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Sin MK, Dowling NM, Roseman JM, Ahmed A, Zamrini E. Late-Life Blood Pressure and Cerebral Amyloid Angiopathy: Findings from the U.S. National Alzheimer's Coordinating Center Uniform Dataset. Neurol Int 2024; 16:821-832. [PMID: 39195563 DOI: 10.3390/neurolint16040061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/23/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
High blood pressure (BP) and cerebral amyloid angiopathy (CAA) are two common risk factors for intracranial hemorrhage, potentially leading to cognitive impairment. Less is known about the relationship between BP and CAA, the examination of which was the objective of this study. We analyzed data from 2510 participants in the National Alzheimer's Coordinating Center (NACC) who had information on longitudinal BP measurements before death and on CAA from autopsy. Using the average of four systolic BPs (SBPs) prior to death, SBP was categorized into three groups: <120 mmHg (n = 435), 120-139 mmHg (n = 1335), and ≥140 mmHg (n = 740). CAA was diagnosed using immunohistochemistry in 1580 participants and categorized as mild (n = 759), moderate (n = 529), or severe (n = 292). When adjusted for age at death, sex, APOE genotype, Braak, CERAD, antihypertensive medication use, and microinfarcts, the odds ratios (95% CIs) for CAA associated with SBPs of 120-139 and ≥140 mmHg were 0.91 (0.74-1.12) and 1.00 (0.80-1.26), respectively. Findings from predictor effect plots show no variation in the probability of CAA between the three SBP categories. Microbleeds had no association with CAA, but among those with SBP ≥ 130 mmHg, the proportion of those with microbleeds was numerically greater in those with more severe CAA (p for trend, 0.084). In conclusion, we found no evidence of an association between SBP and CAA. Future studies need to develop non-invasive laboratory tests to diagnose CAA and prospectively examine this association and its implication on the pathophysiology and outcome of Alzheimer's disease.
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Affiliation(s)
- Mo-Kyung Sin
- College of Nursing, Seattle University, Seattle, WA 98122, USA
| | - N Maritza Dowling
- Department of Acute & Chronic Care, School of Nursing, George Washington University, Washington, DC 20147, USA
- Department of Epidemiology & Biostatistics, Milken School of Public Health, George Washington University, Washington, DC 20147, USA
| | - Jeffrey M Roseman
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ali Ahmed
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC 20242, USA
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington, DC 20052, USA
- Department of Medicine, School of Medicine, Georgetown University, Washington, DC 20057, USA
| | - Edward Zamrini
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC 20242, USA
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington, DC 20052, USA
- Biomedical Informatics Center, School of Medicine & Health Sciences, George Washington University, Washington, DC 20052, USA
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2
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Schiavolin S, Camarda G, Mazzucchelli A, Mariniello A, Marinoni G, Storti B, Canavero I, Bersano A, Leonardi M. Cognitive and psychological characteristics in patients with Cerebral Amyloid Angiopathy: a literature review. Neurol Sci 2024; 45:3031-3049. [PMID: 38388894 DOI: 10.1007/s10072-024-07399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
AIM To review the current data on cognitive and psychological characteristics of patients with CAA and on the instruments used for their evaluation. METHODS A systematic search was performed in Embase, Scopus and PubMed with terms related to "cerebral amyloid angiopathy", "neuropsychological measures" and "patient-reported outcome measures" from January 2001 to December 2021. RESULTS Out of 2851 records, 18 articles were selected. The cognitive evaluation was present in all of which, while the psychological one only in five articles. The MMSE (Mini Mental State Examination), TMT (Trail Making Test), fluency test, verbal learning test, digit span, digit symbol and Rey figure tests were the most used cognitive tests, while executive function, memory, processing speed, visuospatial function, attention and language were the most frequent impaired cognitive functions. Depression was the most considered psychological factor usually measured with BDI (Beck Depression Inventory) and GDS (Geriatric Depression Scale). CONCLUSIONS The results of this study might be used in clinical practice as a guide to choose cognitive and psychological instruments and integrate them in the clinical evaluation. The results might also be used in the research field for studies investigating the impact of cognitive and psychological variables on the disease course and for consensus studies aimed at define a standardized evaluation of these aspects.
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Affiliation(s)
- Silvia Schiavolin
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giorgia Camarda
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
| | - Alessia Mazzucchelli
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Arianna Mariniello
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giulia Marinoni
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Benedetta Storti
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Canavero
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Bersano
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
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Zhang X, Zhang Q, Zhang Q, Wang H, Yin Y, Li H, Huang Q, Guo C, Zhong J, Zhou T, Chen Y, Chen Z, Shan Q, Hu R. Tetrahydrofolate Attenuates Cognitive Impairment after Hemorrhagic Stroke by Promoting Hippocampal Neurogenesis via PTEN Signaling. eNeuro 2024; 11:ENEURO.0021-24.2024. [PMID: 38729764 PMCID: PMC11149488 DOI: 10.1523/eneuro.0021-24.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Intracerebral hemorrhage (ICH), the most common subtype of hemorrhagic stroke, leads to cognitive impairment and imposes significant psychological burdens on patients. Hippocampal neurogenesis has been shown to play an essential role in cognitive function. Our previous study has shown that tetrahydrofolate (THF) promotes the proliferation of neural stem cells (NSCs). However, the effect of THF on cognition after ICH and the underlying mechanisms remain unclear. Here, we demonstrated that administration of THF could restore cognition after ICH. Using Nestin-GFP mice, we further revealed that THF enhanced the proliferation of hippocampal NSCs and neurogenesis after ICH. Mechanistically, we found that THF could prevent ICH-induced elevated level of PTEN and decreased expressions of phosphorylated AKT and mTOR. Furthermore, conditional deletion of PTEN in NSCs of the hippocampus attenuated the inhibitory effect of ICH on the proliferation of NSCs and abnormal neurogenesis. Taken together, these results provide molecular insights into ICH-induced cognitive impairment and suggest translational clinical therapeutic strategy for hemorrhagic stroke.
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Affiliation(s)
- Xuyang Zhang
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Qingzhu Zhang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Qian Zhang
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Haomiao Wang
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yi Yin
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Huanhuan Li
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Qianying Huang
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Chao Guo
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Jun Zhong
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Tengyuan Zhou
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Qiao Shan
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Rong Hu
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
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Gustafson D, Kalaria R, O'Brien J, van den Brink H, Hilal S, Marseglia A, ter Telgte A, Skoog I. VasCog 2023: 20 years of research on vascular behavioural and cognitive disorders. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100224. [PMID: 38868624 PMCID: PMC11167242 DOI: 10.1016/j.cccb.2024.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024]
Abstract
This Commentary describes the 20th Anniversary of VasCog 2023, held in Gothenburg, Sweden.
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Affiliation(s)
- D.R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, MSC 1213, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - R. Kalaria
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - J. O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, United Kingdom
| | - H. van den Brink
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S. Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - A. Marseglia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - A. ter Telgte
- VASCage – Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - I. Skoog
- Center for Ageing and Health, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hwang DY, Kim KS, Muehlschlegel S, Wartenberg KE, Rajajee V, Alexander SA, Busl KM, Creutzfeldt CJ, Fontaine GV, Hocker SE, Madzar D, Mahanes D, Mainali S, Sakowitz OW, Varelas PN, Weimar C, Westermaier T, Meixensberger J. Guidelines for Neuroprognostication in Critically Ill Adults with Intracerebral Hemorrhage. Neurocrit Care 2024; 40:395-414. [PMID: 37923968 PMCID: PMC10959839 DOI: 10.1007/s12028-023-01854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND The objective of this document is to provide recommendations on the formal reliability of major clinical predictors often associated with intracerebral hemorrhage (ICH) neuroprognostication. METHODS A narrative systematic review was completed using the Grading of Recommendations Assessment, Development, and Evaluation methodology and the Population, Intervention, Comparator, Outcome, Timing, Setting questions. Predictors, which included both individual clinical variables and prediction models, were selected based on clinical relevance and attention in the literature. Following construction of the evidence profile and summary of findings, recommendations were based on Grading of Recommendations Assessment, Development, and Evaluation criteria. Good practice statements addressed essential principles of neuroprognostication that could not be framed in the Population, Intervention, Comparator, Outcome, Timing, Setting format. RESULTS Six candidate clinical variables and two clinical grading scales (the original ICH score and maximally treated ICH score) were selected for recommendation creation. A total of 347 articles out of 10,751 articles screened met our eligibility criteria. Consensus statements of good practice included deferring neuroprognostication-aside from the most clinically devastated patients-for at least the first 48-72 h of intensive care unit admission; understanding what outcomes would have been most valued by the patient; and counseling of patients and surrogates whose ultimate neurological recovery may occur over a variable period of time. Although many clinical variables and grading scales are associated with ICH poor outcome, no clinical variable alone or sole clinical grading scale was suggested by the panel as currently being reliable by itself for use in counseling patients with ICH and their surrogates, regarding functional outcome at 3 months and beyond or 30-day mortality. CONCLUSIONS These guidelines provide recommendations on the formal reliability of predictors of poor outcome in the context of counseling patients with ICH and surrogates and suggest broad principles of neuroprognostication. Clinicians formulating their judgments of prognosis for patients with ICH should avoid anchoring bias based solely on any one clinical variable or published clinical grading scale.
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Affiliation(s)
- David Y Hwang
- Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599-7025, USA.
| | - Keri S Kim
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Susanne Muehlschlegel
- Division of Neurosciences Critical Care, Departments of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | | | | | - Katharina M Busl
- Departments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Gabriel V Fontaine
- Departments of Pharmacy and Neurosciences, Intermountain Health, Salt Lake City, UT, USA
| | - Sara E Hocker
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Dominik Madzar
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Dea Mahanes
- Departments of Neurology and Neurosurgery, UVA Health, Charlottesville, VA, USA
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Oliver W Sakowitz
- Department of Neurosurgery, Neurosurgery Center Ludwigsburg-Heilbronn, Ludwigsburg, Germany
| | | | - Christian Weimar
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
- BDH-Klinik Elzach, Elzach, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, Helios Amper-Kliniken Dachau, University of Wuerzburg, Würzburg, Germany
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6
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Tsai HH, Liu CJ, Lee BC, Chen YF, Yen RF, Jeng JS, Tsai LK. Cerebral tau pathology in cerebral amyloid angiopathy. Brain Commun 2024; 6:fcae086. [PMID: 38638152 PMCID: PMC11024817 DOI: 10.1093/braincomms/fcae086] [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: 11/08/2023] [Revised: 02/01/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Tau, a hallmark of Alzheimer's disease, is poorly characterized in cerebral amyloid angiopathy. We aimed to assess the clinico-radiological correlations between tau positron emission tomography scans and cerebral amyloid angiopathy. We assessed cerebral amyloid and hyperphosphorylated tau in patients with probable cerebral amyloid angiopathy (n = 31) and hypertensive small vessel disease (n = 27) using 11C-Pittsburgh compound B and 18F-T807 positron emission tomography. Multivariable regression models were employed to assess radio-clinical features related to cerebral tau pathology in cerebral amyloid angiopathy. Cerebral amyloid angiopathy exhibited a higher cerebral tau burden in the inferior temporal lobe [1.25 (1.17-1.42) versus 1.08 (1.05-1.22), P < 0.001] and all Braak stage regions of interest (P < 0.05) than hypertensive small vessel disease, although the differences were attenuated after age adjustment. Cerebral tau pathology was significantly associated with cerebral amyloid angiopathy-related vascular markers, including cortical superficial siderosis (β = 0.12, 95% confidence interval 0.04-0.21) and cerebral amyloid angiopathy score (β = 0.12, 95% confidence interval 0.03-0.21) after adjustment for age, ApoE4 status and whole cortex amyloid load. Tau pathology correlated significantly with cognitive score (Spearman's ρ=-0.56, P = 0.001) and hippocampal volume (-0.49, P = 0.007), even after adjustment. In conclusion, tau pathology is more frequent in sporadic cerebral amyloid angiopathy than in hypertensive small vessel disease. Cerebral amyloid angiopathy-related vascular pathologies, especially cortical superficial siderosis, are potential markers of cerebral tau pathology suggestive of concomitant Alzheimer's disease.
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Affiliation(s)
- Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Chia-Ju Liu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei 100225, Taiwan
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7
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Almarghalani DA, Bahader GA, Ali M, Tillekeratne LMV, Shah ZA. Cofilin Inhibitor Improves Neurological and Cognitive Functions after Intracerebral Hemorrhage by Suppressing Endoplasmic Reticulum Stress Related-Neuroinflammation. Pharmaceuticals (Basel) 2024; 17:114. [PMID: 38256947 PMCID: PMC10818666 DOI: 10.3390/ph17010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Neuroinflammation after intracerebral hemorrhage (ICH) is a crucial factor that determines the extent of the injury. Cofilin is a cytoskeleton-associated protein that drives neuroinflammation and microglia activation. A novel cofilin inhibitor (CI) synthesized and developed in our lab has turned out to be a potential therapeutic agent for targeting cofilin-mediated neuroinflammation in an in vitro model of ICH and traumatic brain injury. The current study aims to examine the therapeutic potential of CI in a mouse collagenase model of ICH and examine the neurobehavioral outcomes and its mechanism of action. Male mice were subjected to intrastriatal collagenase injection to induce ICH, and sham mice received needle insertion. Various concentrations (25, 50, and 100 mg/kg) of CI were administered to different cohorts of the animals as a single intravenous injection 3 h following ICH and intraperitoneally every 12 h for 3 days. The animals were tested for neurobehavioral parameters for up to 7 days and sacrificed to collect brains for hematoma volume measurement, Western blotting, and immunohistochemistry. Blood was collected for cofilin, TNF-α, and IL-1β assessments. The results indicated that 50 mg/kg CI improved neurological outcomes, reversed post-stroke cognitive impairment, accelerated hematoma resolution, mitigated cofilin rods/aggregates, and reduced microglial and astrocyte activation in mice with ICH. Microglia morphological analysis demonstrated that CI restored the homeostasis ramification pattern of microglia in mice treated with CI. CI suppressed endoplasmic reticulum stress-related neuroinflammation by inhibiting inflammasomes and cell death signaling pathways. We also showed that CI prevented synaptic loss by reviving the pre- and post-synaptic markers. Our results unveil a novel therapeutic approach to treating ICH and open a window for using CI in clinical practice.
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Affiliation(s)
- Daniyah A. Almarghalani
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA
| | - Ghaith A. Bahader
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA
| | - Mohammad Ali
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA
| | - L. M. Viranga Tillekeratne
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA
| | - Zahoor A. Shah
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA
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8
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Zhang Z, Lim MJR. Incident Dementia After Spontaneous Intracerebral Hemorrhage. J Alzheimers Dis 2024; 99:41-51. [PMID: 38640161 DOI: 10.3233/jad-240111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Post-stroke cognitive impairment and dementia (PSCID) is a complication that affects long-term functional outcomes after stroke. Studies on dementia after long-term follow-up in stroke have focused predominantly on ischemic stroke, which may be different from the development of dementia after spontaneous intracerebral hemorrhage (ICH). In this review, we summarize the existing data and hypotheses on the development of dementia after spontaneous ICH, review the management of post-ICH dementia, and suggest areas for future research. Dementia after spontaneous ICH has a cumulative incidence of up to 32.0-37.4% at 5 years post-ICH. Although the pathophysiology of post-ICH dementia has not been fully understood, two main theoretical frameworks can be considered: 1) the triggering role of ICH (both primary and secondary brain injury) in precipitating cognitive decline and dementia; and 2) the contributory role of pre-existing brain pathology (including small vessel disease and neurodegenerative pathology), reduced cognitive reserve, and genetic factors predisposing to cognitive dysfunction. These pathophysiological pathways may have synergistic effects that converge on dysfunction of the neurovascular unit and disruptions in functional connectivity leading to dementia post-ICH. Management of post-ICH dementia may include screening and monitoring, cognitive therapy, and pharmacotherapy. Non-invasive brain stimulation is an emerging therapeutic modality under investigation for safety and efficacy. Our review highlights that there remains a paucity of data and standardized reporting on incident dementia after spontaneous ICH. Further research is imperative for determining the incidence, risk factors, and pathophysiology of post-ICH dementia, in order to identify new therapies for the treatment of this debilitating condition.
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Affiliation(s)
- Zheting Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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9
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Wang H, Yu M, Ren J, Zhong X, Xu D, Gao L, Xu H. Neuroanatomical correlates of cognitive impairment following basal ganglia-thalamic post-hemorrhagic stroke: Uncovering network-wide alterations in hemispheric gray matter asymmetry. Brain Res 2023; 1820:148559. [PMID: 37652090 DOI: 10.1016/j.brainres.2023.148559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/16/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
Cognitive impairment and recovery are central issues in hemorrhagic stroke. This study aimed to investigate whether post-hemorrhagic stroke cognitive impairment (PhSCI) is associated with cortical gray matter (GM) loss and hemispheric asymmetry changes and whether these changes could predict improvements in cognitive function during the recovery. Nineteen patients with PhSCI, comprising 10 with basal ganglia hemorrhage and 9 with thalamic hemorrhage, were recruited. Among them, 9 completed a course of repetitive transcranial magnetic stimulation (rTMS). Additionally, 19 demographically and comorbidity-matched healthy controls were also included. Structural brain MRI and cognitive assessments were performed. Voxel-wise GM volume and hemispheric asymmetry were analyzed. The PhSCI patients exhibited bilateral, yet asymmetric, GM losses in the hippocampus, fusiform, lateral temporal, prefrontal, somatomotor, and inferior parietal regions. The analysis of GM asymmetry revealed that patients showed rightward GM in the lateral temporal, somatomotor, and inferior parietal regions. Among the 9 PhSCI patients who completed rTMS, there was a marginal trend of regional GM increase and leftward GM, and these changes were in parallel with the improvements in cognitive tests. Further lesion connectivity and metanalytic mapping identified two interconnected systems linked to the lesions, which were anchored in the default mode, somatomotor, and salience/cognitive control networks and in the cognitive domains of memory, language, decision-making, and executive function. In conclusion, PhSCI patients exhibited network-wide cortical GM losses, distal to subcortical hemorrhagic lesions, and hemisphere asymmetry changes. These changes appear to predict rTMS-related cognitive improvements, suggesting that even subcortical focal lesions can lead to alterations in distal cortical neuroanatomical architecture. Our preliminary findings provide new insights into the neuroanatomical basis of PhSCI.
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Affiliation(s)
- Huan Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Minhua Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Jinxia Ren
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Xiaoli Zhong
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Dan Xu
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China.
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China.
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10
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Tsai Y, Tsai H, Liu C, Lin S, Chen Y, Jeng J, Tsai L, Yen R. Cerebral amyloid deposition predicts long-term cognitive decline in hemorrhagic small vessel disease. Brain Behav 2023; 13:e3189. [PMID: 37533346 PMCID: PMC10570474 DOI: 10.1002/brb3.3189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND To investigate the association between cerebral amyloid deposition and long-term cognitive outcomes in patients with hemorrhagic small vessel disease (SVD) and survivors of intracerebral hemorrhage (ICH). METHODS Patients experiencing an ICH without overt dementia were prospectively recruited (n = 68) for brain MRI and Pittsburgh compound B (PiB) positron emission tomography scans at baseline. Cognitive function was assessed using the mini-mental status examination (MMSE) and clinical dementia rating after an overall median follow-up of 3.8 years. A positive amyloid scan was defined as a global PiB standardized uptake value ratio >1.2. Associations between follow-up cognitive outcomes and neuroimaging markers were explored using multivariable Cox regression models. RESULTS PiB(+) patients were older (72.1 ± 7.8 vs. 59.9 ± 11.7, p = .002) and more frequently had cerebral amyloid angiopathy (CAA) (63.6% vs. 15.8%, p = .002) than PiB(-) patients. PiB(+) was associated with a higher risk of dementia conversion (32.9 vs. 4.0 per 100-person-years, hazard ratio [HR] = 15.7 [3.0-80.7], p = .001) and MMSE score decline (58.8 vs. 9.9 per 100-person-years, HR = 6.2 [1.9-20.0], p = .002). In the non-CAA subgroup (n = 52), PiB(+) remained an independent predictor of dementia conversion, p = .04). In the Cox models, PiB(+) was an independent predictor of dementia conversion (HR = 15.8 [2.6-95.4], p = .003) and MMSE score decline (HR = 5.7 [1.6-20.3], p = .008) after adjusting for confounders. CONCLUSIONS Cerebral amyloid deposition potentially contributes to long-term cognitive decline in SVD-related ICH.
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Affiliation(s)
- Ya‐Chin Tsai
- Department of Nuclear MedicineNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
| | - Hsin‐Hsi Tsai
- Department of NeurologyNational Taiwan University Hospital Bei‐Hu BranchTaipeiTaiwan
- Department of NeurologyNational Taiwan University HospitalTaipeiTaiwan
| | - Chia‐Ju Liu
- Department of Nuclear MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Sheng‐Sian Lin
- Department of NeurologyNational Taiwan University Hospital Bei‐Hu BranchTaipeiTaiwan
| | - Ya‐Fang Chen
- Department of Medical ImagingNational Taiwan University HospitalTaipeiTaiwan
| | - Jiann‐Shing Jeng
- Department of NeurologyNational Taiwan University Hospital Bei‐Hu BranchTaipeiTaiwan
| | - Li‐Kai Tsai
- Department of NeurologyNational Taiwan University Hospital Bei‐Hu BranchTaipeiTaiwan
- Department of NeurologyNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
| | - Ruoh‐Fang Yen
- Department of Nuclear MedicineNational Taiwan University HospitalTaipeiTaiwan
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11
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Suswati I, Rahayu, Maulida AP, Prasetio AD. Managing Mental Disorders in Intracranial Hemorrhage (ICH) Patients: A Case Study on the Importance of Early Recognition and Intervention. BRAIN HEMORRHAGES 2023. [DOI: 10.1016/j.hest.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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12
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Raposo N, Zanon Zotin MC, Seiffge DJ, Li Q, Goeldlin MB, Charidimou A, Shoamanesh A, Jäger HR, Cordonnier C, Klijn CJM, Smith EE, Greenberg SM, Werring DJ, Viswanathan A. A Causal Classification System for Intracerebral Hemorrhage Subtypes. Ann Neurol 2023; 93:16-28. [PMID: 36197294 PMCID: PMC9839566 DOI: 10.1002/ana.26519] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Determining the underlying causes of intracerebral hemorrhage (ICH) is of major importance, because risk factors, prognosis, and management differ by ICH subtype. We developed a new causal CLASsification system for ICH Subtypes, termed CLAS-ICH, based on recent advances in neuroimaging. METHODS CLAS-ICH defines 5 ICH subtypes: arteriolosclerosis, cerebral amyloid angiopathy, mixed small vessel disease (SVD), other rare forms of SVD (genetic SVD and others), and secondary causes (macrovascular causes, tumor, and other rare causes). Every patient is scored in each category according to the level of diagnostic evidence: (1) well-defined ICH subtype; (2) possible underlying disease; and (0) no evidence of the disease. We evaluated CLAS-ICH in a derivation cohort of 113 patients with ICH from Massachusetts General Hospital, Boston, USA, and in a derivation cohort of 203 patients from Inselspital, Bern, Switzerland. RESULTS In the derivation cohort, a well-defined ICH subtype could be identified in 74 (65.5%) patients, including 24 (21.2%) with arteriolosclerosis, 23 (20.4%) with cerebral amyloid angiopathy, 18 (15.9%) with mixed SVD, and 9 (8.0%) with a secondary cause. One or more possible causes were identified in 42 (37.2%) patients. Interobserver agreement was excellent for each category (kappa value ranging from 0.86 to 1.00). Despite substantial differences in imaging modalities, we obtained similar results in the validation cohort. INTERPRETATION CLAS-ICH is a simple and reliable classification system for ICH subtyping, that captures overlap between causes and the level of diagnostic evidence. CLAS-ICH may guide clinicians to identify ICH causes, and improve ICH classification in multicenter studies. ANN NEUROL 2023;93:16-28.
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Affiliation(s)
- Nicolas Raposo
- Department of neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Maria Clara Zanon Zotin
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Center for Imaging Sciences and Medical Physics, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - David J. Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Martina B. Goeldlin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Andreas Charidimou
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashkan Shoamanesh
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Hans Rolf Jäger
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Catharina JM Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Eric E. Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Steven M. Greenberg
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David J. Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Anand Viswanathan
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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13
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Shinohara M, Matsuda K, Ii Y, Tabei KI, Nakamura N, Hirata Y, Ishikawa H, Matsuyama H, Matsuura K, Maeda M, Tomimoto H, Shindo A. Association between behavioral and psychological symptoms and cerebral small vessel disease MRI findings in memory clinic patients. Front Aging Neurosci 2023; 15:1143834. [PMID: 37032819 PMCID: PMC10079999 DOI: 10.3389/fnagi.2023.1143834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives Cerebral small vessel disease (SVD) is commonly observed among elderly individuals with cognitive impairment and has been recognized as a vascular contributor to dementia and behavioral and psychological symptoms (BPS), however, the relationship between BPS and SVD burden remains unclear. Methods We prospectively recruited 42 patients with mild cognitive impairment (MCI) or mild dementia from the memory clinic in our hospital, who were assigned to either a clinical dementia rating (CDR) of 0.5 or 1.0, respectively. The presence of BPS was determined through interviews with caregivers. The patients underwent brain MRI and three types of SVD scores, total, cerebral amyloid angiopathy (CAA), and modified CAA, were assigned. Patients were also evaluated through various neuropsychological assessments. Results The CDR was significantly higher in patients with BPS (p = 0.001). The use of antihypertensive agents was significantly higher in patients without BPS (p = 0.038). The time taken to complete trail making test set-A was also significantly longer in patients with BPS (p = 0.037). There was no significant difference in total SVD and CAA-SVD score (p = 0.745, and 0.096) and the modified CAA-SVD score was significantly higher in patients with BPS (p = 0.046). In addition, the number of total CMBs and lobar CMBs was significantly higher in patients with BPS (p = 0.001 and 0.001). Receiver operating characteristic curves for BPS showed that for modified CAA-SVD, a cutoff score of 3.5 showed 46.7% sensitivity and 81.5% specificity. Meanwhile, for the total number of cerebral microbleeds (CMBs), a cut-off score of 2.5 showed 80.0% sensitivity and 77.8% specificity and for the number of lobar CMBs, a cut-off score of 2.5 showed 73.3% sensitivity and 77.8% specificity. Conclusion Overall, patients with BPS showed worse CDRs, reduced psychomotor speed, higher modified CAA-SVD scores, larger numbers of total and lobar CMBs. We propose that severe modified CAA scores and higher numbers of total and lobar CMBs are potential risk factors for BPS in patients with mild dementia or MCI. Therefore, by preventing these MRI lesions, the risk of BPS may be mitigated.
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Affiliation(s)
- Masaki Shinohara
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kana Matsuda
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ken-ichi Tabei
- School of Industrial Technology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation, Tokyo, Japan
| | - Naoko Nakamura
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshinori Hirata
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
- *Correspondence: Akihiro Shindo,
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14
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Agrawal S, Schneider JA. Vascular pathology and pathogenesis of cognitive impairment and dementia in older adults. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100148. [PMID: 36324408 PMCID: PMC9616381 DOI: 10.1016/j.cccb.2022.100148] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/25/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022]
Abstract
It is well recognized that brains of older people often harbor cerebrovascular disease pathology including vessel disease and vascular-related tissue injuries and that this is associated with vascular cognitive impairment and contributes to dementia. Here we review vascular pathologies, cognitive impairment, and dementia. We highlight the importance of mixed co-morbid AD/non-AD neurodegenerative and vascular pathology that has been collected in multiple clinical pathologic studies, especially in community-based studies. We also provide an update of vascular pathologies from the Rush Memory and Aging Project and Religious Orders Study cohorts with special emphasis on the differences across age in persons with and without dementia. Finally, we discuss neuropathological perspectives on the interpretation of clinical-pathological studies and emerging data in community-based studies.
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Affiliation(s)
- Sonal Agrawal
- Rush Alzheimer's Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago 60612, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Julie A. Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago 60612, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
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15
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Javaid MA, Selim M, Ortega-Gutierrez S, Lattanzi S, Zargar S, Alaouieh DA, Hong E, Divani AA. Potential application of intranasal insulin delivery for treatment of intracerebral hemorrhage: A review of the literature. J Stroke Cerebrovasc Dis 2022; 31:106489. [PMID: 35489182 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/04/2022] [Accepted: 04/03/2022] [Indexed: 12/01/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is a devastating subtype of stroke associated with high morbidity and mortality that is considered a medical emergency, mainly managed with adequate blood pressure control and creating a favorable hemostatic condition. However, to date, none of the randomized clinical trials have led to an effective treatment for ICH. It is vital to better understand the mechanisms underlying brain injury to effectively decrease ICH-associated morbidity and mortality. It is well known that initial hematoma formation and its expansion have detrimental consequences. The literature has recently focused on other pathological processes, including oxidative stress, neuroinflammation, blood-brain barrier disruption, edema formation, and neurotoxicity, that constitute secondary brain injury. Since conventional management has failed to improve clinical outcomes significantly, various neuroprotective therapies are tested in preclinical and clinical settings. Unlike intravenous administration, intranasal insulin can reach a higher concentration in the cerebrospinal fluid without causing systemic side effects. Intranasal insulin delivery has been introduced as a novel neuroprotective agent for certain neurological diseases, including ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury. Since there is an overlap of mechanisms causing neuroinflammation in these neurological diseases and ICH, we believe that preclinical studies testing the role of intranasal insulin therapy in ICH are warranted.
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Affiliation(s)
| | - Magdy Selim
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Shima Zargar
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | | | - Emily Hong
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Afshin A Divani
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA.
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16
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Potter T, Lioutas VA, Tano M, Pan A, Meeks J, Woo D, Seshadri S, Selim M, Vahidy F. Cognitive Impairment After Intracerebral Hemorrhage: A Systematic Review of Current Evidence and Knowledge Gaps. Front Neurol 2021; 12:716632. [PMID: 34512528 PMCID: PMC8429504 DOI: 10.3389/fneur.2021.716632] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/02/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Cognitive impairment (CI) is commonly observed after intracerebral hemorrhage (ICH). While a growing number of studies have explored this association, several evidence gaps persist. This review seeks to investigate the relationship between CI and ICH. Methods: A two-stage systematic review of research articles, clinical trials, and case series was performed. Initial search used the keywords ["Intracerebral hemorrhage" OR "ICH"] AND ["Cognitive Impairment" OR "Dementia OR "Cognitive Decline"] within the PubMed (last accessed November 3rd, 2020) and ScienceDirect (last accessed October 27th, 2020) databases, without publication date limits. Articles that addressed CI and spontaneous ICH were accepted if CI was assessed after ICH. Articles were rejected if they did not independently address an adult human population or spontaneous ICH, didn't link CI to ICH, were an unrelated document type, or were not written in English. A secondary snowball literature search was performed using reviews identified by the initial search. The Agency for Healthcare research and Quality's assessment tool was used to evaluate bias within studies. Rates of CI and contributory factors were investigated. Results: Search yielded 32 articles that collectively included 22,631 patients. Present evidence indicates a high rate of post-ICH CI (65-84%) in the acute phase (<4 weeks) which is relatively lower at 3 (17.3-40.2%) and 6 months (19-63.3%). Longer term follow-up (≥1 year) demonstrates a gradual increase in CI. Advanced age, female sex, and prior stroke were associated with higher rates of CI. Associations between post-ICH CI and cerebral microbleeds, superficial siderosis, and ICH volume also exist. Pre-ICH cognitive assessment was missing in 28% of included studies. The Mini Mental State Evaluation (44%) and Montreal Cognitive Assessment (16%) were the most common cognitive assessments, albeit with variable thresholds and definitions. Studies rarely (<10%) addressed racial and ethnic disparities. Discussion: Current findings suggest a dynamic course of post-ICH cognitive impairment that may depend on genetic, sociodemographic and clinical factors. Methodological heterogeneity prevented meta-analysis, limiting results. There is a need for the methodologies and time points of post-ICH cognitive assessments to be harmonized across diverse clinical and demographic populations.
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Affiliation(s)
- Thomas Potter
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States
| | | | - Mauricio Tano
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States
- Department of Nuclear Engineering, Texas A&M University, College Station, TX, United States
| | - Alan Pan
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States
| | - Jennifer Meeks
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Farhaan Vahidy
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States
- Neurological Institute, Houston Methodist, Houston, TX, United States
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17
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Raposo N, Zanon Zotin MC, Schoemaker D, Xiong L, Fotiadis P, Charidimou A, Pasi M, Boulouis G, Schwab K, Schirmer MD, Etherton MR, Gurol ME, Greenberg SM, Duering M, Viswanathan A. Peak Width of Skeletonized Mean Diffusivity as Neuroimaging Biomarker in Cerebral Amyloid Angiopathy. AJNR Am J Neuroradiol 2021; 42:875-881. [PMID: 33664113 DOI: 10.3174/ajnr.a7042] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Whole-brain network connectivity has been shown to be a useful biomarker of cerebral amyloid angiopathy and related cognitive impairment. We evaluated an automated DTI-based method, peak width of skeletonized mean diffusivity, in cerebral amyloid angiopathy, together with its association with conventional MRI markers and cognitive functions. MATERIALS AND METHODS We included 24 subjects (mean age, 74.7 [SD, 6.0] years) with probable cerebral amyloid angiopathy and mild cognitive impairment and 62 patients with MCI not attributable to cerebral amyloid angiopathy (non-cerebral amyloid angiopathy-mild cognitive impairment). We compared peak width of skeletonized mean diffusivity between subjects with cerebral amyloid angiopathy-mild cognitive impairment and non-cerebral amyloid angiopathy-mild cognitive impairment and explored its associations with cognitive functions and conventional markers of cerebral small-vessel disease, using linear regression models. RESULTS Subjects with Cerebral amyloid angiopathy-mild cognitive impairment showed increased peak width of skeletonized mean diffusivity in comparison to those with non-cerebral amyloid angiopathy-mild cognitive impairment (P < .001). Peak width of skeletonized mean diffusivity values were correlated with the volume of white matter hyperintensities in both groups. Higher peak width of skeletonized mean diffusivity was associated with worse performance in processing speed among patients with cerebral amyloid angiopathy, after adjusting for other MRI markers of cerebral small vessel disease. The peak width of skeletonized mean diffusivity did not correlate with cognitive functions among those with non-cerebral amyloid angiopathy-mild cognitive impairment. CONCLUSIONS Peak width of skeletonized mean diffusivity is altered in cerebral amyloid angiopathy and is associated with performance in processing speed. This DTI-based method may reflect the degree of white matter structural disruption in cerebral amyloid angiopathy and could be a useful biomarker for cognition in this population.
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Affiliation(s)
- N Raposo
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts .,Department of Neurology (N.R.), Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Institut National de la Santé et de la Recherche Médicale, Toulouse, UPS, France
| | - M C Zanon Zotin
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Imaging Sciences and Medical Physics (M.C.Z.Z.). Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil;, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - D Schoemaker
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - L Xiong
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Fotiadis
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Charidimou
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Pasi
- Department of Neurology (M.P.), Centre Hospitalier Universitaire de Lille, Lille, France
| | - G Boulouis
- Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, Paris, France
| | - K Schwab
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M D Schirmer
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Computer Science and Artificial Intelligence Lab (M.D.S.), Massachusetts Institute of Technology, Boston, Massachusetts.,Department of Population Health Sciences (M.D.S.), German Center for Neurodegenerative Diseases, Bonn, Germany
| | - M R Etherton
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M E Gurol
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S M Greenberg
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Duering
- Medical Image Analysis Center and Quantitative Biomedical Imaging Group (M.D.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - A Viswanathan
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Cognitive Impairment After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 148:141-162. [PMID: 33482414 DOI: 10.1016/j.wneu.2021.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The present systematic review and meta-analysis analyzes the available clinical literature on post-intracerebral hemorrhage (ICH) cognitive impairment. METHODS We conducted a systematic review with meta-analysis following PRISMA guidelines. A search of bibliographic databases up to July 31, 2020 yielded 2155 studies. Twenty articles were included in our final qualitative systematic review and 18 articles in quantitative meta-analysis. RESULTS Based on analysis of data from 18 studies (3270 patients), we found prevalence of post-ICH cognitive impairment to be 46% (confidence interval, 35.9-55.9), with a follow-up duration ranging from 8 days to 4 years. The estimated pooled prevalence of cognitive decline decreased over longitudinal follow-up, from 55% (range, 37.7%-71.15%) within 6 months of ICH to 35% (range, 27%-42.7%) with >6 months to 4 years follow-up after ICH. The modalities used to evaluate cognitive performance after ICH in studies varied widely, ranging from global cognitive measures to domain-specific testing. The cognitive domain most commonly affected included nonverbal IQ, information processing speed, executive function, memory, language, and visuoconstructive abilities. Prognostic factors for poor cognitive performance included severity of cortical atrophy, age, lobar ICH location, and higher number of hemorrhages at baseline. CONCLUSIONS The prevalence of post-ICH cognitive impairment is high. Despite the heterogeneity among studies, the present study identified cognitive domains most commonly affected and predictors of cognitive impairment after ICH. In future, prospective cohort studies with larger sample sizes and standardized cognitive domains testing could more accurately determine prevalence and prognostic factors of post-ICH cognitive decline.
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Planton M, Pariente J, Nemmi F, Albucher JF, Calviere L, Viguier A, Olivot JM, Salabert AS, Payoux P, Peran P, Raposo N. Interhemispheric distribution of amyloid and small vessel disease burden in cerebral amyloid angiopathy-related intracerebral hemorrhage. Eur J Neurol 2020; 27:1664-1671. [PMID: 32394598 DOI: 10.1111/ene.14301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage (ICH) is a devastating presentation of cerebral amyloid angiopathy (CAA), but the mechanisms leading from vascular amyloid deposition to ICH are not well known. Whether amyloid burden and magnetic resonance imaging (MRI) markers of small vessel disease (SVD) are increased in the ICH-affected hemisphere compared to the ICH-free hemisphere in patients with a symptomatic CAA-related ICH was investigated. METHODS Eighteen patients with CAA-related ICH and 18 controls with deep ICH who underwent brain MRI and amyloid positron emission tomography using 18 F-florbetapir were prospectively enrolled. In each hemisphere amyloid uptake using the standardized uptake value ratio and the burden of MRI markers of SVD including cerebral microbleeds, chronic ICH, cortical superficial siderosis, white matter hyperintensities and lacunes were evaluated. Interhemispheric comparisons were assessed by non-parametric matched-pair tests within each patient group. RESULTS Amyloid burden was similarly distributed across the brain hemispheres in patients with CAA-related ICH (standardized uptake value ratio 1.11 vs. 1.12; P = 0.74). Cortical superficial siderosis tended to be more common in the ICH-affected hemisphere compared to the ICH-free hemisphere (61% vs. 33%; P = 0.063). Other MRI markers of SVD did not differ across brain hemispheres. In controls with deep ICH, no interhemispheric difference was observed either for amyloid burden or for MRI markers of SVD. CONCLUSIONS Brain hemorrhage does not appear to be directly linked to amyloid burden in patients with CAA-related ICH. These findings provide new insights into the mechanisms leading to hemorrhage in CAA.
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Affiliation(s)
- M Planton
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - J Pariente
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - F Nemmi
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - J-F Albucher
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - L Calviere
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - A Viguier
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - J-M Olivot
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - A-S Salabert
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Nuclear Medicine, Imaging Center, Toulouse University Hospital, Toulouse, France
| | - P Payoux
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Nuclear Medicine, Imaging Center, Toulouse University Hospital, Toulouse, France
| | - P Peran
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - N Raposo
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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20
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Raposo N, Charidimou A, Roongpiboonsopit D, Onyekaba M, Gurol ME, Rosand J, Greenberg SM, Goldstein JN, Viswanathan A. Convexity subarachnoid hemorrhage in lobar intracerebral hemorrhage: A prognostic marker. Neurology 2020; 94:e968-e977. [PMID: 32019785 PMCID: PMC7238947 DOI: 10.1212/wnl.0000000000009036] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate whether acute convexity subarachnoid hemorrhage (cSAH) associated with acute lobar intracerebral hemorrhage (ICH) increases the risk of ICH recurrence in patients with cerebral amyloid angiopathy (CAA). METHODS We analyzed data from a prospective cohort of consecutive survivors of acute spontaneous lobar ICH fulfilling the Boston criteria for possible or probable CAA (CAA-ICH). We analyzed baseline clinical and MRI data, including cSAH (categorized as adjacent or remote from ICH on a standardized scale), cortical superficial siderosis (cSS), and other CAA MRI markers. Multivariable Cox regression models were used to assess the association between cSAH and recurrent symptomatic ICH during follow-up. RESULTS We included 261 CAA-ICH survivors (mean age 76.2 ± 8.7 years). Of them, 166 (63.6%, 95% confidence interval [CI] 57.7%-69.5%) had cSAH on baseline MRI. During a median follow-up of 28.3 (interquartile range 7.2-57.0) months, 54 (20.7%) patients experienced a recurrent lobar ICH. In Cox regression, any cSAH, adjacent cSAH, and remote cSAH were independent predictors of recurrent ICH after adjustment for other confounders, including cSS. Incidence rate of recurrent ICH in patients with cSAH was 9.9 per 100 person-years (95% CI 7.3-13.0) compared with 1.2 per 100 person-years (95% CI 0.3-3.2) in those without cSAH (adjusted hazard ratio 7.5, 95% CI 2.6-21.1). CONCLUSION In patients with CAA-related acute ICH, cSAH (adjacent or remote from lobar ICH) is commonly observed and heralds an increased risk of recurrent ICH. cSAH may help stratify bleeding risk and should be assessed along with cSS for prognosis and clinical management.
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Affiliation(s)
- Nicolas Raposo
- From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand.
| | - Andreas Charidimou
- From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Duangnapa Roongpiboonsopit
- From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Michelle Onyekaba
- From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | - M Edip Gurol
- From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Jonathan Rosand
- From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Steven M Greenberg
- From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Joshua N Goldstein
- From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Anand Viswanathan
- From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand
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Donnellan C, Werring D. Cognitive impairment before and after intracerebral haemorrhage: a systematic review. Neurol Sci 2019; 41:509-527. [PMID: 31802344 DOI: 10.1007/s10072-019-04150-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/12/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION There is increasing interest in understanding cognitive dysfunction before and after Intracerebral haemorrhage (ICH), given the higher prevalence of dementia reported (ranging from 5 to 44%) for this stroke type. Much of the evidence to date examining cognitive impairment associated with cerebrovascular disease has tended to focus more on ischaemic stroke. The aim of this review was to identify and quantify studies that focused on cognitive dysfunction pre and post ICH. METHODS We conducted a systematic search using databases PubMed, Science Direct, Scopus and PsycINFO to identify studies that exclusively assessed cognitive function pre and post ICH. Studies were included in the review if used a measure of global cognition and/or a neuropsychological battery to assess cognitive function. Nineteen studies were deemed relevant for inclusion, where n = 8 studies examined cognitive impairment pre ICH and n = 11 post ICH. RESULTS Prevalence of cognitive impairment ranged between 9-29% for pre ICH and 14-88% for post ICH. Predictive factors identified for pre and post ICH were previous stroke, ICH volume and location and markers of cerebral amyloid angiopathy (CAA). Most common cognitive domains affected post ICH were information processing speed, executive function, memory, language and visuo-spatial abilities. Most common cognitive assessments tools were the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) for pre-existing cognitive impairment and the Mini-Mental State Examination for global cognition post ICH and the Trail Making Test where neuropsychological tests were used. CONCLUSION Cognitive impairment and dementia affected almost one-third of patients, whether assessed pre or post ICH.
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Affiliation(s)
- Claire Donnellan
- School of Nursing and Midwifery, Faculty of Health Sciences, University of Dublin Trinity College, 2 Clare Street, Dublin 2, Ireland.
| | - David Werring
- Stroke Research Centre, UCL Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
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22
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Blanc C, Viguier A, Calviere L, Planton M, Albucher JF, Rousseau V, Sommet A, Bonneville F, Pariente J, Olivot JM, Raposo N. Underlying Small Vessel Disease Associated With Mixed Cerebral Microbleeds. Front Neurol 2019; 10:1126. [PMID: 31708859 PMCID: PMC6819505 DOI: 10.3389/fneur.2019.01126] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022] Open
Abstract
Background and Purpose: Whether patients with both lobar and deep cerebral microbleeds (mixed CMB) have advanced cerebral amyloid angiopathy (CAA), hypertensive angiopathy (HA) or both is uncertain. To get insight into the underlying small vessel disease (SVD) associated with mixed CMB, we explored its association with cortical superficial siderosis (cSS), a key marker of CAA and other MRI markers of SVD in patients with intracerebral hemorrhage (ICH). Methods: Of 425 consecutive patients with acute ICH who had received brain MRIs, 260 had ≥1 CMB and were included in the analysis. They were categorized as strictly lobar CMB (suggesting CAA), strictly deep CMB (suggesting HA) or mixed CMB. Clinical and imaging characteristics were compared (1) between the three CMB groups and (2) within mixed CMB patients according to the symptomatic ICH location. Results: Overall, 111 (26%) patients had mixed CMB. Compared to strictly lobar CMB (n = 111) and strictly deep CMB (n = 38), patients with mixed CMB had a more severe burden of lacune, white matter hyperintensities and CMB. cSS was observed in 24.3% of patients with mixed CMB compared to 44.1% in strictly lobar CMB and 10.5% in strictly deep CMB (p < 0.0001). Among patients with mixed CMB, 44 (39.6%) had a lobar symptomatic ICH and 67 (60.4%) had a non-lobar ICH. Patients with non-lobar ICH were more likely to have hypertension, whereas those with lobar ICH were more likely to have cSS and chronic lobar ICH and had higher ratio lobar CMB count/total CMB count. Conclusions: Mixed CMB is frequently encountered in patients with ICH and appears as a heterogeneous group, suggesting that both CAA and HA may be contributing to mixed CMB. Neuroimaging markers including ICH location, cSS, and CMB distribution may indicate the predominant underlying vasculopathy, with potential prognostic implications.
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Affiliation(s)
- Clemence Blanc
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Alain Viguier
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Lionel Calviere
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Mélanie Planton
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jean François Albucher
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Vanessa Rousseau
- Epidemiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Agnès Sommet
- Epidemiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Department of Clinical Pharmacology, CIC1436, USMR, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Fabrice Bonneville
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Neuroradiology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jérémie Pariente
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jean Marc Olivot
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Nicolas Raposo
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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Gong K, Zhao L, Guo J, Wang Z. A nomogram to predict cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e17626. [PMID: 31626144 PMCID: PMC6824656 DOI: 10.1097/md.0000000000017626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To establish a nomogram model to predict early cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.A retrospective cohort study was held between January 2016 and October 2018. One hundred twenty seven out of 170 consecutive patients with supratentorial spontaneous intracranial hematoma were enrolled in this study. They were divided into development (n = 92) and validation (n = 35) dataset according to their admission time. Mini-mental State Examination (MMSE) was conducted between the third and the sixth month after the onset of stroke. MMSE ≤ 24 was considered as cognitive impairment. Univariate and multivariate logistic regression was used to screen for independent risk factors which correlate with cognitive impairment on the development dataset. A nomogram was built based on Akaike Information Criterion (AIC). Receiver operating characteristic (ROC) curve and calibration curve on development and validation dataset was drawn with each area under the curves (AUC) calculated. The decision curve analysis was also conducted with the development dataset.The bleeding volume, Glasgow Coma Scale (GCS), and intraventricular hemorrhage (IVH) are the most significant risk factors which may cause cognitive impairment both in the univariate and multivariate analysis. The finial model performed good discrimination ability on both development and validation dataset with AUC 0.911 and 0.919. Most patients would benefit from the model according to the decision curve analysis.A nomogram, constructed based on bleeding volume, GCS, and IVH can provide a feasible tool to evaluate cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.
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Affiliation(s)
| | - Lizheng Zhao
- Department of Rehabilitation, The first Affiliated Hospital of Xia’men University, Xia’men, Fujian, China
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Dinc N, Won SY, Brawanski N, Eibach M, Quick-Weller J, Konczalla J, Berkefeld J, Seifert V, Marquardt G. Differences in bleeding patterns and outcome after intracerebral hemorrhage due to vascular malformations. PLoS One 2019; 14:e0217017. [PMID: 31120937 PMCID: PMC6532871 DOI: 10.1371/journal.pone.0217017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Atypical intracerebral hemorrhage is a common form of primary manifestation of vascular malformations. OBJECTIVE The aim of the present study is to determine clues to the cause of bleeding according to hemorrhage pattern (lobar, basal ganglia, infratentorial). METHODS We retrospectively evaluated 343 consecutive neurosurgical patients with intracerebral hemorrhage (ICH), who were admitted to our neurosurgical department between 2006 and 2016. The study cohort includes only neurosurgical patients. Patients who underwent treatment by neurologists are not represented in this study. We assessed location of hemorrhage, hematoma volumes to rule out differences and predicitve variables for final outcome. RESULTS In 171 cases (49.9%) vascular malformations, such as arteriovenous malformations (AVMs), cavernomas, dural fistulas and aneurysms were the cause of bleeding. 172 (50.1%) patients suffered from an intracerebral hemorrhage due to amyloid angiopathy or long standing hypertension. In patients with infratentorial hemorrhage a malformation was more frequently detected as in patients with supratentorial hemorrhage (36% vs. 16%, OR 2.9 [1.8;4.9], p<0.001). Among the malformations AVMs were most common (81%). Hematoma expansion was smaller in vascular malformation than non-malformation caused bleeding (24.1 cm3 vs. 64.8 cm3, OR 0.5 [0.4;0.7], p < 0.001,). In 6 (2.1%) cases diagnosis remained unclear. Final outcome was more favorable in patients with vascular malformations (63% vs. 12%, OR 12.8 [4.5;36.2], p<0.001). CONCLUSION Localization and bleeding patterns are predictive factors for origin of the hemorrhage. These predictive factors should quickly lead to appropriate vascular diagnostic measures. However, due to the inclusion criteria the validity of the study is limited and multicentre studies with further testing in general ICH patients are required.
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Affiliation(s)
- Nazife Dinc
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
- * E-mail:
| | - Sae-Yeon Won
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Nina Brawanski
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Michael Eibach
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | | | - Jürgen Konczalla
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Joachim Berkefeld
- Department of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
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25
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Baihui Point Laser Acupuncture Ameliorates Cognitive Impairment, Motor Deficit, and Neuronal Loss Partly via Antioxidant and Anti-Inflammatory Effects in an Animal Model of Focal Ischemic Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:1204709. [PMID: 30915140 PMCID: PMC6409074 DOI: 10.1155/2019/1204709] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 01/06/2023]
Abstract
Stroke is recognized as one of the most dangerous killer diseases in Thailand and other countries worldwide. The development of a novel strategy for treating stroke patients is therefore urgently required. The present study investigated the effect of laser acupuncture at the Baihui point on cognitive and functional recovery, neuronal loss, antioxidant enzyme activities, and interleukin-6 (IL-6) activity in the hippocampus in an animal model of focal ischemic stroke. Male Wistar rats were randomly divided into 4 groups: sham operation; permanent occlusion of the right middle cerebral artery (Rt.MCAO); Rt.MCAO with sham laser acupuncture; and Rt.MCAO with Baihui point laser acupuncture. Laser acupuncture at the Baihui point and sham acupuncture at a nonacupoint were performed once daily (10 min at each point) for 14 days after Rt.MCAO. Half of the rats in each group were examined to determine neuron density by Cresyl violet staining, while the other half were examined by biochemical assays to measure glutathione peroxidase (GSH-Px) in the hippocampus, superoxide dismutase (SOD) in mitochondria and interleukin-6 (IL-6) activity in the hippocampus. Laser acupuncture treatment was found to significantly enhance memory and neuron density in CA1 and CA3. Improved neurological score, improved GSH-Px and SOD activities, and decreased density ratio of IL-6 to β-actin were also observed in the hippocampus. In conclusion, Baihui point laser acupuncture alleviates cognitive impairment and motor deficits via antioxidant and anti-inflammatory effects in focal ischemic rats. Further study is warranted to investigate other possible mechanisms of action.
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Pinho J, Costa AS, Araújo JM, Amorim JM, Ferreira C. Intracerebral hemorrhage outcome: A comprehensive update. J Neurol Sci 2019; 398:54-66. [PMID: 30682522 DOI: 10.1016/j.jns.2019.01.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/22/2018] [Accepted: 01/11/2019] [Indexed: 12/15/2022]
Abstract
Non-traumatic intracerebral hemorrhage (ICH) is associated with a significant global burden of disease, and despite being proportionally less frequent than ischemic stroke, in 2010 it was associated with greater worldwide disability-adjusted life years lost. The focus of outcome assessment after ICH has been mortality in most studies, because of the high early case fatality which reaches 40% in some population-based studies. The most robust and consistent predictors of early mortality include age, severity of neurological impairment, hemorrhage volume and antithrombotic therapy at the time of the event. Long-term outcome assessment is multifaceted and includes not only mortality and functional outcome, but also patient self-assessment of the health-related quality of life, occurrence of cognitive impairment, psychiatric disorders, epileptic seizures, recurrent ICH and subsequent thromboembolic events. Several scores which predict mortality and functional outcome after ICH have been validated and are useful in the daily clinical practice, however they must be used in combination with the clinical judgment for individualized patients. Management of patients with ICH both in the acute and chronic phases, requires health care professionals to have a comprehensive and updated perspective on outcome, which informs decisions that are needed to be taken together with the patient and next of kin.
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Affiliation(s)
- João Pinho
- Neurology Department, Hospital de Braga, Portugal.
| | - Ana Sofia Costa
- Department of Neurology, RWTH Aachen University Hospital, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
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Liu Z, Li R, Jiang C, Zhao S, Li W, Tang X. The neuroprotective effect of lithium chloride on cognitive impairment through glycogen synthase kinase-3β inhibition in intracerebral hemorrhage rats. Eur J Pharmacol 2018; 840:50-59. [DOI: 10.1016/j.ejphar.2018.10.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/24/2022]
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Yang JH, Lee HD, Kwak SY, Byun KH, Park SH, Yang D. Mechanism of cognitive impairment in chronic patients with putaminal hemorrhage: A diffusion tensor tractography. Medicine (Baltimore) 2018; 97:e11035. [PMID: 30024496 PMCID: PMC6086472 DOI: 10.1097/md.0000000000011035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
It is not clear whether the fornix and cingulum are involved in cognition after putaminal hemorrhage (PH). We investigated structural changes and differences of the neural tracts, and the relationship between the integrity of the neural tracts and cognition not only at the affected but also at the unaffected side.Sixteen patients with left chronic putaminal hemorrhage and 20 healthy volunteers were enrolled. Using diffusion tensor tractography (DTT), we compared fiber number (FN), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of the neural tracts between patient and control groups. The relationship between the neural tract parameters and neuropsychological results was also analyzed.The left fornix FN was significantly lower than the right fornix FN in the patient group. Except for the cingulum FA, the neural tracts parameters for both the affected and unaffected hemispheres differed significantly between the groups. The fornix FA and ADC at the affected side were significantly correlated with intelligence quotient (IQ), mini-mental status examination (MMSE), and short-term memory. Interestingly, the fornix ADC at the unaffected side was significantly correlated with MMSE. However, none of the cingulum parameters was correlated with neuropsychological results.The fornix integrity is critical for cognitive impairment after putaminal hemorrhage.
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Affiliation(s)
- Jeong-Hee Yang
- Division of Brain Fusion Research, Biomedical Research Center, Ulsan University Hospital
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu
| | - So Young Kwak
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu
| | - Ki Hyun Byun
- Department of Physical Medicine and Rehabilitation, University of Ulsan College of Medicine
| | - Sung Ho Park
- Department of Neurosurgery, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Dongseok Yang
- Department of Physical Medicine and Rehabilitation, University of Ulsan College of Medicine
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Lang B, Kindy MS, Kozel FA, Schultz SK, Taheri S. Multi-Parametric Classification of Vascular Cognitive Impairment and Dementia: The Impact of Diverse Cerebrovascular Injury Biomarkers. J Alzheimers Dis 2018; 62:39-60. [DOI: 10.3233/jad-170733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Brittany Lang
- Clinical Psychology Program, University of South Florida, Tampa, FL, USA
| | - Mark S. Kindy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida Tampa, FL, USA
- James A. Haley VA Medical Center, Tampa, FL, USA
| | - F. Andrew Kozel
- James A. Haley VA Medical Center, Tampa, FL, USA
- Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Susan K. Schultz
- James A. Haley VA Medical Center, Tampa, FL, USA
- Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Saeid Taheri
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida Tampa, FL, USA
- Byrd Alzheimer’s Institute, Tampa, FL, USA
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Planton M, Raposo N, Albucher JF, Pariente J. Cerebral amyloid angiopathy-related cognitive impairment: The search for a specific neuropsychological pattern. Rev Neurol (Paris) 2017; 173:562-565. [DOI: 10.1016/j.neurol.2017.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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Planton M, Raposo N, Danet L, Albucher JF, Péran P, Pariente J. Impact of spontaneous intracerebral hemorrhage on cognitive functioning: An update. Rev Neurol (Paris) 2017; 173:481-489. [PMID: 28838790 DOI: 10.1016/j.neurol.2017.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/26/2017] [Accepted: 06/16/2017] [Indexed: 12/22/2022]
Abstract
Intracerebral hemorrhage (ICH) accounts for 15% of all strokes and approximately 50% of stroke-related mortality and disability worldwide. Patients who have experienced ICH are at high risk of negative outcome, including stroke and cognitive disorders. Vascular cognitive impairment are frequently seen after brain hemorrhage, yet little is known about them, as most studies have focused on neuropsychological outcome in ischemic stroke survivors, using well-documented acute and chronic cognitive scores. However, recent evidence supports the notion that ICH and dementia are closely related and each increases the risk of the other. The location of the lesion also plays a significant role as regards the neuropsychological profile, while the pathophysiology of ICH can indicate a specific pattern of dysfunction. Several cognitive domains may be affected, such as language, memory, executive function, processing speed and gnosis.
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Affiliation(s)
- M Planton
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France.
| | - N Raposo
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - L Danet
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - J-F Albucher
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - P Péran
- Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - J Pariente
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
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