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Schäfer M, Browne LP, Truong U, Bjornstad P, Tell S, Snell-Bergeon J, Baumgartner A, Hunter KS, Reusch JEB, Barker AJ, Nadeau KJ, Schauer IE. Bromocriptine Improves Central Aortic Stiffness in Adolescents With Type 1 Diabetes: Arterial Health Results From the BCQR-T1D Study. Hypertension 2023; 80:482-491. [PMID: 36472197 PMCID: PMC9852005 DOI: 10.1161/hypertensionaha.122.19547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The presence of vascular dysfunction is a well-recognized feature in youth with type 1 diabetes (T1D), accentuating their lifetime risk of cardiovascular events. Therapeutic strategies to mitigate vascular dysfunction are a high clinical priority. In the bromocriptine quick release T1D study (BCQR-T1D), we tested the hypothesis that BCQR would improve vascular health in youth with T1D. METHODS BCQR-T1D was a placebo-controlled, random-order, double-blinded, cross-over study investigating the cardiovascular and metabolic impact of BCQR in T1D. Adolescents in the BCQR-T1D study were randomized 1:1 to phase-1: 4 weeks of BCQR or placebo after which blood pressure and central aortic stiffness measurements by pulse wave velocity, relative area change, and distensibility from phase-contrast magnetic resonance imaging were performed. Following a 4-week washout period, phase 2 was performed in identical fashion with the alternate treatment. RESULTS Thirty-four adolescents (mean age 15.9±2.6 years, hemoglobin A1c 8.6±1.1%, body mass index percentile 71.4±26.1, median T1D duration 5.8 years) with T1D were enrolled and had magnetic resonance imaging data available. Compared with placebo, BCQR therapy decreased systolic (∆=-5 mmHg [95% CI, -3 to -7]; P<0.001) and diastolic blood pressure (∆=-2 mmHg [95% CI, -4 to 0]; P=0.039). BCQR reduced ascending aortic pulse wave velocity (∆=-0.4 m/s; P=0.018) and increased relative area change (∆=-2.6%, P=0.083) and distensibility (∆=0.08%/mmHg; P=0.017). In the thoraco-abdominal aorta, BCQR decreased pulse wave velocity (∆=-0.2 m/s; P=0.007) and increased distensibility (∆=0.05 %/mmHg; P=0.013). CONCLUSIONS BCQR improved blood pressure and central and peripheral aortic stiffness and pressure hemodynamics in adolescents with T1D over 4 weeks versus placebo. BCQR may improve aortic stiffness in youth with T1D, supporting future longer-term studies.
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Affiliation(s)
- Michal Schäfer
- Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado – School of Medicine, Aurora, CO
| | - Lorna P. Browne
- Department of Radiology, University of Colorado – School of Medicine, Aurora, CO
| | - Uyen Truong
- Department of Cardiology, Children’s Hospital of Richmond at Virginia Commonwealth University
| | - Petter Bjornstad
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado – School of Medicine, Aurora, CO
| | - Shoshana Tell
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado – School of Medicine, Aurora, CO
| | - Janet Snell-Bergeon
- Barbara Davis Center, Department of Medicine, University of Colorado – School of Medicine, Aurora, CO
| | - Amy Baumgartner
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado – School of Medicine, Aurora, CO
| | - Kendall S. Hunter
- Department of Bioengineering, University of Colorado Denver | Anschutz Medical Campus, CO
| | - Jane E. B. Reusch
- Section of Endocrinology, Rocky Mountain Regional VAMC, Aurora, CO
- Division of Endocrinology, Department of Medicine, University of Colorado – School of Medicine, Aurora, CO
- Center for Women’s Health Research, University of Colorado – School of Medicine, Aurora, CO
| | - Alex J. Barker
- Department of Radiology, University of Colorado – School of Medicine, Aurora, CO
- Department of Bioengineering, University of Colorado Denver | Anschutz Medical Campus, CO
| | - Kristen J. Nadeau
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado – School of Medicine, Aurora, CO
| | - Irene E. Schauer
- Section of Endocrinology, Rocky Mountain Regional VAMC, Aurora, CO
- Division of Endocrinology, Department of Medicine, University of Colorado – School of Medicine, Aurora, CO
- Center for Women’s Health Research, University of Colorado – School of Medicine, Aurora, CO
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Shang X, Hill E, Liu J, Zhu Z, Ge Z, Wang W, He M. Association of type 1 diabetes and age at diagnosis of type 2 diabetes with brain volume and risk of dementia in the UK Biobank: A prospective cohort study of community-dwelling participants. Diabet Med 2023; 40:e14966. [PMID: 36177651 DOI: 10.1111/dme.14966] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/28/2022] [Accepted: 09/25/2022] [Indexed: 01/17/2023]
Abstract
AIMS To investigate the association of type 1 diabetes (T1D) and age at diagnosis of type 2 diabetes (T2D) with brain structure and incident dementia. METHODS Our analysis was based on the UK Biobank. We included 1376 participants with diabetes and 2752 randomly selected controls for brain volume analysis, and 25,141 participants with diabetes and 50,282 randomly selected controls for dementia analysis. Brain volume was measured using magnetic resonance imaging. Dementia was identified using hospital inpatient records and mortality register data until January 2021. RESULTS T2D diagnosed at a younger age was associated with larger reductions in brain volume. After adjustment for glycated haemoglobin (HbA1c) and other covariates, only T2D diagnosed <50 years was associated with smaller total brain volume (β (95% CI): -14.56 (-24.67, -4.44) ml), and grey (-6.47[-12.75, -0.20] ml) and white matter volumes (-8.08[-14.66, -1.51] ml). Corresponding numbers for total brain, grey matter and white matter volumes associated with T1D were -62.86 (-93.71,-32.01), -34.27 (-53.72, -14.83), and -28.59 (-47.65, -9.52) ml, respectively. During a median follow-up of 11.9 years, 2035 new dementia cases were identified. Younger age at diagnosis of T2D was associated with larger excessive risk of dementia, whereas T2D diagnosed <50 years was associated with the largest hazard ratio (HR) (95% CI: 2.03[1.53-2.69]) in the multivariable analysis. The HR (95% CI) for dementia associated with T1D was 2.08 (1.40-3.09). CONCLUSION Individuals with T1D or T2D diagnosed at younger age are at larger excessive risk of brain volume reduction and dementia.
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Affiliation(s)
- Xianwen Shang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Eye Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangzhou, China
| | - Edward Hill
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Jiahao Liu
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Zhuoting Zhu
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Eye Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangzhou, China
| | - Zongyuan Ge
- Monash e-Research Center, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Center, Monash University, Melbourne, Victoria, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Eye Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, Melbourne, Victoria, Australia
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3
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Wolf V, Abdul Y, Ergul A. Novel Targets and Interventions for Cognitive Complications of Diabetes. Front Physiol 2022; 12:815758. [PMID: 35058808 PMCID: PMC8764363 DOI: 10.3389/fphys.2021.815758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 01/16/2023] Open
Abstract
Diabetes and cognitive dysfunction, ranging from mild cognitive impairment to dementia, often coexist in individuals over 65 years of age. Vascular contributions to cognitive impairment/dementia (VCID) are the second leading cause of dementias under the umbrella of Alzheimer's disease and related dementias (ADRD). Over half of dementia patients have VCID either as a single pathology or a mixed dementia with AD. While the prevalence of type 2 diabetes in individuals with dementia can be as high as 39% and diabetes increases the risk of cerebrovascular disease and stroke, VCID remains to be one of the less understood and less studied complications of diabetes. We have identified cerebrovascular dysfunction and compromised endothelial integrity leading to decreased cerebral blood flow and iron deposition into the brain, respectively, as targets for intervention for the prevention of VCID in diabetes. This review will focus on targeted therapies that improve endothelial function or remove iron without systemic effects, such as agents delivered intranasally, that may result in actionable and disease-modifying novel treatments in the high-risk diabetic population.
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Affiliation(s)
- Victoria Wolf
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Yasir Abdul
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States,*Correspondence: Yasir Abdul,
| | - Adviye Ergul
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
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4
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Kulecki M, Uruska A, Naskret D, Zozulinska-Ziolkiewicz D. Arterial Stiffness and Type 1 Diabetes: The Current State of Knowledge. Curr Diabetes Rev 2022; 18:e140621194054. [PMID: 35546329 DOI: 10.2174/1573399817666210614113827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/01/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
The most common cause of mortality among people with type 1 diabetes is cardiovascular diseases. Arterial stiffness allows predicting cardiovascular complications, cardiovascular mortality, and all-cause mortality. There are different ways to measure arterial stiffness; the gold standard is pulse wave velocity. Arterial stiffness is increased in people with type 1 diabetes compared to healthy controls. It increases with age and duration of type 1 diabetes. Arterial stiffness among people with type 1 diabetes positively correlates with systolic blood pressure, obesity, glycated hemoglobin, waist circumference, and waist to hip ratio. It has a negative correlation with the estimated glomerular filtration rate, high-density lipoprotein, and the absence of carotid plaques. The increased arterial stiffness could result from insulin resistance, collagen increase due to inadequate enzymatic glycation, and endothelial and autonomic dysfunction. The insulin-induced decrease in arterial stiffness is impaired in type 1 diabetes. There are not enough proofs to use pharmacotherapy in the prevention of arterial stiffness, but some of the medicaments got promising results in single studies, for example, renin-angiotensin-aldosterone system inhibitors, statins, and SGLT2 inhibitors. The main strategy of prevention of arterial stiffness progression remains glycemic control and a healthy lifestyle.
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Affiliation(s)
- Michal Kulecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
| | - Dariusz Naskret
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
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Filip P, Canna A, Moheet A, Bednarik P, Grohn H, Li X, Kumar AF, Olawsky E, Eberly LE, Seaquist ER, Mangia S. Structural Alterations in Deep Brain Structures in Type 1 Diabetes. Diabetes 2020; 69:2458-2466. [PMID: 32839347 PMCID: PMC7576566 DOI: 10.2337/db19-1100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 08/19/2020] [Indexed: 01/28/2023]
Abstract
Even though well known in type 2 diabetes, the existence of brain changes in type 1 diabetes (T1D) and both their neuroanatomical and clinical features are less well characterized. To fill the void in the current understanding of this disease, we sought to determine the possible neural correlate in long-duration T1D at several levels, including macrostructural, microstructural cerebral damage, and blood flow alterations. In this cross-sectional study, we compared a cohort of 61 patients with T1D with an average disease duration of 21 years with 54 well-matched control subjects without diabetes in a multimodal MRI protocol providing macrostructural metrics (cortical thickness and structural volumes), microstructural measures (T1-weighted/T2-weighted [T1w/T2w] ratio as a marker of myelin content, inflammation, and edema), and cerebral blood flow. Patients with T1D had higher T1w/T2w ratios in the right parahippocampal gyrus, the executive part of both putamina, both thalami, and the cerebellum. These alterations were reflected in lower putaminal and thalamic volume bilaterally. No cerebral blood flow differences between groups were found in any of these structures, suggesting nonvascular etiologies of these changes. Our findings implicate a marked nonvascular disruption in T1D of several essential neural nodes engaged in both cognitive and motor processing.
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Affiliation(s)
- Pavel Filip
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
- First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czech Republic
| | - Antonietta Canna
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Amir Moheet
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Petr Bednarik
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
- High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Heidi Grohn
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Xiufeng Li
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Anjali F Kumar
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Evan Olawsky
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - Silvia Mangia
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
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Schäfer M, Nadeau KJ, Reusch JEB. Cardiovascular disease in young People with Type 1 Diabetes: Search for Cardiovascular Biomarkers. J Diabetes Complications 2020; 34:107651. [PMID: 32546422 PMCID: PMC7585936 DOI: 10.1016/j.jdiacomp.2020.107651] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Abstract
Premature onset of cardiovascular disease is common in people with type 1 diabetes and is relatively understudied in youth. Several reports in adolescents and young adults with diabetes demonstrate evidence of arterial stiffness and cardiac dysfunction, yet critical gaps exist in our current understanding of the temporal progression of cardiac and vascular dysfunction in these youth, and mechanistic investigations with robust pathophysiologic assessment are lacking. This review attempts to summarize relevant cardiovascular studies concerning children, adolescents, and young adults with type 1 diabetes. We focus on imaging-based biomarkers routinely applied to youth and adults that are well-established in their ability to predict adjudicated cardiovascular outcomes, and their relevant physiologic interpretation. Particularly, we focus the attention to 1) cardiac ventricular strain imaging techniques which are known to be predictive of clinical outcomes in patients with heterogenous causes of heart failure, and 2) stiffness in large arteries, a well-established prognostic marker of cardiovascular events. We conclude that there remains an urgent need for sensitive and quantitative biomarkers to define the natural history of cardiac and vascular disease origination and progression in type 1 diabetes, and set the stage for interpreting interventional studies focused on preventing, reversing or slowing disease progression.
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Affiliation(s)
- Michal Schäfer
- Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado - School of Medicine, Aurora, CO, United States of America.
| | - Kristen J Nadeau
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado - School of Medicine, Aurora, CO, United States of America
| | - Jane E B Reusch
- Section of Endocrinology, Rocky Mountain Regional VAMC, CO, United States of America; Division of Endocrinology, Department of Medicine, United States of America; Center for Women's Health Research, University of Colorado - School of Medicine, Aurora, CO, United States of America
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7
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Liu J, Fan W, Jia Y, Su X, Wu W, Long X, Sun X, Liu J, Sun W, Zhang T, Gong Q, Shi H, Zhu Q, Wang J. Altered Gray Matter Volume in Patients With Type 1 Diabetes Mellitus. Front Endocrinol (Lausanne) 2020; 11:45. [PMID: 32117070 PMCID: PMC7031205 DOI: 10.3389/fendo.2020.00045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/24/2020] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose: Many imaging studies have reported structure alterations in patients with type 1 diabetes mellitus (T1DM) by using voxel-based morphometry (VBM). Nevertheless, the results reported were inconsistent and had not been reviewed quantitatively. Accordingly, the quantitative meta-analysis which including VBM studies of patients with T1DM was conducted. Materials and Methods: The gray matter volume alterations in patients with T1DM was estimated by using the software seed-based d mapping. Meantime, the meta-regression was applied to detect the effects of some demographics and clinical characteristics. Results: Six studies were finally included, which with 6 datasets comprising 414 T1DM patients and 216 healthy controls. The pooled meta-analyses detected that patients with T1DM showed robustly increased gray matter volume in the left dorsolateral superior frontal gyrus and middle frontal gyrus and a decreased gray matter volume in the right lingual gyrus, cerebellum, precuneus, the left inferior temporal gyrus, and middle temporal gyrus. The meta-regression showed that the mean age, the female patient's ratio, duration of illness and HbAlc% for T1DM patients were not linearly related with gray matter alterations. Conclusion: This meta-analysis demonstrates that gray matter volume decreases in T1DM patients were mainly locates in the cortical regions and cerebellum.
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Affiliation(s)
- Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuxi Jia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaoyun Su
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenjun Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xi Long
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xin Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jie Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wengang Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | | | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Haojun Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Haojun Shi
| | - Qing Zhu
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Qing Zhu
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Jing Wang
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8
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Karayiannis C, Moran C, Sharman JE, Beare R, Quinn SJ, Phan TG, Wood AG, Thrift AG, Wang WC, Srikanth V. Blood Pressure, Aortic Stiffness, Hemodynamics, and Cognition in Twin Pairs Discordant for Type 2 Diabetes. J Alzheimers Dis 2019; 71:763-773. [DOI: 10.3233/jad-190319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Christopher Karayiannis
- Department of Medicine, Peninsula Health and Monash University, Melbourne, Australia
- Stroke and Ageing Research Centre, Medicine, School of Clinical Sciences, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Chris Moran
- Department of Medicine, Peninsula Health and Monash University, Melbourne, Australia
- Stroke and Ageing Research Centre, Medicine, School of Clinical Sciences, Monash Medical Centre, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Richard Beare
- Department of Medicine, Peninsula Health and Monash University, Melbourne, Australia
- Stroke and Ageing Research Centre, Medicine, School of Clinical Sciences, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Stephen J. Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - Thanh G. Phan
- Stroke and Ageing Research Centre, Medicine, School of Clinical Sciences, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Amanda G. Wood
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
- Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Amanda G. Thrift
- Stroke and Ageing Research Centre, Medicine, School of Clinical Sciences, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Wei C. Wang
- Department of Medicine, Peninsula Health and Monash University, Melbourne, Australia
| | - Velandai Srikanth
- Department of Medicine, Peninsula Health and Monash University, Melbourne, Australia
- Stroke and Ageing Research Centre, Medicine, School of Clinical Sciences, Monash Medical Centre, Monash University, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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9
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Staffaroni AM, Cobigo Y, Elahi FM, Casaletto KB, Walters SM, Wolf A, Lindbergh CA, Rosen HJ, Kramer JH. A longitudinal characterization of perfusion in the aging brain and associations with cognition and neural structure. Hum Brain Mapp 2019; 40:3522-3533. [PMID: 31062904 PMCID: PMC6693488 DOI: 10.1002/hbm.24613] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 01/01/2023] Open
Abstract
Cerebral perfusion declines across the lifespan and is altered in the early stages of several age-related neuropathologies. Little is known, however, about the longitudinal evolution of perfusion in healthy older adults, particularly when perfusion is quantified using magnetic resonance imaging with arterial spin labeling (ASL). The objective was to characterize longitudinal perfusion in typically aging adults and elucidate associations with cognition and brain structure. Adults who were functionally intact at baseline (n = 161, ages 47-89) underwent ASL imaging to quantify whole-brain gray matter perfusion; a subset (n = 136) had repeated imaging (average follow-up: 2.3 years). Neuropsychological testing at each visit was summarized into executive function, memory, and processing speed composites. Global gray matter volume, white matter microstructure (mean diffusivity), and white matter hyperintensities were also quantified. We assessed baseline associations among perfusion, cognition, and brain structure using linear regression, and longitudinal relationships using linear mixed effects models. Greater baseline perfusion, particularly in the left dorsolateral prefrontal cortex and right thalamus, was associated with better executive functions. Greater whole-brain perfusion loss was associated with worsening brain structure and declining processing speed. This study helps validate noninvasive MRI-based perfusion imaging and underscores the importance of cerebral blood flow in cognitive aging.
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Affiliation(s)
- Adam M. Staffaroni
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Yann Cobigo
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Fanny M. Elahi
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Kaitlin B. Casaletto
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Samantha M. Walters
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Amy Wolf
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Cutter A. Lindbergh
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Howard J. Rosen
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
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10
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Jordan JH, Todd RM, Vasu S, Hundley WG. Cardiovascular Magnetic Resonance in the Oncology Patient. JACC Cardiovasc Imaging 2018; 11:1150-1172. [PMID: 30092971 PMCID: PMC6242266 DOI: 10.1016/j.jcmg.2018.06.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/05/2018] [Accepted: 06/14/2018] [Indexed: 01/20/2023]
Abstract
Patients with or receiving potentially cardiotoxic treatment for cancer are susceptible to developing decrements in left ventricular mass, diastolic function, or systolic function. They may also experience valvular heart disease, pericardial disease, or intracardiac masses. Cardiovascular magnetic resonance may be used to assess cardiac anatomy, structure, and function and to characterize myocardial tissue. This combination of features facilitates the diagnosis and management of disease processes in patients with or those who have survived cancer. This report outlines and describes prior research involving cardiovascular magnetic resonance for assessing cardiovascular disease in patients with or previously having received treatment for cancer.
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Affiliation(s)
- Jennifer H Jordan
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Ryan M Todd
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sujethra Vasu
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Gregory Hundley
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina
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11
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Yoon S, Kim J, Musen G, Renshaw PF, Hwang J, Bolo NR, Kim JE, Simonson DC, Weinger K, Ryan CM, Lyoo IK, Jacobson AM. Prefronto-temporal white matter microstructural alterations 20 years after the diagnosis of type 1 diabetes mellitus. Pediatr Diabetes 2018; 19:478-485. [PMID: 28929564 PMCID: PMC5860922 DOI: 10.1111/pedi.12574] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/05/2017] [Accepted: 08/06/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Microvascular pathophysiology that uniquely manifests as white matter (WM) abnormalities is often implicated in type 1 diabetes mellitus (T1DM)-related central nervous system (CNS) complications. This study sought to identify regional WM abnormalities in young adults diagnosed with T1DM and further examine their association with cognitive and emotional dysfunction. RESEARCH DESIGN AND METHODS Diffusion tensor images (DTI) obtained from 34 young adults with T1DM for ≥15 years (mean duration, 20.9 years), and 16 age- and sex-matched healthy control subjects were analyzed using tract-based spatial statistics. Fractional anisotropy (FA) values of the whole brain were analyzed, and their associations with memory function and depressive symptoms were assessed. RESULTS Whole brain voxel-wise analyses showed that T1DM-related FA reductions were most prominent within the fronto-temporo-parietal regions of the brain. Reduced FA values in the bilateral superior longitudinal fasciculi, at which group differences were most prominent, correlated with lower working memory performance in young adults with T1DM (left, P < .001; right, P = .009). Subsyndromal depressive symptoms were also associated with lower FA values in the right inferior fronto-occipital fasciculus (P = .004). CONCLUSION Widespread WM microstructural abnormalities in the fronto-temporo-parietal brain regions, which are associated with emotional and cognitive dysfunction, may be a contributing factor to the neural mechanisms underlying T1DM-related CNS complications, thus affecting the quality of life in young adults with T1DM.
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Affiliation(s)
- Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jungyoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Gail Musen
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Research Division, Joslin Diabetes Center, Boston, MA, USA
| | - Perry F Renshaw
- The Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Jaeuk Hwang
- Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Nicolas R Bolo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jieun E. Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Donald C Simonson
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Katie Weinger
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Research Division, Joslin Diabetes Center, Boston, MA, USA
| | - Christopher M Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea,College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Alan M Jacobson
- Research Division, Joslin Diabetes Center, Boston, MA, USA,Research Institute, Winthrop University Hospital, Mineola, NY, USA
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12
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Coucha M, Abdelsaid M, Ward R, Abdul Y, Ergul A. Impact of Metabolic Diseases on Cerebral Circulation: Structural and Functional Consequences. Compr Physiol 2018; 8:773-799. [PMID: 29687902 DOI: 10.1002/cphy.c170019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Metabolic diseases including obesity, insulin resistance, and diabetes have profound effects on cerebral circulation. These diseases not only affect the architecture of cerebral blood arteries causing adverse remodeling, pathological neovascularization, and vasoregression but also alter the physiology of blood vessels resulting in compromised myogenic reactivity, neurovascular uncoupling, and endothelial dysfunction. Coupled with the disruption of blood brain barrier (BBB) integrity, changes in blood flow and microbleeds into the brain rapidly occur. This overview is organized into sections describing cerebrovascular architecture, physiology, and BBB in these diseases. In each section, we review these properties starting with larger arteries moving into smaller vessels. Where information is available, we review in the order of obesity, insulin resistance, and diabetes. We also tried to include information on biological variables such as the sex of the animal models noted since most of the information summarized was obtained using male animals. © 2018 American Physiological Society. Compr Physiol 8:773-799, 2018.
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Affiliation(s)
- Maha Coucha
- South University, School of Pharmacy, Savannah, Georgia, USA
| | | | - Rebecca Ward
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Yasir Abdul
- Charlie Norwood VA Medical Center, Augusta, Georgia, USA.,Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Adviye Ergul
- Charlie Norwood VA Medical Center, Augusta, Georgia, USA.,Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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13
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Thorin-Trescases N, de Montgolfier O, Pinçon A, Raignault A, Caland L, Labbé P, Thorin E. Impact of pulse pressure on cerebrovascular events leading to age-related cognitive decline. Am J Physiol Heart Circ Physiol 2018; 314:H1214-H1224. [PMID: 29451817 DOI: 10.1152/ajpheart.00637.2017] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Aging is a modern concept: human life expectancy has more than doubled in less than 150 yr in Western countries. Longer life span, however, reveals age-related diseases, including cerebrovascular diseases. The vascular system is a prime target of aging: the "wear and tear" of large elastic arteries exposed to a lifelong pulsatile pressure causes arterial stiffening by fragmentation of elastin fibers and replacement by stiffer collagen. This arterial stiffening increases in return the amplitude of the pulse pressure (PP), its wave penetrating deeper into the microcirculation of low-resistance, high-flow organs such as the brain. Several studies have associated peripheral arterial stiffness responsible for the sustained increase in PP, with brain microvascular diseases such as cerebral small vessel disease, cortical gray matter thinning, white matter atrophy, and cognitive dysfunction in older individuals and prematurely in hypertensive and diabetic patients. The rarefaction of white matter is also associated with middle cerebral artery pulsatility that is strongly dependent on PP and artery stiffness. PP and brain damage are likely associated, but the sequence of mechanistic events has not been established. Elevated PP promotes endothelial dysfunction that may slowly develop in parallel with the accumulation of proinflammatory senescent cells and oxidative stress, generating cerebrovascular damage and remodeling, as well as brain structural changes. Here, we review data suggesting that age-related increased peripheral artery stiffness may promote the penetration of a high PP to cerebral microvessels, likely causing functional, structural, metabolic, and hemodynamic alterations that could ultimately promote neuronal dysfunction and cognitive decline.
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Affiliation(s)
| | - Olivia de Montgolfier
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
| | - Anthony Pinçon
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
| | - Adeline Raignault
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada
| | - Laurie Caland
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
| | - Pauline Labbé
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
| | - Eric Thorin
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada.,Department of Surgery, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
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14
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Hosseini SMH, Mazaika P, Mauras N, Buckingham B, Weinzimer SA, Tsalikian E, White NH, Reiss AL. Altered Integration of Structural Covariance Networks in Young Children With Type 1 Diabetes. Hum Brain Mapp 2018; 37:4034-4046. [PMID: 27339089 DOI: 10.1002/hbm.23293] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 05/24/2016] [Accepted: 06/12/2016] [Indexed: 02/05/2023] Open
Abstract
Type 1 diabetes mellitus (T1D), one of the most frequent chronic diseases in children, is associated with glucose dysregulation that contributes to an increased risk for neurocognitive deficits. While there is a bulk of evidence regarding neurocognitive deficits in adults with T1D, little is known about how early-onset T1D affects neural networks in young children. Recent data demonstrated widespread alterations in regional gray matter and white matter associated with T1D in young children. These widespread neuroanatomical changes might impact the organization of large-scale brain networks. In the present study, we applied graph-theoretical analysis to test whether the organization of structural covariance networks in the brain for a cohort of young children with T1D (N = 141) is altered compared to healthy controls (HC; N = 69). While the networks in both groups followed a small world organization-an architecture that is simultaneously highly segregated and integrated-the T1D network showed significantly longer path length compared with HC, suggesting reduced global integration of brain networks in young children with T1D. In addition, network robustness analysis revealed that the T1D network model showed more vulnerability to neural insult compared with HC. These results suggest that early-onset T1D negatively impacts the global organization of structural covariance networks and influences the trajectory of brain development in childhood. This is the first study to examine structural covariance networks in young children with T1D. Improving glycemic control for young children with T1D might help prevent alterations in brain networks in this population. Hum Brain Mapp 37:4034-4046, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California.
| | - Paul Mazaika
- Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California
| | - Nelly Mauras
- Division of Endocrinology, Nemours Children's Health System, Jacksonville, Florida
| | - Bruce Buckingham
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
| | - Stuart A Weinzimer
- Division of Pediatric Endocrinology, Yale University, New Haven, Connecticut
| | - Eva Tsalikian
- Division of Pediatric Endocrinology, University of Iowa, Iowa City, Iowa
| | - Neil H White
- Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Allan L Reiss
- Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California
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15
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Armstrong AC, Muller M, Ambale-Ventakesh B, Halstead M, Kishi S, Bryan N, Sidney S, Correia LCL, Gidding SS, Launer LJ, Lima JA. Association of early left ventricular dysfunction with advanced magnetic resonance white matter and gray matter brain measures: The CARDIA study. Echocardiography 2017; 34:1617-1622. [PMID: 29114921 PMCID: PMC5718174 DOI: 10.1111/echo.13695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Relations between heart failure and clinically manifested stroke are well known, but the associations between heart and brain early abnormalities are not totally clear. AIMS We explore relations of subclinical brain abnormalities with early cardiac dysfunction in a large healthy middle-aged biracial cohort. METHODS The CARDIA study enrolled 5115 young adults aged 18-30 years at baseline (1985-1986). We assessed 719 Caucasian and African American participants of the CARDIA study, with echocardiograms and brain MRI at follow-up year 25 (2010-2011). Echocardiography assessed aortic root diameter; LVEF; circumferential, longitudinal, and radial deformation. Cerebral MRI DTI, and, on a subset, ASL perfusion sequences were used to assess white matter fractional anisotropy and gray matter cerebral blood flow (CBF). Linear regression explored relations between cardiac parameters and cerebral measures, adjusting for anthropometrics, risk factors, and brain constitutional variation. RESULTS Mean age 50 ± 4 years, SBP 118 ± 15 mm Hg; 60% white, and 48% men. Mean CBF was 46 ± 9 mL/100 g/min, and white matter fractional anisotropy was 0.31 ± 0.02. Worse circumferential deformation and larger aortic root were related to worse white matter fractional anisotropy. Worse radial systolic deformation was related to worse CBF in multivariable models. LVEF did not relate to early brain abnormalities. CONCLUSIONS In spite of no apparent effect of LV ejection fraction, early subclinical cardiac dysfunction and brain abnormalities are present and associated in middle-aged generally healthy individuals.
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Affiliation(s)
- Anderson C. Armstrong
- Johns Hopkins University, Baltimore, MD
- Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil
| | | | | | | | | | - Nick Bryan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania
| | - Stephen Sidney
- Health System Kaiser Permanente Northern California Division of Research, Oakland, CA
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16
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Moran C, Beare R, Phan T, Starkstein S, Bruce D, Romina M, Srikanth V. Neuroimaging and its Relevance to Understanding Pathways Linking Diabetes and Cognitive Dysfunction. J Alzheimers Dis 2017; 59:405-419. [DOI: 10.3233/jad-161166] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Chris Moran
- Department of Medicine, Peninsula Health, Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
- Aged Care Services, Caulfield Hospital, Alfred Health, Melbourne, VIC, Australia
- Stroke and Ageing Research Group, Vascular Brain Ageing Division, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Neurosciences, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Richard Beare
- Department of Medicine, Peninsula Health, Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
- Stroke and Ageing Research Group, Vascular Brain Ageing Division, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Neurosciences, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Thanh Phan
- Stroke and Ageing Research Group, Vascular Brain Ageing Division, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Neurosciences, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Sergio Starkstein
- Fremantle Hospital, WA, Australia
- University of Western Australia, WA, Australia
| | - David Bruce
- Fremantle Hospital, WA, Australia
- University of Western Australia, WA, Australia
| | - Mizrahi Romina
- Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Velandai Srikanth
- Department of Medicine, Peninsula Health, Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
- Stroke and Ageing Research Group, Vascular Brain Ageing Division, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Neurosciences, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
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17
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Hardigan T, Hernandez C, Ward R, Hoda MN, Ergul A. TLR2 knockout protects against diabetes-mediated changes in cerebral perfusion and cognitive deficits. Am J Physiol Regul Integr Comp Physiol 2017; 312:R927-R937. [PMID: 28336553 DOI: 10.1152/ajpregu.00482.2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/25/2017] [Accepted: 02/17/2017] [Indexed: 12/29/2022]
Abstract
The risk of cognitive decline in diabetes (Type 1 and Type 2) is significantly greater compared with normoglycemic patients, and the risk of developing dementia in diabetic patients is doubled. The etiology for this is likely multifactorial, but one mechanism that has gained increasing attention is decreased cerebral perfusion as a result of cerebrovascular dysfunction. The innate immune system has been shown to play a role in diabetic vascular complications, notably through the Toll-like receptor (TLR)-stimulated release of proinflammatory cytokines and chemokines that lead to vascular damage. TLR2 has been implicated in playing a crucial role in the development of diabetic microvascular complications, such as nephropathy, and thus, we hypothesized that TLR2-mediated cerebrovascular dysfunction leads to decreased cerebral blood flow (CBF) and cognitive impairment in diabetes. Knockout of TLR2 conferred protection from impaired CBF in early-stage diabetes and from hyperperfusion in long-term diabetes, prevented the development of endothelium-dependent vascular dysfunction in diabetes, created a hyperactive and anxiolytic phenotype, and protected against diabetes-induced impairment of long-term hippocampal and prefrontal cortex-mediated fear learning. In conclusion, these findings support the involvement of TLR2 in the pathogenesis of diabetic vascular disease and cognitive impairment.
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Affiliation(s)
- Trevor Hardigan
- Department of Physiology, University of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Caterina Hernandez
- Department of Pharmacology and Toxicology, University of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia.,Department of Small Animal Behavior Core Facility, University of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Rebecca Ward
- Department of Neuroscience, University of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - M Nasrul Hoda
- Department of Medical Laboratory, Imaging and Radiologic Sciences, University of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia.,Department of Neurology, University of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia.,Program in Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia; and
| | - Adviye Ergul
- Department of Physiology, University of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia; .,Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia
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18
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Hardigan T, Ward R, Ergul A. Cerebrovascular complications of diabetes: focus on cognitive dysfunction. Clin Sci (Lond) 2016; 130:1807-22. [PMID: 27634842 PMCID: PMC5599301 DOI: 10.1042/cs20160397] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/11/2015] [Indexed: 01/01/2023]
Abstract
The incidence of diabetes has more than doubled in the United States in the last 30 years and the global disease rate is projected to double by 2030. Cognitive impairment has been associated with diabetes, worsening quality of life in patients. The structural and functional interaction of neurons with the surrounding vasculature is critical for proper function of the central nervous system including domains involved in learning and memory. Thus, in this review we explore cognitive impairment in patients and experimental models, focusing on links to vascular dysfunction and structural changes. Lastly, we propose a role for the innate immunity-mediated inflammation in neurovascular changes in diabetes.
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Affiliation(s)
- Trevor Hardigan
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA 30912, U.S.A
| | - Rebecca Ward
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, U.S.A
| | - Adviye Ergul
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA 30912, U.S.A. Charlie Norwood Veterans Administration Medical Center, Augusta, GA 30912, U.S.A.
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19
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Moulton CD, Costafreda SG, Horton P, Ismail K, Fu CHY. Meta-analyses of structural regional cerebral effects in type 1 and type 2 diabetes. Brain Imaging Behav 2016; 9:651-62. [PMID: 25563229 DOI: 10.1007/s11682-014-9348-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diabetes is associated with macrovascular and microvascular complications and is a major risk factor for neurological and psychiatric disorders, such as dementia and depression. Type 1 diabetes (T1DM) and type 2 diabetes (T2DM) have distinct etiologies and pathophysiological effects while sharing a common endpoint of persistent hyperglycemia. Neuroimaging studies in T1DM have revealed reductions in numerous regions, including the parahippocampal and occipital regions, while in T2DM there have been numerous reports of hippocampal atrophy. This meta-analysis aimed to identify consistent regional abnormalities in cerebral structures in T1DM and T2DM respectively, and also to examine the impact of potential confounds, including age, depression and vascular risk factors. Neuroimaging studies of both voxel-based morphometry (VBM) data and volumetric data were included. Ten T1DM studies (n = 613 patients) and 23 T2DM studies (n = 1364 patients) fulfilled inclusion criteria. The T1DM meta-analysis revealed reduced bilateral thalamus grey matter density in adults. The T2DM meta-analysis revealed reduced global brain volume and regional atrophy in the hippocampi, basal ganglia, and orbitofrontal and occipital lobes. Moreover, hippocampal atrophy in T2DM was not modified by hypertension, although there were more marked reductions in younger patients relative to healthy controls. In conclusion, T1DM and T2DM demonstrated distinct cerebral effects with generalised and specific target areas of grey matter reduction. Thalamic atrophy in T1DM may be a substrate of associated cognitive deficits. In T2DM, global cerebral atrophy may reflect atherosclerotic factors, while hippocampal atrophy was an independent effect providing a potential common neuropathological etiology for the comorbidity of T2DM with dementia and depression.
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Affiliation(s)
- Calum D Moulton
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
| | - Sergi G Costafreda
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Paul Horton
- Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - Cynthia H Y Fu
- School of Psychology, University of East London, London, UK
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20
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Mazaika PK, Weinzimer SA, Mauras N, Buckingham B, White NH, Tsalikian E, Hershey T, Cato A, Aye T, Fox L, Wilson DM, Tansey MJ, Tamborlane W, Peng D, Raman M, Marzelli M, Reiss AL. Variations in Brain Volume and Growth in Young Children With Type 1 Diabetes. Diabetes 2016; 65:476-85. [PMID: 26512024 PMCID: PMC4747456 DOI: 10.2337/db15-1242] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/17/2015] [Indexed: 12/11/2022]
Abstract
Early-onset type 1 diabetes may affect the developing brain during a critical window of rapid brain maturation. Structural MRI was performed on 141 children with diabetes (4-10 years of age at study entry) and 69 age-matched control subjects at two time points spaced 18 months apart. For the children with diabetes, the mean (±SD) HbA1c level was 7.9 ± 0.9% (63 ± 9.8 mmol/mol) at both time points. Relative to control subjects, children with diabetes had significantly less growth of cortical gray matter volume and cortical surface area and significantly less growth of white matter volume throughout the cortex and cerebellum. For the population with diabetes, the change in the blood glucose level at the time of scan across longitudinal time points was negatively correlated with the change in gray and white matter volumes, suggesting that fluctuating glucose levels in children with diabetes may be associated with corresponding fluctuations in brain volume. In addition, measures of hyperglycemia and glycemic variation were significantly negatively correlated with the development of surface curvature. These results demonstrate that early-onset type 1 diabetes has widespread effects on the growth of gray and white matter in children whose blood glucose levels are well within the current treatment guidelines for the management of diabetes.
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Affiliation(s)
- Paul K Mazaika
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Nelly Mauras
- Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, FL
| | - Bruce Buckingham
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Neil H White
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Eva Tsalikian
- Department of Pediatric Endocrinology, The University of Iowa, Iowa City, IA
| | - Tamara Hershey
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Allison Cato
- Division of Neurology, Nemours Children's Health System, Jacksonville, FL
| | - Tandy Aye
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Larry Fox
- Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, FL
| | - Darrell M Wilson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Michael J Tansey
- Department of Pediatric Endocrinology, The University of Iowa, Iowa City, IA
| | - William Tamborlane
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Daniel Peng
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Mira Raman
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Matthew Marzelli
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA Department of Bioengineering, Stanford University School of Medicine, Stanford, CA Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Allan L Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA Department of Pediatrics, Stanford University School of Medicine, Stanford, CA Department of Radiology, Stanford University School of Medicine, Stanford, CA
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21
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CAO ZHEN, YE BIDI, SHEN ZHIWEI, CHENG XIAOFANG, YANG ZHONGXIAN, LIU YANYAN, WU RENHUA, GENG KUAN, XIAO YEYU. 2D-1H proton magnetic resonance spectroscopic imaging study on brain metabolite alterations in patients with diabetic hypertension. Mol Med Rep 2015; 11:4232-8. [PMID: 25652580 PMCID: PMC4394930 DOI: 10.3892/mmr.2015.3305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 01/09/2015] [Indexed: 02/05/2023] Open
Abstract
The aim of the present study was to investigate the possible metabolic alterations in the frontal cortex and parietal white matter in patients with diabetic hypertension (DHT) using proton magnetic resonance (MR) spectroscopic imaging. A total of 33 DHT patients and 30 healthy control subjects aged between 45 and 75 were included in the present study. All subjects were right‑handed. The spectroscopy data were collected using a GE Healthcare 1.5T MR scanner. The multi‑voxels were located in the semioval center (repetition time/echo time=1,500 ms/35 ms). The area of interest was 8x10x2 cm in volume and contained the two sides of the frontal cortex and the parietal white matter. The spectra data were processed using SAGE software. The ratios of brain metabolite concentrations, particularly for N‑acetylaspartate (NAA)/creatine (Cr) and Choline (Cho)/Cr were calculated and analyzed. Statistical analyses were performed using SPSS 17.0. The NAA/Cr ratio of the bilateral prefrontal cortex of the DHT group was significantly lower than that of the control group (left t=‑7.854, P=0.000 and right t=‑5.787, P=0.000), The Cho/Cr ratio was also much lower than the control group (left t=2.422, P=0.024 and right t=2.920, P=0.007). NAA/Cr ratio of the left parietal white matter of the DHT group was extremely lower than that of the control group (t=‑4.199, P=0.000). Therefore, DHT may result in metabolic disorders in the frontal cortex and parietal white matter but the metabolic alterations are different in various regions of the brain. The alteration in cerebral metabolism is associated with diabetes and hypertension. The ratios of NAA/Cr and Cho/Cr are potential metabolic markers for the brain damage induced by DHT.
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Affiliation(s)
- ZHEN CAO
- Department of Medical Imaging, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - BI-DI YE
- Department of Medical Imaging, The Central Hospital of Huizhou City, Huizhou, Guangdong 516001, P.R. China
| | - ZHI-WEI SHEN
- Department of Medical Imaging, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - XIAO-FANG CHENG
- Department of Medical Imaging, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - ZHONG-XIAN YANG
- Department of Medical Imaging, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - YAN-YAN LIU
- Department of Medical Imaging, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - REN-HUA WU
- Department of Medical Imaging, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- Correspondence to: Dr Ren-Hua Wu or Dr Ye-Yu Xiao, Department of Medical Imaging, The Second Affiliated Hospital, Shantou University Medical College, 69 Dongxiabei Road, Shantou, Guangdong 515041, P.R. China, E mail: , E mail:
| | - KUAN GENG
- Department of Medical Imaging, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - YE-YU XIAO
- Department of Medical Imaging, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
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22
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Mauras N, Mazaika P, Buckingham B, Weinzimer S, White NH, Tsalikian E, Hershey T, Cato A, Cheng P, Kollman C, Beck RW, Ruedy K, Aye T, Fox L, Arbelaez AM, Wilson D, Tansey M, Tamborlane W, Peng D, Marzelli M, Winer KK, Reiss AL. Longitudinal assessment of neuroanatomical and cognitive differences in young children with type 1 diabetes: association with hyperglycemia. Diabetes 2015; 64:1770-9. [PMID: 25488901 PMCID: PMC4407847 DOI: 10.2337/db14-1445] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/05/2014] [Indexed: 12/11/2022]
Abstract
Significant regional differences in gray and white matter volume and subtle cognitive differences between young diabetic and nondiabetic children have been observed. Here, we assessed whether these differences change over time and the relation with dysglycemia. Children ages 4 to <10 years with (n = 144) and without (n = 72) type 1 diabetes (T1D) had high-resolution structural MRI and comprehensive neurocognitive tests at baseline and 18 months and continuous glucose monitoring and HbA1c performed quarterly for 18 months. There were no differences in cognitive and executive function scores between groups at 18 months. However, children with diabetes had slower total gray and white matter growth than control subjects. Gray matter regions (left precuneus, right temporal, frontal, and parietal lobes and right medial-frontal cortex) showed lesser growth in diabetes, as did white matter areas (splenium of the corpus callosum, bilateral superior-parietal lobe, bilateral anterior forceps, and inferior-frontal fasciculus). These changes were associated with higher cumulative hyperglycemia and glucose variability but not with hypoglycemia. Young children with T1D have significant differences in total and regional gray and white matter growth in brain regions involved in complex sensorimotor processing and cognition compared with age-matched control subjects over 18 months, suggesting that chronic hyperglycemia may be detrimental to the developing brain.
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Affiliation(s)
- Nelly Mauras
- Division of Endocrinology, Diabetes & Metabolism, Nemours Children's Clinic, Jacksonville, FL
| | - Paul Mazaika
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Bruce Buckingham
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Stuart Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Neil H White
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Eva Tsalikian
- Pediatric Endocrinology, University of Iowa, Iowa City, IA
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Allison Cato
- Division of Neurology, Nemours Children's Clinic, Jacksonville, FL
| | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | | | - Tandy Aye
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Larry Fox
- Division of Endocrinology, Diabetes & Metabolism, Nemours Children's Clinic, Jacksonville, FL
| | - Ana Maria Arbelaez
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Darrell Wilson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Michael Tansey
- Pediatric Endocrinology, University of Iowa, Iowa City, IA
| | - William Tamborlane
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Daniel Peng
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Matthew Marzelli
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA Department of Bioengineering, Stanford University School of Medicine, Stanford, CA
| | - Karen K Winer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Allan L Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA Department of Pediatrics, Stanford University School of Medicine, Stanford, CA Department of Radiology, Stanford University School of Medicine, Stanford, CA
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23
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Comparing cerebrovascular reactivity measured using BOLD and cerebral blood flow MRI: The effect of basal vascular tension on vasodilatory and vasoconstrictive reactivity. Neuroimage 2015; 110:110-23. [PMID: 25655446 DOI: 10.1016/j.neuroimage.2015.01.050] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/15/2015] [Accepted: 01/26/2015] [Indexed: 11/23/2022] Open
Abstract
Cerebrovascular reactivity (CVR) is an important metric of cerebrovascular health. While the BOLD fMRI method in conjunction with carbon-dioxide (CO2) based vascular manipulation has been the most commonly used, the BOLD signal is not a direct measure of vascular changes, and the use of arterial-spin labeling (ASL) cerebral blood flow (CBF) imaging is increasingly advocated. Nonetheless, given the differing dependencies of BOLD and CBF on vascular baseline conditions and the diverse CO2 manipulation types currently used in the literature, knowledge of potential biases introduced by each technique is critical for the interpretation of CVR measurements. In this work, we use simultaneous BOLD-CBF acquisitions during both vasodilatory (hypercapnic) and vasoconstrictive (hypocapnic) stimuli to measure CVR. We further imposed different levels of baseline vascular tension by inducing hypercapnic and hypocapnic baselines, separately from normocapnia by 4mmHg. We saw significant and diverse dependencies on vascular stimulus and baseline condition in both BOLD and CBF CVR measurements: (i) BOLD-based CVR is more sensitive to basal vascular tension than CBF-based CVR; (ii) the use of a combination of vasodilatory and vasoconstrictive stimuli maximizes the sensitivity of CBF-based CVR to vascular tension changes; (iii) the BOLD and CBF vascular response delays are both significantly lengthened at predilated baseline. As vascular tension can often be altered by potential pathology, our findings are important considerations when interpreting CVR measurements in health and disease.
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24
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Climie RED, Srikanth V, Beare R, Keith LJ, Fell J, Davies JE, Sharman JE. Aortic reservoir characteristics and brain structure in people with type 2 diabetes mellitus; a cross sectional study. Cardiovasc Diabetol 2014; 13:143. [PMID: 25338824 PMCID: PMC4221700 DOI: 10.1186/s12933-014-0143-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/06/2014] [Indexed: 01/09/2023] Open
Abstract
Background Central hemodynamics help to maintain appropriate cerebral and other end-organ perfusion, and may be altered with ageing and type 2 diabetes mellitus (T2DM). We aimed to determine the associations between central hemodynamics and brain structure at rest and during exercise in people with and without T2DM. Methods In a sample of people with T2DM and healthy controls, resting and exercise measures of aortic reservoir characteristics (including excess pressure integral [Pexcess]) and other central hemodynamics (including augmentation index [AIx] and aortic pulse wave velocity [aPWV]) were recorded. Brain volumes (including gray matter volume [GMV] and white matter lesions [WML]) were derived from magnetic resonance imaging (MRI) scans. Multivariable linear regression was used to study the associations of hemodynamic variables with brain structure in the two groups adjusting for age, sex, daytime systolic BP (SBP) and heart rate. Results There were 37 T2DM (63 ± 9 years; 47% male) and 37 healthy individuals (52 ± 8 years; 51% male). In T2DM, resting aPWV was inversely associated with GMV (standardized β = −0.47, p = 0.036). In healthy participants, resting Pexcess was inversely associated with GMV (β = −0.23, p = 0.043) and AIx was associated with WML volume (β = 0.52, p = 0.021). There were no associations between exercise hemodynamics and brain volumes in either group. Conclusions Brain atrophy is associated with resting aortic stiffness in T2DM, and resting Pexcess in healthy individuals. Central vascular mechanisms underlying structural brain changes may differ between healthy individuals and T2DM.
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25
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Gauthier CJ, Lefort M, Mekary S, Desjardins-Crépeau L, Skimminge A, Iversen P, Madjar C, Desjardins M, Lesage F, Garde E, Frouin F, Bherer L, Hoge RD. Hearts and minds: linking vascular rigidity and aerobic fitness with cognitive aging. Neurobiol Aging 2014; 36:304-14. [PMID: 25308963 DOI: 10.1016/j.neurobiolaging.2014.08.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/18/2014] [Accepted: 08/15/2014] [Indexed: 12/20/2022]
Abstract
Human aging is accompanied by both vascular and cognitive changes. Although arteries throughout the body are known to become stiffer with age, this vessel hardening is believed to start at the level of the aorta and progress to other organs, including the brain. Progression of this vascular impairment may contribute to cognitive changes that arise with a similar time course during aging. Conversely, it has been proposed that regular exercise plays a protective role, attenuating the impact of age on vascular and metabolic physiology. Here, the impact of vascular degradation in the absence of disease was investigated within 2 groups of healthy younger and older adults. Age-related changes in executive function, elasticity of the aortic arch, cardiorespiratory fitness, and cerebrovascular reactivity were quantified, as well as the association between these parameters within the older group. In the cohort studied, older adults exhibited a decline in executive functions, measured as a slower performance in a modified Stroop task (1247.90 ± 204.50 vs. 898.20 ± 211.10 ms on the inhibition and/or switching component, respectively) than younger adults. Older participants also showed higher aortic pulse wave velocity (8.98 ± 3.56 vs. 3.95 ± 0.82 m/s, respectively) and lower VO₂ max (29.04 ± 6.92 vs. 42.32 ± 7.31 mL O2/kg/min, respectively) than younger adults. Within the older group, faster performance of the modified Stroop task was associated with preserved aortic elasticity (lower aortic pulse wave velocity; p = 0.046) and higher cardiorespiratory fitness (VO₂ max; p = 0.036). Furthermore, VO₂ max was found to be negatively associated with blood oxygenation level dependent cerebrovascular reactivity to CO₂ in frontal regions involved in the task (p = 0.038) but positively associated with cerebrovascular reactivity in periventricular watershed regions and within the postcentral gyrus. Overall, the results of this study support the hypothesis that cognitive status in aging is linked to vascular health, and that preservation of vessel elasticity may be one of the key mechanisms by which physical exercise helps to alleviate cognitive aging.
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Affiliation(s)
- Claudine Joëlle Gauthier
- Department of Physiology/Biomedical Engineering, Université de Montréal, Montreal, Canada; CRIUGM, Montreal, Canada; Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Muriel Lefort
- Sorbonne Universités UPMC Paris 06, CNRS, INSERM, LIB, Paris, France
| | - Saïd Mekary
- CRIUGM, Montreal, Canada; Department of Kinesiology, Université de Montréal, Montreal, Canada
| | | | - Arnold Skimminge
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Pernille Iversen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Cécile Madjar
- CRIUGM, Montreal, Canada; Douglas Hospital/MNI, McGill University, Institut de Génie Biomédical, Montreal, Canada
| | - Michèle Desjardins
- Sorbonne Universités UPMC Paris 06, CNRS, INSERM, LIB, Paris, France; Départment de Génie Électrique, École Polytechnique de Montréal, Montréal, Canada; Montreal Heart Institute, Montreal, Canada
| | - Frédéric Lesage
- Sorbonne Universités UPMC Paris 06, CNRS, INSERM, LIB, Paris, France; Départment de Génie Électrique, École Polytechnique de Montréal, Montréal, Canada
| | - Ellen Garde
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Frédérique Frouin
- Sorbonne Universités UPMC Paris 06, CNRS, INSERM, LIB, Paris, France
| | - Louis Bherer
- CRIUGM, Montreal, Canada; Psychology Department, UQAM, Montreal, Canada; PERFORM, Concordia University, Montreal, Canada
| | - Richard D Hoge
- Department of Physiology/Biomedical Engineering, Université de Montréal, Montreal, Canada; CRIUGM, Montreal, Canada
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26
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Aortic stiffness is associated with white matter integrity in patients with type 1 diabetes. Eur Radiol 2014; 24:2031-7. [DOI: 10.1007/s00330-014-3179-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 03/19/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
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27
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Alosco ML, Gunstad J, Xu X, Clark US, Labbe DR, Riskin-Jones HH, Terrero G, Schwarz NF, Walsh EG, Poppas A, Cohen RA, Sweet LH. The impact of hypertension on cerebral perfusion and cortical thickness in older adults. ACTA ACUST UNITED AC 2014; 8:561-70. [PMID: 25151318 DOI: 10.1016/j.jash.2014.04.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/23/2014] [Accepted: 04/07/2014] [Indexed: 12/25/2022]
Abstract
Hypertension may increase risk for dementia possibly because of its association with decreased cortical thickness. Disturbed cerebral autoregulation is one plausible mechanism by which hypertension impacts the cerebral structure, but the associations among hypertension, brain perfusion, and cortical thickness are poorly understood. The current sample consisted of 58 older adults with varying levels of vascular disease. Diagnostic history of hypertension and antihypertensive medication status was ascertained through self-report, and when available, confirmed by medical record review. All participants underwent arterial spin labeling and T1-weighted magnetic resonance imaging to quantify total and regional cortical perfusion and thickness. Analysis of covariance adjusting for medical variables showed that participants with hypertension exhibited reduced temporal and occipital brain perfusion and total and regional cortical thickness relative to those without hypertension. The effects of hypertension on total brain perfusion remained unchanged even after adjustment for age, although no such pattern emerged for cortical thickness. Decreased total brain perfusion predicted reduced thickness of the total brain and of the frontal, temporal, and parietal lobe cortices. Antihypertensive treatment was not associated with total cerebral perfusion or cortical thickness. This study provides initial evidence for the adverse effects of a diagnostic history of hypertension on brain hypoperfusion and reduced cortical thickness. Longitudinal studies are needed to investigate the role of hypertension and its interaction with other contributing factors (e.g., age) in the manifestation of cerebral hypoperfusion and reduced cortical thickness.
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Affiliation(s)
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, OH, USA
| | - Xiaomeng Xu
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | - Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Donald R Labbe
- Alpert Medical School of Brown University, the Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Hannah H Riskin-Jones
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gretel Terrero
- Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Edward G Walsh
- Brown University, Departments of Neuroscience and Diagnostic Imaging., Providence, RI, USA
| | - Athena Poppas
- Alpert Medical School of Brown University, Department of Medicine, Providence, RI, USA
| | - Ronald A Cohen
- Cognitive Aging and Memory Program, Clinical Translational Research Program, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Lawrence H Sweet
- Alpert Medical School of Brown University, the Department of Psychiatry and Human Behavior, Providence, RI, USA; Department of Psychology, University of Georgia, Athens, GA, USA
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28
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van Duinkerken E, Ijzerman RG, van der Zijl NJ, Barkhof F, Pouwels PJW, Schoonheim MM, Moll AC, Boerop J, Wessels AM, Klein M, Snoek FJ, Diamant M. Differential impact of subclinical carotid artery disease on cerebral structure and functioning in type 1 diabetes patients with versus those without proliferative retinopathy. Cardiovasc Diabetol 2014; 13:58. [PMID: 24620788 PMCID: PMC3995631 DOI: 10.1186/1475-2840-13-58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/07/2014] [Indexed: 12/18/2022] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) is associated with cerebral compromise, typically found in patients with microangiopathy. Associations between subclinical macroangiopathy and the brain, whether or not in the presence of microangiopathy, have not been fully explored in T1DM. We hypothesized that subclinical macroangiopathy in adult T1DM may affect the brain and interacts with microangiopathy. Methods In 51 asymptomatic T1DM patients with, 53 without proliferative retinopathy and 51 controls, right common carotid artery ultrasound was used to assess intima media thickness (cIMT) and distensibility (cD). Neuropsychological tests for cognitive functions, and magnetic resonance imagining for white matter integrity and functional connectivity, i.e. neuronal communication, were used. Results After correction for confounders, cIMT was borderline significantly increased in all T1DM patients (P = 0.071), whereas cD was not statistically significantly altered (P = 0.45). Patients with proliferative retinopathy showed the largest increase in cIMT and decrease in cD. In all participants, after adjustment for confounders, increased cIMT was related to decreased white matter integrity (β = −0.198 P = 0.041) and decreased functional connectivity in visual areas (β = −0.195 P = 0.046). For cognition, there was a significant interaction between cIMT and the presence of proliferative retinopathy after adjustment for confounding factors (all P < 0.05). Increased cIMT was associated with lower general cognitive ability (β = −0.334; P = 0.018), information processing speed (β = −0.361; P = 0.010) and attention (β = −0.394; P = 0.005) scores in patients without, but not in patients with proliferative retinopathy. Conclusions These findings suggest that subclinical macroangiopathy may be a factor in the development of diabetes-related cognitive changes in uncomplicated T1DM, whereas in patients with advanced T1DM, proliferative retinopathy may rather be the driving force of cerebral compromise.
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Affiliation(s)
- Eelco van Duinkerken
- Diabetes Center/Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117 - Room MF-G417, 1081 HV, Amsterdam, The Netherlands.
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29
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Babin D, Devos D, Pižurica A, Westenberg J, Vansteenkiste E, Philips W. Robust segmentation methods with an application to aortic pulse wave velocity calculation. Comput Med Imaging Graph 2014; 38:179-89. [PMID: 24405817 DOI: 10.1016/j.compmedimag.2013.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 11/06/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
Abstract
Aortic stiffness has proven to be an important diagnostic and prognostic factor of many cardiovascular diseases, as well as an estimate of overall cardiovascular health. Pulse wave velocity (PWV) represents a good measure of the aortic stiffness, while the aortic distensibility is used as an aortic elasticity index. Obtaining the PWV and the aortic distensibility from magnetic resonance imaging (MRI) data requires diverse segmentation tasks, namely the extraction of the aortic center line and the segmentation of aortic regions, combined with signal processing methods for the analysis of the pulse wave. In our study non-contrasted MRI images of abdomen were used in healthy volunteers (22 data sets) for the sake of non-invasive analysis and contrasted magnetic resonance (MR) images were used for the aortic examination of Marfan syndrome patients (8 data sets). In this research we present a novel robust segmentation technique for the PWV and aortic distensibility calculation as a complete image processing toolbox. We introduce a novel graph-based method for the centerline extraction of a thoraco-abdominal aorta for the length calculation from 3-D MRI data, robust to artifacts and noise. Moreover, we design a new projection-based segmentation method for transverse aortic region delineation in cardiac magnetic resonance (CMR) images which is robust to high presence of artifacts. Finally, we propose a novel method for analysis of velocity curves in order to obtain pulse wave propagation times. In order to validate the proposed method we compare the obtained results with manually determined aortic centerlines and a region segmentation by an expert, while the results of the PWV measurement were compared to a validated software (LUMC, Leiden, the Netherlands). The obtained results show high correctness and effectiveness of our method for the aortic PWV and distensibility calculation.
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Affiliation(s)
- Danilo Babin
- Department of Telecommunications and Information Processing - TELIN-IPI-iMinds, Faculty of Sciences, Ghent University, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
| | - Daniel Devos
- Department of Radiology, Cardiovascular MR & CT, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Aleksandra Pižurica
- Department of Telecommunications and Information Processing - TELIN-IPI-iMinds, Faculty of Sciences, Ghent University, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
| | - Jos Westenberg
- Department of Radiology, LUMC, Leiden University Medical Center, Albinusedreef 2, 2333 ZA Leiden, The Netherlands.
| | - Ewout Vansteenkiste
- Department of Telecommunications and Information Processing - TELIN-IPI-iMinds, Faculty of Sciences, Ghent University, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
| | - Wilfried Philips
- Department of Telecommunications and Information Processing - TELIN-IPI-iMinds, Faculty of Sciences, Ghent University, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
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30
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Marzelli MJ, Mazaika PK, Barnea-Goraly N, Hershey T, Tsalikian E, Tamborlane W, Mauras N, White NH, Buckingham B, Beck RW, Ruedy KJ, Kollman C, Cheng P, Reiss AL. Neuroanatomical correlates of dysglycemia in young children with type 1 diabetes. Diabetes 2014; 63:343-53. [PMID: 24170697 PMCID: PMC3868050 DOI: 10.2337/db13-0179] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Studies of brain structure in type 1 diabetes (T1D) describe widespread neuroanatomical differences related to exposure to glycemic dysregulation in adults and adolescents. In this study, we investigate the neuroanatomical correlates of dysglycemia in very young children with early-onset T1D. Structural magnetic resonance images of the brain were acquired in 142 children with T1D and 68 age-matched control subjects (mean age 7.0 ± 1.7 years) on six identical scanners. Whole-brain volumetric analyses were conducted using voxel-based morphometry to detect regional differences between groups and to investigate correlations between regional brain volumes and measures of glycemic exposure (including data from continuous glucose monitoring). Relative to control subjects, the T1D group displayed decreased gray matter volume (GMV) in bilateral occipital and cerebellar regions (P < 0.001) and increased GMV in the left inferior prefrontal, insula, and temporal pole regions (P = 0.002). Within the T1D group, hyperglycemic exposure was associated with decreased GMV in medial frontal and temporal-occipital regions and increased GMV in lateral prefrontal regions. Cognitive correlations of intelligence quotient to GMV were found in cerebellar-occipital regions and medial prefrontal cortex for control subjects, as expected, but not for the T1D group. Thus, early-onset T1D affects regions of the brain that are associated with typical cognitive development.
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Affiliation(s)
- Matthew J. Marzelli
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
- Department of Bioengineering, Stanford University, Stanford, CA
| | - Paul K. Mazaika
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Naama Barnea-Goraly
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Tamara Hershey
- Department of Psychiatry, Department of Neurology, and Department of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Eva Tsalikian
- Pediatric Endocrinology, The University of Iowa, Des Moines, IA
| | | | - Nelly Mauras
- Pediatric Endocrinology, Nemours Children’s Clinic, Jacksonville, FL
| | - Neil H. White
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | | | | | - Katrina J. Ruedy
- Jaeb Center for Health Research, Tampa, FL
- Corresponding author: Katrina J. Ruedy,
| | | | | | - Allan L. Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
- Department of Pediatrics, Stanford University, Stanford, CA
- Department of Radiology, Stanford University, Stanford, CA
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31
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Alosco ML, Gunstad J, Jerskey BA, Xu X, Clark US, Hassenstab J, Cote DM, Walsh EG, Labbe DR, Hoge R, Cohen RA, Sweet LH. The adverse effects of reduced cerebral perfusion on cognition and brain structure in older adults with cardiovascular disease. Brain Behav 2013; 3:626-36. [PMID: 24363966 PMCID: PMC3868168 DOI: 10.1002/brb3.171] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/30/2013] [Accepted: 08/11/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is well established that aging and vascular processes interact to disrupt cerebral hemodynamics in older adults. However, the independent effects of cerebral perfusion on neurocognitive function among older adults remain poorly understood. We examined the associations among cerebral perfusion, cognitive function, and brain structure in older adults with varying degrees of vascular disease using perfusion magnetic resonance imaging (MRI) arterial spin labeling (ASL). MATERIALS AND METHODS 52 older adults underwent neuroimaging and were administered the Mini Mental State Examination (MMSE), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and measures of attention/executive function. ASL and T1-weighted MRI were used to quantify total brain perfusion, total brain volume (TBV), and cortical thickness. RESULTS Regression analyses showed reduced total brain perfusion was associated with poorer performance on the MMSE, RBANS total index, immediate and delayed memory composites, and Trail Making Test B. Reduced frontal lobe perfusion was associated with worse executive and memory function. A similar pattern emerged between temporal lobe perfusion and immediate memory. Regression analyses revealed that decreased total brain perfusion was associated with smaller TBV and mean cortical thickness. Regional effects of reduced total cerebral perfusion were found on temporal and parietal lobe volumes and frontal and temporal cortical thickness. DISCUSSION Reduced cerebral perfusion is independently associated with poorer cognition, smaller TBV, and reduced cortical thickness in older adults. CONCLUSION Prospective studies are needed to clarify patterns of cognitive decline and brain atrophy associated with cerebral hypoperfusion.
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Affiliation(s)
| | - John Gunstad
- Department of Psychology, Kent State University Kent, Ohio
| | - Beth A Jerskey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Providence, Rhode Island
| | - Xiaomeng Xu
- Department of Psychology, Idaho State University Pocatello, Idaho
| | - Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai New York, NY
| | - Jason Hassenstab
- Department of Neurology, Washington University at St. Louis St. Louis, Missouri
| | | | - Edward G Walsh
- Department of Neuroscience, Brown University Providence, Rhode Island
| | - Donald R Labbe
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Providence, Rhode Island
| | - Richard Hoge
- Department of Physiology, Université de Montréal Montréal, Quebec, Canada
| | - Ronald A Cohen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Providence, Rhode Island ; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida Gainesville, Florida
| | - Lawrence H Sweet
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Providence, Rhode Island ; Butler Hospital Providence, Rhode Island ; Department of Psychology, University of Georgia Athens, Georgia
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Chen JJ, Rosas HD, Salat DH. The relationship between cortical blood flow and sub-cortical white-matter health across the adult age span. PLoS One 2013; 8:e56733. [PMID: 23437228 PMCID: PMC3578934 DOI: 10.1371/journal.pone.0056733] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/14/2013] [Indexed: 11/18/2022] Open
Abstract
Degeneration of cerebral white matter is commonly observed in aging, and the associated degradation in neural connectivity contributes to cognitive decline in older adults. Vascular dysfunction has been implicated as a potential mechanism for general age-related neural tissue deterioration; however, no prior study has examined the direct relationship between cortical vascular health and subcortical white-matter integrity. In this work, we aimed to determine whether blood supply to the brain is associated with microstructural integrity of connective tissue, and whether such associations are regionally specific and mainly accounted for by aging. We examined the association between cerebral blood flow (CBF) in the cortical mantle, measured using arterial spin labeling (ASL), and subcortical white-matter integrity, measured using diffusion tensor imaging (DTI), in a group of healthy adults spanning early to late adulthood. We found cortical CBF to be significantly associated with white-matter integrity throughout the brain. In addition, these associations were only partially tied to aging, as they remained even when statistically controlling for age, and when restricting the analyses to a young subset of the sample. Furthermore, vascular risk was not a prominent determinant of these effects. These findings suggest that the overall blood supply to the brain is an important indicator of white-matter health in the normal range of variations amongst adults, and that the decline in CBF with advancing age may potentially exacerbate deterioration of the connective anatomy of the brain.
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Affiliation(s)
- J Jean Chen
- Rotman Research Institute, Baycrest Centre for Geriatric Care, University of Toronto, Toronto, Canada.
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King KS, Chen KX, Hulsey KM, McColl RW, Weiner MF, Nakonezny PA, Peshock RM. White matter hyperintensities: use of aortic arch pulse wave velocity to predict volume independent of other cardiovascular risk factors. Radiology 2013; 267:709-17. [PMID: 23392429 DOI: 10.1148/radiol.13121598] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the relationship between pulse wave velocity (PWV) from the aortic arch and subsequent cerebral microvascular disease independent of other baseline cardiovascular risk factors among the participants in the multiethnic Dallas Heart Study. MATERIALS AND METHODS Each subject gave written consent to participate in this HIPAA-compliant, institutional review board-approved prospective study. Aortic arch PWV was measured with phase-contrast magnetic resonance (MR) imaging in a population sample (n = 1270) drawn from the probability-based Dallas Heart Study. Seven years later, the volume of white matter hyperintensities (WMHs) was determined from brain MR images. Linear regression was conducted with aortic arch PWV, 15 other cardiovascular risk factors, and age, sex, and ethnicity included as predictors of WMH. The authors implemented a smoothly clipped absolute deviation-penalized variable selection method to evaluate an optimal predictive risk factor model. RESULTS Aortic arch PWV helped predict WMH volume independent of the other demographic and cardiovascular risk factors (regression coefficient: 0.29; standard error: 0.06; 95% confidence interval: 0.17, 0.42; P < .0001). The optimal predictor variables of subsequent WMH volume adjusted for sex and ethnicity included aortic arch PWV, age, systolic blood pressure, hypertension treatment, and congestive heart failure. The authors estimated that a 1% increase in aortic arch PWV (in meters per second) is related to a 0.3% increase in subsequent WMH volume (in milliliters) when all other variables in the model are held constant. CONCLUSION Aortic arch PWV measured with phase-contrast MR imaging is a highly significant independent predictor of subsequent WMH volume, with a higher standardized effect than any other cardiovascular risk factor assessed except for age. In an optimal predictive model of subsequent WMH burden, aortic arch PWV provides a distinct contribution along with systolic blood pressure, hypertension treatment, congestive heart failure, and age.
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Affiliation(s)
- Kevin S King
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
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Rosano C, Watson N, Chang Y, Newman AB, Aizenstein HJ, Du Y, Venkatraman V, Harris TB, Barinas-Mitchell E, Sutton-Tyrrell K. Aortic pulse wave velocity predicts focal white matter hyperintensities in a biracial cohort of older adults. Hypertension 2012; 61:160-5. [PMID: 23172923 DOI: 10.1161/hypertensionaha.112.198069] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the cross-sectional relationship of arterial stiffness with cerebral small vessel disease is consistently shown in middle-aged and young-old adults, it is less clear whether these associations remain significant over time in very old adults. We hypothesize that arterial stiffness is longitudinally associated with white matter characteristics, and associations are stronger within watershed areas. Neuroimaging was obtained in 2006-2008 from 303 elderly (mean age 82.9 years, 59% women, 41% black) with pulse wave velocity (PWV) measures in 1997-1998. Multivariable regression models estimated the coefficients for PWV (cm/sec) in relationship to presence, severity, and spatial distribution of white matter hyperintensities (WMH), gray matter volume, and fractional anisotropy from diffusion tensor, adjusting for demographic, cardiovascular risk factors, and diseases from 1997-1998 to 2006-2008. Higher PWV in 1997-1998 was associated with greater WMH volume in 2006-2008 within the left superior longitudinal fasciculus (age and total brain WMH adjusted, P=0.023), but not with WMH in other tracts or with fractional anisotropy or gray matter volume from total brain (P>0.2). Associations were stronger in blacks than in whites, remaining significant in fully adjusted models. Elderly with WMH in tracts related to processing speed and memory are more likely to have had higher PWV values 10 years prior, before neuroimaging data being available. Future studies should address whether arterial stiffness can serve as an early biomarker of covert brain structural abnormalities and whether early arterial stiffness control can promote successful brain aging, especially in black elderly.
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Affiliation(s)
- Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
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de Roos A. Reversibility of Intrathoracic Lipotoxicity in Obesity After Bariatric Surgery. J Am Coll Cardiol 2012; 60:1390-2. [DOI: 10.1016/j.jacc.2012.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/10/2012] [Indexed: 10/27/2022]
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Aortic stiffness in type-1 diabetes mellitus; beware of hypertension. Int J Cardiovasc Imaging 2012; 28:551-4. [PMID: 21442264 PMCID: PMC3326363 DOI: 10.1007/s10554-011-9850-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 03/10/2011] [Indexed: 12/02/2022]
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Time-dependent alterations in rat macrovessels with type 1 diabetes. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:278620. [PMID: 22315586 PMCID: PMC3270547 DOI: 10.1155/2012/278620] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 10/03/2011] [Accepted: 10/07/2011] [Indexed: 11/17/2022]
Abstract
Vascular complications are associated with the progressive severity of diabetes, resulting in significant morbidity and mortality. This study quantifies functional vascular parameters and macrovascular structure in a rat model of type 1 diabetes. While there was no difference in the systemic arterial elastance (Ea) with 50 days of diabetes, changes were noted in the aorta and femoral artery including increased tunica media extracellular matrix content, decreased width of both the media and individual smooth muscle cell layers, and increased incidence of damaged mitochondria. Extracellular matrix proteins and elastin levels were significantly greater in the aorta of diabetic animals. These differences correlated with diminished matrix metalloprotease activity in the aorta of the diabetic animals. In conclusion, diabetes significantly altered the structure and ultrastructure of the aorta and femoral artery before systemic changes in arterial elastance could be detected.
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Westenberg JJM, van Poelgeest EP, Steendijk P, Grotenhuis HB, Jukema JW, de Roos A. Bramwell-Hill modeling for local aortic pulse wave velocity estimation: a validation study with velocity-encoded cardiovascular magnetic resonance and invasive pressure assessment. J Cardiovasc Magn Reson 2012; 14:2. [PMID: 22230116 PMCID: PMC3312851 DOI: 10.1186/1532-429x-14-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 01/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Bramwell-Hill model describes the relation between vascular wall stiffness expressed in aortic distensibility and the pulse wave velocity (PWV), which is the propagation speed of the systolic pressure wave through the aorta. The main objective of this study was to test the validity of this model locally in the aorta by using PWV-assessments based on in-plane velocity-encoded cardiovascular magnetic resonance (CMR), with invasive pressure measurements serving as the gold standard. METHODS Seventeen patients (14 male, 3 female, mean age ± standard deviation = 57 ± 9 years) awaiting cardiac catheterization were prospectively included. During catheterization, intra-arterial pressure measurements were obtained in the aorta at multiple locations 5.8 cm apart. PWV was determined regionally over the aortic arch and locally in the proximal descending aorta. Subsequently, patients underwent a CMR examination to measure aortic PWV and aortic distention. Distensibility was determined locally from the aortic distension at the proximal descending aorta and the pulse pressure measured invasively during catheterization and non-invasively from brachial cuff-assessment. PWV was determined regionally in the aortic arch using through-plane and in-plane velocity-encoded CMR, and locally at the proximal descending aorta using in-plane velocity-encoded CMR. Validity of the Bramwell-Hill model was tested by evaluating associations between distensibility and PWV. Also, theoretical PWV was calculated from distensibility measurements and compared with pressure-assessed PWV. RESULTS In-plane velocity-encoded CMR provides stronger correlation (p = 0.02) between CMR and pressure-assessed PWV than through-plane velocity-encoded CMR (r = 0.69 versus r = 0.26), with a non-significant mean error of 0.2 ± 1.6 m/s for in-plane versus a significant (p = 0.006) error of 1.3 ± 1.7 m/s for through-plane velocity-encoded CMR. The Bramwell-Hill model shows a significantly (p = 0.01) stronger association between distensibility and PWV for local assessment (r = 0.8) than for regional assessment (r = 0.7), both for CMR and for pressure-assessed PWV. Theoretical PWV is strongly correlated (r = 0.8) with pressure-assessed PWV, with a statistically significant (p = 0.04) mean underestimation of 0.6 ± 1.1 m/s. This theoretical PWV-estimation is more accurate when invasively-assessed pulse pressure is used instead of brachial cuff-assessment (p = 0.03). CONCLUSIONS CMR with in-plane velocity-encoding is the optimal approach for studying Bramwell-Hill associations between local PWV and aortic distensibility. This approach enables non-invasive estimation of local pulse pressure and distensibility.
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Affiliation(s)
- Jos JM Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Heynric B Grotenhuis
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - JW Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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