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Sin MK, Cheng Y, Roseman J, Zamrini E, Ahmed A. Relationship between Cerebral Microinfarcts and Dementia by Sex: Findings from a community-based Autopsy Study. INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASE AND STROKE 2024; 7:171. [PMID: 38689945 PMCID: PMC11060706 DOI: 10.29011/2688-8734.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Cerebral microinfarcts are common in older adults and are associated with cognitive impairment. Less is known about sex-related variation in the relationship between cerebral microinfarcts and dementia in older adults, the examination of which was the objective of this study. This case-control study was based on the 727 participants (419 women) in the Adult Changes in Thought (ACT) autopsy data. Microinfarcts were ascertained by blinded board-certified neuropathologists, and dementia diagnoses were made by the ACT Consensus Diagnosis Conference per DSM-IV. Multivariable logistic regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI). Microinfarcts were present in 49% (356/727) of the participants, which was numerically higher in women: 51% (213/419) vs 46% (143/308). aOR (95% CI) for dementia associated with any microinfarct for female and male participants were 1.45 (0.91-2.30) and 1.24 (0.75-2.06), respectively (p for interaction, 0.34). Respective aORs (95%CIs) associated with ≥2 microinfarcts were 1.37 (0.79-2.36) and 1.53 (0.84-2.78), with interaction p, 0.84. Subcortical microinfarcts were present in 36% (138/381) and 23% (78/346) of patients with and without dementia (aOR, 1.65; 95% CI, 1.14-2.38). Respective aOR (95% CI) in female and male participants were 1.70 (1.03-2.82) and 1.59 (0.90-2.80), (p for interaction, 0.55). There was no association with cortical microinfarcts (aOR, 1.19; 95% CI, 0.83-1.69). These findings suggest that association between microinfarcts and dementia is primarily mediated by subcortical microinfarcts, but we found no evidence of sex-related variation. Future studies with greater power are needed to determine if the associations we found are replicable.
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Affiliation(s)
- Mo-Kyung Sin
- College of Nursing, Seattle University, Seattle, USA
| | - Yan Cheng
- Biomedical Informatics Center, School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
| | - Jeffrey Roseman
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Zamrini
- Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA; Irvine Clinical Research, Irvine, CA, USA
| | - Ali Ahmed
- Veterans Affairs Medical Center, George Washington University, and School of Medicine, Georgetown University, Washington, DC, USA
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Scheffler M, Salomir R, Maturana E, Montandon ML, Kövari EV, Haller S. Identification of hippocampal cortical microinfarcts on postmortem 3-T magnetic resonance imaging. Neuroradiology 2021; 63:1569-1573. [PMID: 33909116 PMCID: PMC8376696 DOI: 10.1007/s00234-021-02717-8] [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: 02/20/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
Cortical microinfarcts (CMI) are increasingly recognized in the neurological community as a biomarker related to cognitive impairment and dementia. If their radiological depiction has been largely described in experimental settings using ultra-high-field magnetic resonance imaging (MRI), less is known about their visibility on routinely used 3-T MRI. In this radiologic-pathologic correlation study, using 3-T post-mortem MRI, we searched for hippocampal CMI, in a double-blinded fashion, and found that only 4/36, or 11%, were clearly demonstrated on both radiological and histopathological exams.
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Affiliation(s)
- Max Scheffler
- Division of Radiology, Geneva University Hospitals, Chemin du Pont-Bochet 3, 1226, Thonex, Switzerland.
| | - Rares Salomir
- Image Guided Interventions Laboratory, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.,Division of Radiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Enrique Maturana
- Division of Radiology, Geneva University Hospitals, Chemin du Pont-Bochet 3, 1226, Thonex, Switzerland
| | - Marie-Louise Montandon
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Route de Loëx 151, 1233, Bernex, Switzerland.,Department of Psychiatry, Geneva University Hospitals, Chemin du Petit Bel-Air 2, 1225, Chene-Bourg, Switzerland
| | - Enikö V Kövari
- Department of Psychiatry, Geneva University Hospitals, Chemin du Petit Bel-Air 2, 1225, Chene-Bourg, Switzerland
| | - Sven Haller
- CIMC - Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201, Geneva, Switzerland.,Radiology, Department of Surgical Sciences, Uppsala University, 75236, Sjukhusvägen, Sweden
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Abstract
Brain stimulation techniques can modulate cognitive functions in many neuropsychiatric diseases. Pilot studies have shown promising effects of brain stimulations on Alzheimer's disease (AD). Brain stimulations can be categorized into non-invasive brain stimulation (NIBS) and invasive brain stimulation (IBS). IBS includes deep brain stimulation (DBS), and invasive vagus nerve stimulation (VNS), whereas NIBS includes transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), electroconvulsive treatment (ECT), magnetic seizure therapy (MST), cranial electrostimulation (CES), and non-invasive VNS. We reviewed the cutting-edge research on these brain stimulation techniques and discussed their therapeutic effects on AD. Both IBS and NIBS may have potential to be developed as novel treatments for AD; however, mixed findings may result from different study designs, patients selection, population, or samples sizes. Therefore, the efficacy of NIBS and IBS in AD remains uncertain, and needs to be further investigated. Moreover, more standardized study designs with larger sample sizes and longitudinal follow-up are warranted for establishing a structural guide for future studies and clinical application.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Chieh-Hsin Lin
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Chronic cerebral hypoperfusion alters amyloid-β peptide pools leading to cerebral amyloid angiopathy, microinfarcts and haemorrhages in Tg-SwDI mice. Clin Sci (Lond) 2017; 131:2109-2123. [PMID: 28667120 DOI: 10.1042/cs20170962] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 02/07/2023]
Abstract
Cerebral hypoperfusion is an early feature of Alzheimer's disease (AD) that influences the progression from mild cognitive impairment to dementia. Understanding the mechanism is of critical importance in the search for new effective therapies. We hypothesized that cerebral hypoperfusion promotes the accumulation of amyloid-β (Aβ) and degenerative changes in the brain and is a potential mechanism contributing to development of dementia. To address this, we studied the effects of chronic cerebral hypoperfusion induced by bilateral carotid artery stenosis on Aβ peptide pools in a transgenic mouse model of AD (transgenic mice with Swedish, Dutch and Iowa mutations in human amyloid precursor protein (APP) (Tg-SwDI)). Cerebrovascular integrity was characterized by quantifying the occurrence of microinfarcts and haemorrhages and compared with wild-type mice without Aβ. A significant increase in soluble Aβ peptides (Aβ40/42) was detected after 1 month of hypoperfusion in the parenchyma in parallel with elevated APP and APP proteolytic products. Following 3 months, a significant increase in insoluble Aβ40/42 was determined in the parenchyma and vasculature. Microinfarct load was significantly increased in the Tg-SwDI as compared with wild-type mice and further exacerbated by hypoperfusion at 1 and 3 months. In addition, the number of Tg-SwDI hypoperfused mice with haemorrhages was increased compared with hypoperfused wild-type mice. Soluble parenchymal Aβ was associated with elevated NADPH oxidase-2 (NOX2) which was exacerbated by 1-month hypoperfusion. We suggest that in response to hypoperfusion, increased Aβ production/deposition may contribute to degenerative processes by triggering oxidative stress promoting cerebrovascular disruption and the development of microinfarcts.
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Abstract
Alois Alzheimer is best known for his description of the pre-senile
neurodegenerative disease named after him. However, his previous interest in
vascular brain diseases, underlying cognitive and behavioral changes, was very
strong. Besides describing the Arteriosclerotic atrophy of the brain and the
arteriosclerotic subtype of Senile dementia which he viewed as main forms of
vascular brain diseases, he also identified and described a series of conditions
he considered subforms. These may be divided, as suggested by the authors of the
present paper, into 3 groups: gliosis and sclerosis, subcortical atrophies, and
apoplectic. The subforms of the three groups present characteristic
neuropathological features and clinical, cognitive and behavioral
manifestations. These provide the basis, together with part of the main forms,
for the contemporary condition known as Vascular Cognitive Impairment.
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Affiliation(s)
- Eliasz Engelhardt
- Full Professor (retired), Cognitive and Behavioral Neurology Unit - Institute of Neurology / Institute of Psychiatry - Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro RJ, Brazil
| | - Lea T Grinberg
- Assistant Professor, Department of Neurology and Pathology, University of California, San Francisco, San Francisco, USA. 33Professor, PhD, Department of Pathology, School of Medicine, University of Sao Paulo, Sao Paulo SP, Brazil.,Professor, PhD, Department of Pathology, School of Medicine, University of Sao Paulo, Sao Paulo SP, Brazil
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