADL approach may facilitate location-dependent characterization of WMH in older individuals with memory impairment. We proposed a multi-atlas based method for simultaneous detection and location of WMH on FLAIR images. The method generates whole-brain segmentation for location-dependent WMH analysis. The method showed reasonably high detection accuracy in comparison with other methods. Results revealed a selective association between deep brain WMH and subject age. Results suggested increased WMH in the inferior white matter in MCI patients.
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Affiliation(s)
- Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China; Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corinne Pettigrew
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenichi Oishi
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yusuke Tomogane
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chenfei Ye
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ting Ma
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael I Miller
- Department of Biomedicine Engineering, Johns Hopkins University, Baltimore, MD, USA; Center of Imaging Science, Johns Hopkins University, Baltimore, MD, USA; Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Susumu Mori
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
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