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Silva AR, Santos I, Fernandes C, Silva C, Pereira D, Galego O, Queiroz H, Almeida MDR, Baldeiras I, Santo G. The relevance of the socio-emotional deficits in cerebral small vessels disease (CSVD): An exploratory study with sporadic CSVD and CADASIL patients. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100186. [PMID: 38162294 PMCID: PMC10757198 DOI: 10.1016/j.cccb.2023.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/03/2023] [Accepted: 09/25/2023] [Indexed: 01/03/2024]
Abstract
Background Cerebral Small Vessels Disease (CSVD) is categorized in different forms, the most common being the sporadic form and a genetic variant - Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Amongst the most frequent clinical manifestations are the neuropsychological changes of cognitive, behavioral, and emotional nature, whose features are still under debate. Objective This exploratory study aimed to compare the neuropsychological profile of a sporadic CSVD sample and a CADASIL sample with an age, education, and gender matched control group, between the ages of 30-65 YO (total sample mean age=51.16; SD=4.31). Methods 20 patients with sporadic CSVD, 20 patients with CADASIL and 20 matched controls completed a neuropsychological assessment battery. Global cognitive state, processing speed, working memory, attention, executive dysfunction, episodic memory, social cognition, impulsivity, apathy, alexithymia, depression, and anxiety were measured. White matter hyperintensities (WMH) volume were quantified and measured as lesion burden. Results The cognitive differences found between the clinical groups combined (after confirming no differences between the two clinical groups) and matched controls were restricted to speed processing scores (d = 0.32 95 % CI [.12-.47]). The socio-emotional and behavioral profile revealed significantly higher levels of depression (d = 0.21, 95 % CI [.16-.33]). and anxiety (d = 0.25 95 % CI [.19-.32]) in CADASIL and sporadic CSVD groups, and the same for the alexithymia score (d = 0.533 95 % CI [.32-.65]) were the clinical groups revealed impoverished emotional processing compared to controls. WMH only significantly correlated with the cognitive changes and age. Conclusions In our study, CADASIL and sporadic cSVD patients combined, present multiple emotional-behavioral symptoms - alexithymia, anxiety, depression, and in a lower extent apathy and impulsivity - suggesting for the presence of emotion dysregulation behaviors, present independently of age and of the presence of cognitive deficits. Despite of the small sample size that could underpower some findings, this exploratory research supported that these symptoms may have a significant impact in disease monitoring, progression, and prognosis, requiring further investigation regarding their neurophysiological substrates.
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Affiliation(s)
- Ana Rita Silva
- CINEICC – Center for Research in Neuropsychology and Cognitive Behavioral Interventions of the University of Coimbra, Colegio Novo Street, N/A, Coimbra 3000-115, Portugal
| | - Irina Santos
- Neurology Department, Academic and Clinical Centre – Coimbra University Hospitals, Coimbra, Portugal
| | - Carolina Fernandes
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, CNC-CIBB, Coimbra, Portugal
| | - Cristiana Silva
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, CNC-CIBB, Coimbra, Portugal
| | - Daniela Pereira
- Neurorradiology Functional Unit, Coimbra University Hospitals, Coimbra, Portugal
| | - Orlando Galego
- Neurorradiology Functional Unit, Coimbra University Hospitals, Coimbra, Portugal
| | - Henrique Queiroz
- Neurorradiology Functional Unit, Coimbra University Hospitals, Coimbra, Portugal
| | | | - Inês Baldeiras
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Gustavo Santo
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, CNC-CIBB, Coimbra, Portugal
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2
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He X, Dou W, Shi H. The Diagnostic Value of the Combined 3D Pseudo-Continuous Arterial Spin Labeling and Diffusion Kurtosis Imaging in Patients With Binswanger’s Disease. Front Neurosci 2022; 16:853422. [PMID: 35844226 PMCID: PMC9280636 DOI: 10.3389/fnins.2022.853422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose The clinical diagnosis of Binswanger’s disease (BD), a chronic progressive form of subcortical vascular dementia, remains challenging. 3D pseudo-continuous arterial-spin-labeling (pcASL) and diffusion kurtosis imaging (DKI) can quantitatively reveal the microcirculation changes and heterogeneity of white matter (WM), respectively. We thus aimed to determine the diagnostic value of the combined 3D-pcASL and DKI in BD. Materials and Methods A total of 35 patients with BD and 33 healthy controls underwent 3D-ASL and DKI experiments. The perfusion parameter of cerebral blood flow (CBF), diffusion parameters of fractional anisotropy (FA), mean/axial/radial diffusivity (MD/Da/Dr), and kurtosis parameters of anisotropy fraction of kurtosis (FAk) and mean/axial/radial kurtosis MK/Ka/Kr were obtained to quantitatively measure the parametric distributions of functional brain subregions. One-way analysis of variance and post hoc t-test were applied to explore the different distributions of DKI/ASL-derived parameters among brain subregions of BD. In addition, all region-specific DKI/ASL parameters were separately analyzed in Pearson correlation analysis to investigate the relationship with Mini-Mental State Examination (MMSE), a typical clinical scale for cognitive function assessment in patients with BD. Results FA/FAk/MK/Ka/Kr was significantly declined in all WM hyperintensities (WMHs) of BD compared with healthy controls, while the corresponding MD/Da/Dr was significantly increased (all p < 0.005). In addition, significant changes, similar to the WMHs of patients with BD, were also observed in almost all DKI parameters in WM normal areas and genu/splenium of the corpus callosum (GCC/SCC) in BD (p < 0.005). Finally, CBF was significantly reduced in all of the above regions we measured in patients with BD (p < 0.005). For patients with BD, MMSE showed a negative correlation with MD/Da in thalamus (r = −0.42/−0.58; p < 0.05), and a positive correlation with CBF in PWM/TWM (r = 0.49/0.39; p < 0.05). Using receiver operating characteristic (ROC) analysis, FA/FAk/Kr in GCC, CBF/FA/Dr/FAk in SCC, MD/Da/Ka in thalamus, and the combined FA/MD/Dr/CBF in TWM showed high accuracy [area under the curves (AUCs) 0.957/0.946/0.942/0.986] in distinguishing patients with BD from healthy controls. Conclusion We found that combined DKI and 3D-ASL are helpful in diagnosing patients with BD, especially with FA, MD, Dr, and CBF in the temporal WM region. Additionally, the kurtosis parameters of DKI can sensitively monitor the potentially damaged WM areas in patients with BD patients, adding complementary clinical value.
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Affiliation(s)
- Xiaoyi He
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Radiology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | | | - Hao Shi
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- *Correspondence: Hao Shi,
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3
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Gliovascular Mechanisms and White Matter Injury in Vascular Cognitive Impairment and Dementia. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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4
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Tang X, Jiang L, Luo Y, Fan H, Song L, Liu P, Chen Y. Leukoaraiosis and acute ischemic stroke. Eur J Neurosci 2021; 54:6202-6213. [PMID: 34331366 DOI: 10.1111/ejn.15406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
Ischaemic stroke is characterized by high morbidity, high disability rate, high mortality and high recurrence rate, which can have a grave impact on the quality of life of the patients and consequently becomes an economic burden on their families and society. With the developments in imaging technology in recent years, patients with acute cerebral infarction are predominantly more likely to be diagnosed with leukoaraiosis (LA). LA is a common degenerative disease of the nervous system, which is related to cognitive decline, depression, abnormal gait, ischaemic stroke and atherosclerosis. The aetiology of LA is not clear and there is no gold standard for imaging assessment. Related studies have shown that LA has an adverse effect on the prognosis of cerebral infarction, but some experts have contrary beliefs. Hence, we undertook the present review of the literature on the mechanism and the effect of LA on the prognosis of patients with acute ischaemic stroke.
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Affiliation(s)
- Xiaojia Tang
- Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou City, China
| | - Li Jiang
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou City, China
| | - Yuhan Luo
- Health Management Center, People's Hospital of Deyang City, Deyang City, China
| | - Hongyang Fan
- Department of Neurology, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang City, China
| | - Lilong Song
- Department of Neurology, Shanghai Fourth People's Hospital, Shanghai City, China
| | - Peipei Liu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou City, China
| | - Yingzhu Chen
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou City, China
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5
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Caprihan A, Raja R, Hillmer LJ, Erhardt EB, Prestopnik J, Thompson J, Adair JC, Knoefel JE, Rosenberg GA. A double-dichotomy clustering of dual pathology dementia patients. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100011. [PMID: 34746872 PMCID: PMC8570532 DOI: 10.1016/j.cccb.2021.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Subcortical ischemic vascular disease (SIVD) and Alzheimer's disease (AD) related dementia can coexist in older subjects, leading to mixed dementia (MX). Identification of dementia sub-groups is important for designing proper treatment plans and clinical trials. METHOD An Alzheimer's disease severity (ADS) score and a vascular disease severity (VDS) score are calculated from CSF and MRI biomarkers, respectively. These scores, being sensitive to different Alzheimer's and vascular disease processes are combined orthogonally in a double-dichotomy plot. This formed an objective basis for clustering the subjects into four groups, consisting of AD, SIVD, MX and leukoaraiosis (LA). The relationship of these four groups is examined with respect to cognitive assessments and clinical diagnosis. RESULTS Cluster analysis had at least 83% agreement with the clinical diagnosis for groups based either on Alzheimer's or on vascular sensitive biomarkers, and a combined agreement of 68.8% for clustering the four groups. The VDS score was correlated to executive function (r = -0.28, p < 0.01) and the ADS score to memory function (r = -0.35, p < 0.002) after adjusting for age, sex, and education. In the subset of patients for which the cluster scores and clinical diagnoses agreed, the correlations were stronger (VDS score-executive function: r = -0.37, p < 0.006 and ADS score-memory function: r = -0.58, p < 0.0001). CONCLUSIONS The double-dichotomy clustering based on imaging and fluid biomarkers offers an unbiased method for identifying mixed dementia patients and selecting better defined sub-groups. Differential correlations with neuropsychological tests support the hypothesis that the categories of dementia represent different etiologies.
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Affiliation(s)
| | - Rajikha Raja
- The Mind Research Network, Albuquerque, NM, United States
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Laura J. Hillmer
- Department of Neurology, University of New Mexico, Albuquerque, NM, United States
| | - Erik Barry Erhardt
- Departments of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, United States
| | - Jill Prestopnik
- Department of Neurology, University of New Mexico, Albuquerque, NM, United States
| | - Jeffrey Thompson
- Department of Neurology, University of New Mexico, Albuquerque, NM, United States
| | - John C Adair
- Department of Neurology, University of New Mexico, Albuquerque, NM, United States
| | - Janice E. Knoefel
- Department of Neurology, University of New Mexico, Albuquerque, NM, United States
| | - Gary A. Rosenberg
- Department of Neurology, University of New Mexico, Albuquerque, NM, United States
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6
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Mdawar B, Abi Faraj C, Khani M, Shamseddeen W. Episode of mixed mood with psychotic features secondary to Binswanger disease: a case report with a literature review. BMJ Case Rep 2021; 14:14/3/e238957. [PMID: 33664028 PMCID: PMC7934766 DOI: 10.1136/bcr-2020-238957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Neurodegenerative and mood disorders in the geriatric population might exhibit interchangeable cognitive and behavioural symptoms. This overlap in presentation might raise a diagnostic challenge for psychiatrists evaluating elderly patients who are presenting with such symptoms. Additionally, there is limited data published about early psychiatric manifestations of neurodegenerative disorders in the elderly. We report a case of a 71-year-old with a history of refractory depressive disorder and multiple cardiovascular risk factors presenting with verbalisation of suicidal and homicidal intent as well as mixed mood and psychotic symptoms. The patient was diagnosed with Binswanger's disease (BD). We also provide a literature review of challenging early psychiatric presentations of neurocognitive disorders and a summary of similar cases to help facilitate diagnosis of BD cases in future.
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Affiliation(s)
- Bernadette Mdawar
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Munir Khani
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wael Shamseddeen
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
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7
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Helman G, Viaene AN, Takanohashi A, Breur M, Berger R, Woidill S, Cottrell JR, Schiffmann R, Crow YJ, Simons C, Bugiani M, Vanderver A. Cerebral Microangiopathy in Leukoencephalopathy With Cerebral Calcifications and Cysts: A Pathological Description. J Child Neurol 2021; 36:133-140. [PMID: 32988269 DOI: 10.1177/0883073820958330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Leukoencephalopathy with calcifications and cysts (LCC) is a neurological syndrome recently associated with pathogenic variants in SNORD118. We report autopsy neuropathological findings from an individual with genetically confirmed LCC. Histologic studies included staining of formalin-fixed paraffin-embedded tissue sections by hematoxylin and eosin, elastic van Gieson, and luxol fast blue. Immunohistochemistry stains against glial fibrillary acidic protein, proteolipid protein, phosphorylated neurofilament, CD31, alpha-interferon, LN3, and inflammatory markers were performed. Gross examination revealed dark tan/gray appearing white matter with widespread calcifications. Microscopy revealed a diffuse destructive process due to a vasculopathy with secondary ischemic lesions and mineralization. The vasculopathy involved clustered small vessels, resembling vascular malformations, and sporadic lymphocytic infiltration of vessel walls. The white matter was also diffusely abnormal, with concurrent loss of myelin and axons, tissue rarefaction with multifocal cystic degeneration, and the presence of foamy macrophages, secondary calcifications, and astrogliosis. The midbrain, pons, and cerebellum were diffusely involved. It is not understood why variants in SNORD118 result in a disorder that predominantly causes neurological disease and significantly disrupts the cerebral vasculature. Clinical and radiological benefit was recently reported in an LCC patient treated with Bevacizumab; it is important that these patients are rapidly diagnosed and trial of this treatment modality is considered in appropriate circumstances.
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Affiliation(s)
- Guy Helman
- 34361Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Melbourne, Australia.,Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Angela N Viaene
- Department of Pathology and Laboratory Medicine, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Asako Takanohashi
- Division of Neurology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marjolein Breur
- Department of Pediatrics/Child Neurology, 1209VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands.,Department of Pathology, 1209VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Rebecca Berger
- Department of Pathology and Laboratory Medicine, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah Woidill
- Division of Neurology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John R Cottrell
- University of Maryland Brain and Tissue Bank, College Park, MD, USA
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Yanick J Crow
- Centre for Genomics and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Laboratory of Neurogenetics and Neuroinflammation, Paris Descartes University, Institut Imagine, Paris, France
| | - Cas Simons
- 34361Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Melbourne, Australia.,Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Marianna Bugiani
- Department of Pediatrics/Child Neurology, 1209VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands.,Department of Pathology, 1209VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Adeline Vanderver
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Neurology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
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8
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Văcăraș V, Cordoș AM, Rahovan I, Frunze S, Mureșanu DF. Binswanger's disease: Case presentation and differential diagnosis. Clin Case Rep 2020; 8:3450-3457. [PMID: 33363950 PMCID: PMC7752439 DOI: 10.1002/ccr3.3459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/22/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022] Open
Abstract
Establishing a diagnosis of Binswanger's disease requires a multimodal approach. As new pathophysiological mechanisms are revealed, tests that should yield greater specificity will become available in the years to come.
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Affiliation(s)
- Vitalie Văcăraș
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj‐NapocaCluj‐NapocaRomania
- Neurology DepartmentCluj‐Napoca County Emergency HospitalCluj‐NapocaRomania
| | | | - Imelda Rahovan
- Neurology DepartmentCluj‐Napoca County Emergency HospitalCluj‐NapocaRomania
| | - Sorina Frunze
- Neurology DepartmentCluj‐Napoca County Emergency HospitalCluj‐NapocaRomania
| | - Dafin Fior Mureșanu
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj‐NapocaCluj‐NapocaRomania
- Neurology DepartmentCluj‐Napoca County Emergency HospitalCluj‐NapocaRomania
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9
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Espiritu AI, Saranza GRM, Anlacan VMM, Suratos CTR, Jamora RDG. Generalized chorea associated with subcortical leukoaraiosis of Binswanger type: a case report. Neurodegener Dis Manag 2020; 10:9-13. [PMID: 32027572 DOI: 10.2217/nmt-2019-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Binswanger disease (BD) involves injuries to the brain small vessels, resulting to gradually progressive subcortical ischemia. This disorder manifests with dementia, gait abnormalities, upper motor signs and parkinsonism, and presents as extensive, confluent, bilateral cerebral white matter hyperintensities in the MRI. Cases of BD typically manifests with vascular risk factors, such as hypertension and multiple strokes. We report a unique case of a Filipino patient whom we have diagnosed with BD presenting with no cardinal signs of parkinsonism, but with generalized choreiform movement disorder and without a history of hypertension and symptomatic strokes. To our knowledge, this is the first report presenting an adult patient with subcortical leukoaraiosis of Binswanger type associated with a hyperkinetic movement disorder.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, 1000, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, 1000, Philippines
| | - Gerard Raimon M Saranza
- Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, 1000, Philippines.,Morton & Gloria Shulman Movement Disorders Clinic & Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, M5T 2S8, Canada
| | - Veeda Michelle M Anlacan
- Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, 1000, Philippines.,Center for Memory & Cognition, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, 1000, Philippines
| | - Cezar Thomas R Suratos
- Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, 1000, Philippines
| | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, 1000, Philippines
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10
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Maksimovich IV. Intracerebral Transcatheter Laser Photobiomodulation Therapy in the Treatment of Binswanger's Disease and Vascular Parkinsonism: Research and Clinical Experience. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:606-614. [PMID: 31390288 DOI: 10.1089/photob.2019.4649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: This research is devoted to intracerebral transcatheter laser photobiomodulation therapy (PBMT) in the treatment of ischemic and neurodegenerative lesions of cerebral white matter in patients with Binswanger's disease (BD) and vascular parkinsonism (VP) in comparison with conservative treatment methods. Background: Recent studies have shown PBMT high potential in the treatment of various cerebral lesions. Materials and methods: Twenty-seven patients with BD, 58-81 years of age (mean age 78), 17 (62.96%) men, and 10 (27.04%) women. Of these, test group 1-14 (51.85%) patients-underwent intracerebral transcatheter laser PBMT, and control group 1-13 (48.15%) patients-had conservative treatment. Besides, 62 patients with VP, 52-80 years of age (mean age 77), 48 (77.42%) men, and 14 (22.58%) women. Of these, test group 2-37 (59.68%) patients-underwent intracerebral transcatheter laser PBMT, and control group 2-25 (40.32%) patients-had conservative treatment. Results: Good and satisfactory clinical results were obtained in Test group 1 and Test group 2 patients in 49 (92.45%) cases, with a persistent decrease of dementia and motor impairment, and recovery of cognitive functions and daily life activity. Control group 1 and Control group 2 patients showed a satisfactory clinical result in 6 (15.79%) cases. Persistent positive dynamics was not observed. Conclusions: Intracerebral transcatheter laser PBMT is a pathogenetically justified, effective treatment for BD and VP; it restores cerebral collateral and capillary blood supply, improves microcirculation, restores cellular and tissue metabolism, stimulates neurogenesis, and causes regenerative processes in the brain.
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Affiliation(s)
- Ivan V Maksimovich
- Clinic of Cardiovascular Diseases named after Most Holy John Tobolsky, Moscow, Russia
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11
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Rosenberg GA, Prestopnik J, Knoefel J, Adair JC, Thompson J, Raja R, Caprihan A. A Multimodal Approach to Stratification of Patients with Dementia: Selection of Mixed Dementia Patients Prior to Autopsy. Brain Sci 2019; 9:E187. [PMID: 31374883 PMCID: PMC6721392 DOI: 10.3390/brainsci9080187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/21/2019] [Accepted: 07/29/2019] [Indexed: 11/22/2022] Open
Abstract
Alzheimer's disease (AD) and vascular cognitive impairment and dementia (VCID) are major causes of dementia, and when combined lead to accelerated cognitive loss. We hypothesized that biomarkers of neurodegeneration and neuroinflammation could be used to stratify patients into diagnostic groups. Diagnosis of AD can be made biologically with detection of amyloid and tau proteins in the cerebrospinal fluid (CSF) and vascular disease can be identified with diffusion tensor imaging (DTI). We recruited patients with cognitive complaints and made an initial clinical diagnosis. After one year of follow-up we made a biological diagnosis based on the use of biomarkers obtained from DTI, CSF AD, and inflammatory proteins, and neuropsychological testing. Patients with AD had primarily findings of neurodegeneration (CSF showing increased tau and reduced amyloid), while patients with neuroinflammation had abnormal DTI mean diffusion (MD) in the white matter. Using the biological biomarkers resulted in many of the clinically diagnosed AD patients moving into mixed dementia (MX). Biomarkers of inflammation tended to be higher in the MX than in either the AD or VCID, suggesting dual pathology leads to increased inflammation, which could explain accelerated cognitive decline in that group.
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Affiliation(s)
- Gary A Rosenberg
- Department of Neurology, University of New Mexico Health Sciences Center and the MIND Research Network, Albuquerque, NM 87131, USA.
| | - Jillian Prestopnik
- Department of Neurology, University of New Mexico Health Sciences Center and the MIND Research Network, Albuquerque, NM 87131, USA
| | - Janice Knoefel
- Department of Neurology, University of New Mexico Health Sciences Center and the MIND Research Network, Albuquerque, NM 87131, USA
| | - John C Adair
- Department of Neurology, University of New Mexico Health Sciences Center and the MIND Research Network, Albuquerque, NM 87131, USA
| | - Jeffrey Thompson
- Department of Neurology, University of New Mexico Health Sciences Center and the MIND Research Network, Albuquerque, NM 87131, USA
| | - Rajikha Raja
- Department of Neurology, University of New Mexico Health Sciences Center and the MIND Research Network, Albuquerque, NM 87131, USA
| | - Arvind Caprihan
- Department of Neurology, University of New Mexico Health Sciences Center and the MIND Research Network, Albuquerque, NM 87131, USA
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12
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Fu Z, Iraji A, Caprihan A, Adair JC, Sui J, Rosenberg GA, Calhoun VD. In search of multimodal brain alterations in Alzheimer's and Binswanger's disease. NEUROIMAGE-CLINICAL 2019; 26:101937. [PMID: 31351845 PMCID: PMC7229329 DOI: 10.1016/j.nicl.2019.101937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/16/2019] [Accepted: 07/14/2019] [Indexed: 11/07/2022]
Abstract
Structural and functional brain abnormalities have been widely identified in dementia, but with variable replicability and significant overlap. Alzheimer's disease (AD) and Binswanger's disease (BD) share similar symptoms and common brain changes that can confound diagnosis. In this study, we aimed to investigate correlated structural and functional brain changes in AD and BD by combining resting-state functional magnetic resonance imaging (fMRI) and diffusion MRI. A group independent component analysis was first performed on the fMRI data to extract 49 intrinsic connectivity networks (ICNs). Then we conducted a multi-set canonical correlation analysis on three features, functional network connectivity (FNC) between ICNs, fractional anisotropy (FA) and mean diffusivity (MD). Two inter-correlated components show significant group differences. The first component demonstrates distinct brain changes between AD and BD. AD shows increased cerebellar FNC but decreased thalamic and hippocampal FNC. Such FNC alterations are linked to the decreased corpus callosum FA. AD also has increased MD in the frontal and temporal cortex, but BD shows opposite alterations. The second component demonstrates specific brain changes in BD. Increased FNC is mainly between default mode and sensory regions, while decreased FNC is mainly within the default mode domain and related to auditory regions. The FNC changes are associated with FA changes in posterior/middle cingulum cortex and visual cortex and increased MD in thalamus and hippocampus. Our findings provide evidence of linked functional and structural deficits in dementia and suggest that AD and BD have both common and distinct changes in white matter integrity and functional connectivity. This is the first study to explore multi-modalities changes in different dementia. A multimodal fusion method is applied to identify joint components. Brain abnormalities in different modalities are highly correlated. Alzheimer's and Binswanger's disease share similar brain changes. Alzheimer's and Binswanger's disease also have distinct brain changes.
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Affiliation(s)
- Zening Fu
- The Mind Research Network, Albuquerque, NM, United States.
| | - Armin Iraji
- The Mind Research Network, Albuquerque, NM, United States
| | | | - John C Adair
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Jing Sui
- The Mind Research Network, Albuquerque, NM, United States; Chinese Academy of Sciences (CAS) Centre for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, China
| | - Gary A Rosenberg
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, NM, United States; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, United States
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Forsberg KME, Zhang Y, Reiners J, Ander M, Niedermayer A, Fang L, Neugebauer H, Kassubek J, Katona I, Weis J, Ludolph AC, Del Tredici K, Braak H, Yilmazer-Hanke D. Endothelial damage, vascular bagging and remodeling of the microvascular bed in human microangiopathy with deep white matter lesions. Acta Neuropathol Commun 2018; 6:128. [PMID: 30470258 PMCID: PMC6260986 DOI: 10.1186/s40478-018-0632-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022] Open
Abstract
White matter lesions (WMLs) are a common manifestation of small vessel disease (SVD) in the elderly population. They are associated with an enhanced risk of developing gait abnormalities, poor executive function, dementia, and stroke with high mortality. Hypoperfusion and the resulting endothelial damage are thought to contribute to the development of WMLs. The focus of the present study was the analysis of the microvascular bed in SVD patients with deep WMLs (DWMLs) by using double- and triple-label immunohistochemistry and immunofluorescence. Simultaneous visualization of collagen IV (COLL4)-positive membranes and the endothelial glycocalyx in thick sections allowed us to identify endothelial recession in different types of string vessels, and two new forms of small vessel/capillary pathology, which we called vascular bagging and ghost string vessels. Vascular bags were pouches and tubes that were attached to vessel walls and were formed by multiple layers of COLL4-positive membranes. Vascular bagging was most severe in the DWMLs of cases with pure SVD (no additional vascular brain injury, VBI). Quantification of vascular bagging, string vessels, and the density/size of CD68-positive cells further showed widespread pathological changes in the frontoparietal and/or temporal white matter in SVD, including pure SVD and SVD with VBI, as well as a significant effect of the covariate age. Plasma protein leakage into vascular bags and the white matter parenchyma pointed to endothelial damage and basement membrane permeability. Hypertrophic IBA1-positive microglial cells and CD68-positive macrophages were found in white matter areas covered with networks of ghost vessels in SVD, suggesting phagocytosis of remnants of string vessels. However, the overall vessel density was not altered in our SVD cohort, which might result from continuous replacement of vessels. Our findings support the view that SVD is a progressive and generalized disease process, in which endothelial damage and vascular bagging drive remodeling of the microvasculature.
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Raz L, Bhaskar K, Weaver J, Marini S, Zhang Q, Thompson JF, Espinoza C, Iqbal S, Maphis NM, Weston L, Sillerud LO, Caprihan A, Pesko JC, Erhardt EB, Rosenberg GA. Hypoxia promotes tau hyperphosphorylation with associated neuropathology in vascular dysfunction. Neurobiol Dis 2018; 126:124-136. [PMID: 30010004 DOI: 10.1016/j.nbd.2018.07.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/11/2018] [Accepted: 07/10/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hypertension-induced microvascular brain injury is a major vascular contributor to cognitive impairment and dementia. We hypothesized that chronic hypoxia promotes the hyperphosphorylation of tau and cell death in an accelerated spontaneously hypertensive stroke prone rat model of vascular cognitive impairment. METHODS Hypertensive male rats (n = 13) were fed a high salt, low protein Japanese permissive diet and were compared to Wistar Kyoto control rats (n = 5). RESULTS Using electron paramagnetic resonance oximetry to measure in vivo tissue oxygen levels and magnetic resonance imaging to assess structural brain damage, we found compromised gray (dorsolateral cortex: p = .018) and white matter (corpus callosum: p = .016; external capsule: p = .049) structural integrity, reduced cerebral blood flow (dorsolateral cortex: p = .005; hippocampus: p < .001; corpus callosum: p = .001; external capsule: p < .001) and a significant drop in cortical oxygen levels (p < .05). Consistently, we found reduced oxygen carrying neuronal neuroglobin (p = .008), suggestive of chronic cerebral hypoperfusion in high salt-fed rats. We also observed a corresponding increase in free radicals (NADPH oxidase: p = .013), p-Tau (pThr231) in dorsolateral cortex (p = .011) and hippocampus (p = .003), active interleukin-1β (p < .001) and neurodegeneration (dorsolateral cortex: p = .043, hippocampus: p = .044). Human patients with subcortical ischemic vascular disease, a type of vascular dementia (n = 38; mean age = 68; male/female ratio = 23/15) showed reduced hippocampal volumes and cortical shrinking (p < .05) consistent with the neuronal cell death observed in our hypertensive rat model as compared to healthy controls (n = 47; mean age = 63; male/female ratio = 18/29). CONCLUSIONS Our data support an association between hypertension-induced vascular dysfunction and the sporadic occurrence of phosphorylated tau and cell death in the rat model, correlating with patient brain atrophy, which is relevant to vascular disease.
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Affiliation(s)
- Limor Raz
- Department of Neurology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - Kiran Bhaskar
- Department of Neurology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States; Department of Molecular Genetics and Microbiology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - John Weaver
- BRaIN Imaging Center, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - Sandro Marini
- Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States.
| | - Quanguang Zhang
- Department of Neuroscience and Regenerative Medicine, Department of Neurology, Augusta University, 1120 15th Street, Augusta, GA 30912, United States.
| | - Jeffery F Thompson
- Department of Neurology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - Candice Espinoza
- Department of Neurology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - Sulaiman Iqbal
- Department of Neurology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - Nicole M Maphis
- Department of Molecular Genetics and Microbiology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - Lea Weston
- Department of Molecular Genetics and Microbiology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - Laurel O Sillerud
- Department of Neurology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States; MIND Research Network, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - Arvind Caprihan
- MIND Research Network, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - John C Pesko
- Department of Mathematics and Statistics, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States
| | - Erik B Erhardt
- Department of Mathematics and Statistics, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
| | - Gary A Rosenberg
- Department of Neurology, 1 University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
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Rosenberg GA. Binswanger's disease: biomarkers in the inflammatory form of vascular cognitive impairment and dementia. J Neurochem 2018; 144:634-643. [PMID: 28902409 PMCID: PMC5849485 DOI: 10.1111/jnc.14218] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/17/2017] [Accepted: 08/30/2017] [Indexed: 12/13/2022]
Abstract
Vascular cognitive impairment and dementia (VCID) is a major public health concern because of the increased incidence of vascular disease in the aging population and the impact of vascular disease on Alzheimer's disease. VCID is a heterogeneous group of diseases for which there are no proven treatments. Biomarkers can be used to select more homogeneous populations. Small vessel disease is the most prevalent form of VCID and is the optimal form for treatment trials because there is a progressive course with characteristic pathological changes. Subcortical ischemic vascular disease of the Binswanger type (SIVD-BD) has a characteristic set of features that can be used both to identify patients and to follow treatment. SIVD-BD patients have clinical, neuropsychological, cerebrospinal fluid (CSF) and imaging features that can be used as biomarkers. No one feature is diagnostic, but a multimodal approach defines the SIVD-BD spectrum disorder. The most important features are large white matter lesions with axonal damage, blood-brain barrier disruption as shown by magnetic resonance imaging and CSF, and neuropsychological evidence of executive dysfunction. We have used these features to create a Binswanger Disease Scale and a probability of SIVD-BD, using a machine-learning algorithm. The patients discussed in this review are derived from published studies. Biomarkers not only aid in early diagnosis before the disease process has progressed too far for treatment, but also can indicate response to treatment. Refining the use of biomarkers will allow dementia treatment to enter the era of precision medicine. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Gary A Rosenberg
- Professor of Neurology, Neurosciences, and Cell Biology, UNM Memory and Aging Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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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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17
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Vakhnina NN, Zakharov VV. Disturbances of gait and postural stability in chronic cerebral ischemia. Zh Nevrol Psikhiatr Im S S Korsakova 2017. [DOI: 10.17116/jnevro20171171178-84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Huisa BN, Caprihan A, Thompson J, Prestopnik J, Qualls CR, Rosenberg GA. Long-Term Blood-Brain Barrier Permeability Changes in Binswanger Disease. Stroke 2015; 46:2413-8. [PMID: 26205374 PMCID: PMC4550546 DOI: 10.1161/strokeaha.115.009589] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/10/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE The blood-brain barrier (BBB) is disrupted in small vessel disease patients with lacunes and white matter hyperintensities (WMHs). The relationship of WMHs and regional BBB permeability changes has not been studied. We hypothesized that BBB disruption occurs in normal appearing WM and regions near the WMHs. To test the hypothesis, we repeated BBB permeability measurements in patients with extensive WMHs related to Binswanger disease. METHODS We selected a subset of 22 Binswanger disease subjects from a well-characterized larger prospective vascular cognitive impairment cohort. We used 16 age-matched controls for comparison. The abnormal WM permeability (WMP) was measured twice for several years using dynamic contrast-enhanced magnetic resonance imaging. WMP maps were constructed from voxels above a predetermined threshold. Scans from first and second visits were coregistered. WM was divided into 3 regions: normal appearing WM, WMH ring, and WMH core. The ring was defined as 2 mm on each side of the WMH border. WMP was calculated in each of the 3 specific regions. We used paired t test, ANOVA, and Fisher exact test to compare individual changes. RESULTS WMP was significantly higher in subjects than in controls (P<0.001). There was no correlation between WMH load and WMP. High permeability regions had minimal overlap between first and second scans. Nine percent of WMP was within the WMHs, 49% within the normal appearing WM, and 52% within the WMH ring (P<0.001; ANOVA). CONCLUSIONS Increased BBB permeability in normal appearing WM and close to the WMH borders supports a relationship between BBB disruption and the development of WMHs.
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Affiliation(s)
- Branko N Huisa
- From the Departments of Neurology (B.N.H., J.T., J.P., G.A.R.), Neurosciences (G.A.R.), Cell Biology and Physiology (G.A.R.), Mathematics and Statistics (G.A.R.), and Clincal Translational Science Center (C.R.Q.), University of New Mexico Health Sciences Center, Albuquerque; and MIND Research Network, Albuquerque, NM (A.C.)
| | - Arvind Caprihan
- From the Departments of Neurology (B.N.H., J.T., J.P., G.A.R.), Neurosciences (G.A.R.), Cell Biology and Physiology (G.A.R.), Mathematics and Statistics (G.A.R.), and Clincal Translational Science Center (C.R.Q.), University of New Mexico Health Sciences Center, Albuquerque; and MIND Research Network, Albuquerque, NM (A.C.)
| | - Jeffrey Thompson
- From the Departments of Neurology (B.N.H., J.T., J.P., G.A.R.), Neurosciences (G.A.R.), Cell Biology and Physiology (G.A.R.), Mathematics and Statistics (G.A.R.), and Clincal Translational Science Center (C.R.Q.), University of New Mexico Health Sciences Center, Albuquerque; and MIND Research Network, Albuquerque, NM (A.C.)
| | - Jillian Prestopnik
- From the Departments of Neurology (B.N.H., J.T., J.P., G.A.R.), Neurosciences (G.A.R.), Cell Biology and Physiology (G.A.R.), Mathematics and Statistics (G.A.R.), and Clincal Translational Science Center (C.R.Q.), University of New Mexico Health Sciences Center, Albuquerque; and MIND Research Network, Albuquerque, NM (A.C.)
| | - Clifford R Qualls
- From the Departments of Neurology (B.N.H., J.T., J.P., G.A.R.), Neurosciences (G.A.R.), Cell Biology and Physiology (G.A.R.), Mathematics and Statistics (G.A.R.), and Clincal Translational Science Center (C.R.Q.), University of New Mexico Health Sciences Center, Albuquerque; and MIND Research Network, Albuquerque, NM (A.C.)
| | - Gary A Rosenberg
- From the Departments of Neurology (B.N.H., J.T., J.P., G.A.R.), Neurosciences (G.A.R.), Cell Biology and Physiology (G.A.R.), Mathematics and Statistics (G.A.R.), and Clincal Translational Science Center (C.R.Q.), University of New Mexico Health Sciences Center, Albuquerque; and MIND Research Network, Albuquerque, NM (A.C.).
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