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Wang X, Shi Y, Chen Y, Gao Y, Wang T, Li Z, Wang Y. Blood-Brain Barrier Breakdown is a Sensitive Biomarker of Cognitive and Language Impairment in Patients with White Matter Hyperintensities. Neurol Ther 2023; 12:1745-1758. [PMID: 37490234 PMCID: PMC10444912 DOI: 10.1007/s40120-023-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Similar white matter hyperintensities (WMH) burden may have varied cognitive outcomes in patients with cerebral small vessel disease (CSVD). This study aimed to evaluate whether blood-brain barrier (BBB) permeability is associated with cognitive impairment (CI) heterogeneity in patients with WMH. METHODS We recruited 51 participants with WMH. We evaluated WMH burden using the Fazekas scale and WMH volume on structural magnetic resonance imaging (MRI), and assessed BBB permeability using dynamic contrast-enhanced (DCE)-MRI. We used permeability-surface area product (PS) from the Patlak model to represent BBB permeability. All patients underwent Mini-Mental State Examination (MMSE), Boston Naming Test (BNT) and animal verbal fluency test (VFT) for cognitive assessment. We divided patients into CI and non-CI groups based on their MMSE scores (< 27 or ≥ 27) and used multiple linear regression models to investigate the associations between MRI parameters and cognitive function. RESULTS Patients in the two groups did not differ in Fazekas scores and WMH volume. However, patients in the CI group showed significantly higher PS in the WMH regions than those in non-CI group (1.89 × 10-3 versus 1.00 × 10-3, p = 0.032 in periventricular WMH [PVWMH]; 1.27 × 10-3 versus 0.74 × 10-3, p = 0.043 in deep WMH [DWMH]), indicating the breakdown of BBB in the CI group. In all patients with WMH, increased BBB permeability in PVWMH and DWMH was significantly associated with lower cognitive and language function after adjustment for age, education level (EL) and intracranial volume (ICV). In the CI group, this correlation remained significant. WMH volume was not associated with cognitive performance in either all patients or those with CI. CONCLUSION BBB impairment might be a more sensitive indicator for cognitive and language dysfunction than WMH volume in patients with WMH and possibly explains the heterogeneity of cognitive performance in patients with similar WMH burden.
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Affiliation(s)
- Xing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Yulu Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Yiyi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Ying Gao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Tingting Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Zhengyang Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- Chinese Institute for Brain Research, Beijing, 100070, China.
- National Centre for Neurological Diseases, Beijing, 100070, China.
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China.
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China.
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Salvadori E, Brambilla M, Maestri G, Nicotra A, Cova I, Pomati S, Pantoni L. The clinical profile of cerebral small vessel disease: Toward an evidence-based identification of cognitive markers. Alzheimers Dement 2023; 19:244-260. [PMID: 35362229 PMCID: PMC10084195 DOI: 10.1002/alz.12650] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 01/18/2023]
Abstract
There is no consensus on which test is more suited to outline the cognitive deficits of cerebral small vessel disease (cSVD) patients. We explored the ability of eight cognitive tests, selected in a previous systematic review as the most commonly used in this population, to differentiate among cSVD patients, controls, and other dementing conditions performing a meta-analysis of 86 studies. We found that cSVD patients performed worse than healthy controls in all tests while data on the comparison to neurodegenerative diseases were limited. We outlined a lack of data on these tests' accuracy on the diagnosis. Cognitive tests measuring processing speed were those mostly associated with neuroimaging cSVD markers. There is currently incomplete evidence that a single test could differentiate cSVD patients with cognitive decline from other dementing diseases. We make preliminary proposals on possible strategies to gain information about the clinical definition of cSVD that currently remains a neuroimaging-based one.
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Affiliation(s)
| | | | - Giorgia Maestri
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Alessia Nicotra
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Ilaria Cova
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Simone Pomati
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Leonardo Pantoni
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Stroke and Dementia Lab, 'Luigi Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Association between Changes in White Matter Microstructure and Cognitive Impairment in White Matter Lesions. Brain Sci 2022; 12:brainsci12040482. [PMID: 35448013 PMCID: PMC9026911 DOI: 10.3390/brainsci12040482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 02/05/2023] Open
Abstract
This study investigated the characteristics of cognitive impairment in patients with white matter lesions (WMLs) caused by cerebral small vessel disease and the corresponding changes in WM microstructures. Diffusion tensor imaging (DTI) data of 50 patients with WMLs and 37 healthy controls were collected. Patients were divided into vascular cognitive impairment non-dementia and vascular dementia groups. Tract-based spatial statistics showed that patients with WMLs had significantly lower fractional anisotropy (FA) and higher mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values throughout the WM areas but predominately in the forceps minor, forceps major (FMA), bilateral corticospinal tract, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, inferior longitudinal fasciculus (ILF), and anterior thalamic radiation, compared to the control group. These fiber bundles were selected as regions of interest. There were significant differences in the FA, MD, AD, and RD values (p < 0.05) between groups. The DTI metrics of all fiber bundles significantly correlated with the Montreal Cognitive Assessment (p < 0.05), with the exception of the AD values of the FMA and ILF. Patients with WMLs showed changes in diffusion parameters in the main WM fiber bundles. Quantifiable changes in WM microstructure are the main pathological basis of cognitive impairment, and may serve as a biomarker of WMLs.
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Lu T, Wang Z, Cui Y, Zhou J, Wang Y, Ju S. Disrupted Structural Brain Connectome Is Related to Cognitive Impairment in Patients With Ischemic Leukoaraiosis. Front Hum Neurosci 2021; 15:654750. [PMID: 34177491 PMCID: PMC8223255 DOI: 10.3389/fnhum.2021.654750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Ischemic leukoaraiosis (ILA) is related to cognitive impairment and vascular dementia in the elderly. One possible mechanism could be the disruption of white matter (WM) tracts and network function that connect distributed brain regions involved in cognition. The purpose of this study was to investigate the relationship between structural connectome and cognitive functions in ILA patients. A total of 89 patients with ILA (Fazekas score ≥ 3) and 90 healthy controls (HCs) underwent comprehensive neuropsychological examinations and diffusion tensor imaging scans. The tract-based spatial statistics approach was employed to investigate the WM integrity. Graph theoretical analysis was further applied to construct the topological architecture of the structural connectome in ILA patients. Partial correlation analysis was used to investigate the relationships between network measures and cognitive performances in the ILA group. Compared with HCs, the ILA patients showed widespread WM integrity disruptions. The ILA group displayed increased characteristic path length (L p) and decreased global network efficiency at the level of the whole brain relative to HCs, and reduced nodal efficiencies, predominantly in the frontal-subcortical and limbic system regions. Furthermore, these structural connectomic alterations were associated with cognitive impairment in ILA patients. The association between WM changes (i.e., fractional anisotropy and mean diffusivity measures) and cognitive function was mediated by the structural connectivity measures (i.e., local network efficiency and L p). In conclusion, cognitive impairment in ILA patients is related to microstructural disruption of multiple WM fibers and topological disorganization of structural networks, which have implications in understanding the relationship between ILA and the possible attendant cognitive impairment.
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Affiliation(s)
- Tong Lu
- Nanjing Medical University, Nanjing, China.,Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zan Wang
- Department of Neurology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ying Cui
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jiaying Zhou
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yuancheng Wang
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Shenghong Ju
- Nanjing Medical University, Nanjing, China.,Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Benson JC, Seyedsaadat SM, Mark I, Nasr DM, Rabinstein AA, Kallmes DF, Brinjikji W. Leukoaraiosis and acute ischemic stroke: 90-day clinical outcome following endovascular recanalization, with proposed "L-ASPECTS". J Neurointerv Surg 2021; 13:384-389. [PMID: 32487764 DOI: 10.1136/neurintsurg-2020-015957] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND To assess if leukoaraiosis severity is associated with outcome in patients with acute ischemic stroke (AIS) following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score. METHODS A retrospective review was completed of AIS patients that underwent mechanical thrombectomy for anterior circulation large vessel occlusion. The primary outcome measure was 90-day mRS. A proposed Leukoaraiosis-ASPECTS ("L-ASPECTS") was calculated by subtracting from the traditional ASPECT based on leukoaraiosis severity (1 point subtracted if mild, 2 if moderate, 3 if severe). L-ASEPCTS score performance was validated using a consecutive cohort of 75 AIS LVO patients. RESULTS 174 patients were included in this retrospective analysis: average age: 68.0±9.1. 28 (16.1%) had no leukoaraiosis, 66 (37.9%) had mild, 62 (35.6%) had moderate, and 18 (10.3%) had severe. Leukoaraiosis severity was associated with worse 90-day mRS among all patients (P=0.0005). Both L-ASPECTS and ASPECTS were associated with poor outcomes, but the area under the curve (AUC) was higher with L-ASPECTS (P<0.0001 and AUC=0.7 for L-ASPECTS; P=0.04 and AUC=0.59 for ASPECTS). In the validation cohort, the AUC for L-ASPECTS was 0.79 while the AUC for ASPECTS was 0.70. Of patients that had successful reperfusion (mTICI 2b/3), the AUC for traditional ASPECTS in predicting good functional outcome was 0.80: AUC for L-ASPECTS was 0.89. CONCLUSIONS Leukoaraiosis severity on pre-mechanical thrombectomy NCCT is associated with worse 90-day outcome in patients with AIS following endovascular recanalization, and is an independent risk factor for worse outcomes. A proposed L-ASPECTS score had stronger association with outcome than the traditional ASPECTS score.
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Affiliation(s)
| | | | - Ian Mark
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Deena M Nasr
- Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Wang Z, Bai L, Liu Q, Wang S, Sun C, Zhang M, Zhang Y. Corpus callosum integrity loss predicts cognitive impairment in Leukoaraiosis. Ann Clin Transl Neurol 2020; 7:2409-2420. [PMID: 33119959 PMCID: PMC7732249 DOI: 10.1002/acn3.51231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate regional white matter fibers loss in Leukoaraiosis (LA) and its relationship with cognitive impairments. Methods Fifty‐six participants with LA and 38 healthy controls underwent clinical evaluations and MR scans. Participants with LA were classified as cognitively normal (LA‐NC, n = 18), vascular cognitive impairment of none dementia (LA‐VCIND, n = 24), and vascular dementia (LA‐VaD, n = 14) by Mini‐Mental State Examination and Clinical Dementia Rating. Cognitive domains including visual‐spatial, naming, attention, language, abstraction, memory, and orientation were assessed. With the use of Tract‐based spatial statistics, mean fractional anisotropy (FA) of major white matter fiber tracts were compared between LA and controls and among LA groups with varying levels of cognitive impairments. Regression analyses were performed to evaluate relationships between FA values and cognitive performance. Results Participants showed significant FA reduction in the corpus callosum (CC), bilateral corona radiata, anterior limb of the internal capsule, external capsule, posterior thalamic radiation, and superior longitudinal fasciculus compared to controls and across LA groups. The LA‐VaD group showed consistent damage in the body and genu of CC compared to the LA‐NC and LA‐VCIND groups. A positive correlation between visual‐spatial and FA reduction in right anterior corona radiates in LA‐VCIND and body of CC in LA‐ VaD. Interpretation We found regional fiber loss in the CC across the cognitive spectrum in patients with LA and correlations between FA and visuospatial impairment in the anterior corona radiata in patients with LA‐VCIND and in the body of CC in patients with LA‐VaD.
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Affiliation(s)
- Zhuonan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.,Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Qi Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Chuanzhu Sun
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yumei Zhang
- Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Yang FPG, Bal SS, Lee JF, Chen CC. White Matter Differences in Networks in Elders with Mild Cognitive Impairment and Alzheimer's Disease. Brain Connect 2020; 11:180-188. [PMID: 32731749 DOI: 10.1089/brain.2020.0767] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Alzheimer's disease (AD) is associated with impairment of large-scale brain networks, disruption in structural connections, and functional disconnection between distant brain regions. Although decreased functional connectivity has been thoroughly investigated and reported by existing functional neuroimaging literature, this study investigated network-based differences due to the structural changes in white matter pathways in AD patients. We hypothesize that diffusion metrics of disrupted tracts that go through cognitive networks related with intrinsic awareness, motor movement, and executive control can be utilized as biomarkers to distinguish prodromal stage from AD stage. Methods: Diffusion MRI data of a total 154 subjects, including patients with clinical AD (n = 47) and patients with mild cognitive impairment (MCI) (n = 107) was used. To study structural changes associated with white matter fiber pathways voxel-averaged diffusion metrics and fiber density metrics were calculated. Results: Study revealed that AD patients exhibit disruptions in intrahemispheric tracts and projection fiber tracts as suggested by diffusion indices. Our whole brain analysis revealed that network differences within default mode network (DMN), sensory motor network, and frontoparietal networks are associated with disruption in inferior fronto-occipital fasciculus (IFOF), corticospinal tract, and superior longitudinal fasciculus. Global function revealed by Mini Mental State Examination correlate with those fiber pathways that form reciprocal connections within networks associated with motor movement and executive control. Conclusion: Diffusion metrics appear to be more sensitive than fiber density metrics in differentiating the structural changes in the white matter. Decreased fractional anisotropy along with increased mean diffusivity and radial diffusivity in forceps minor, corticospinal tract, and IFOF as an imaging biomarker would be ideal to distinguish AD patients from MCI patients. Difference of DMN, sensory motor network, and frontal parietal network in our study reveals that AD patients may suffer from poor motor movement and degraded executive control.
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Affiliation(s)
- Fan Pei Gloria Yang
- Center for Cognition and Mind Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Sukhdeep Singh Bal
- Department of Mathematical Sciences Liverpool, University of Liverpool, Merseyside, United Kingdom.,International Intercollegiate PhD Programme, National Tsing Hua University, Hsinchu, Taiwan
| | - Jia-Fu Lee
- Department of Psychiatry, Taipei Tzu Chi Hospital, Taipei, Taiwan
| | - Chia-Chi Chen
- Department of Early Childhood Care and Education, Kang Ning Junior College of Nursing, Taipei, Taiwan
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Chen HF, Huang LL, Li HY, Qian Y, Yang D, Qing Z, Luo CM, Li MC, Zhang B, Xu Y. Microstructural disruption of the right inferior fronto-occipital and inferior longitudinal fasciculus contributes to WMH-related cognitive impairment. CNS Neurosci Ther 2020; 26:576-588. [PMID: 31901155 PMCID: PMC7163793 DOI: 10.1111/cns.13283] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/07/2019] [Accepted: 12/12/2019] [Indexed: 01/03/2023] Open
Abstract
Aims White matter hyperintensity (WMH) is the most common neuroimaging manifestation of cerebral small vessel disease and is related to cognitive dysfunction or dementia. This study aimed to investigate the mechanism and effective indicators to predict WMH‐related cognitive impairment. Methods We recruited 22 healthy controls (HC), 25 cases of WMH with normal cognition (WMH‐NC), and 23 cases of WMH with mild cognitive impairment (WMH‐MCI). All individuals underwent diffusion tensor imaging (DTI) and a standardized neuropsychological assessment. Automated Fiber Quantification was used to extract altered DTI metrics between groups, and partial correlation was performed to assess the associations between WM integrity and cognitive performance. Furthermore, machine learning analyses were performed to determine underlying imaging markers of WMH‐related cognitive impairment. Results Our study found that mean diffusivity (MD) values of several fiber bundles including the bilateral anterior thalamic radiation (ATR), the left inferior fronto‐occipital fasciculus (IFOF), the right inferior longitudinal fasciculus (ILF), and the right superior longitudinal fasciculus (SLF) were negatively correlated with memory function, while that of the anterior component of the right IFOF and the posterior and intermediate component of the right ILF showed significant negative correlation with MMSE and episodic memory, respectively. Furthermore, machine learning analyses showed that the accuracy of recognizing WMH‐MCI patients from the WMH populations was up to 80.5% and the intermediate and posterior components of the right ILF and the anterior component of the right IFOF contribute the most. Conclusions Changes in the properties of DTI may be the potential mechanism of WMH‐related MCI, especially the right IFOF and the right ILF, which may become imaging markers for predicting WMH‐related cognitive dysfunction.
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Affiliation(s)
- Hai-Feng Chen
- Department of Neurology, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Drum Tower Hospital, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Clinic Medical Center for Neurology, Nanjing, China
| | - Li-Li Huang
- Department of Neurology, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Drum Tower Hospital, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Clinic Medical Center for Neurology, Nanjing, China
| | - Hui-Ya Li
- Department of Neurology, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Drum Tower Hospital, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Clinic Medical Center for Neurology, Nanjing, China
| | - Yi Qian
- Department of Neurology, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Drum Tower Hospital, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Clinic Medical Center for Neurology, Nanjing, China
| | - Dan Yang
- Department of Neurology, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Drum Tower Hospital, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Clinic Medical Center for Neurology, Nanjing, China
| | - Zhao Qing
- Department of Radiology, Afliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Cai-Mei Luo
- Department of Neurology, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Drum Tower Hospital, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Clinic Medical Center for Neurology, Nanjing, China
| | - Meng-Chun Li
- Department of Neurology, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Drum Tower Hospital, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Clinic Medical Center for Neurology, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Afliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yun Xu
- Department of Neurology, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Drum Tower Hospital, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Clinic Medical Center for Neurology, Nanjing, China
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Tsui-Caldwell YHW, Farrer TJ, McDonnell Z, Christensen Z, Finuf C, Bigler ED, Tschanz JT, Norton MC, Welsh-Bohmer KA. MRI Clinical Ratings and Cognitive Function in a Cross-Sectional Population Study of Dementia: The Cache County Memory Study. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2019; 6:100-107. [PMID: 30756116 DOI: 10.14283/jpad.2019.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND White matter integrity in aging populations is associated with increased risk of cognitive decline, dementia diagnosis, and mortality. Population-based data can elucidate this association. OBJECTIVES To examine the association between white matter integrity, as measured by a clinical rating scale of hyperintensities, and mental status in older adults including advanced aging. DESIGN Scheltens Ratings Scale was used to qualitatively assess white matter (WM) hyperintensities in participants of the Cache County Memory Study (CCMS), an epidemiological study of Alzheimer's disease in an exceptionally long-lived population. Further, the relation between Mini-Mental State Exam (MMSE) and WM hyperintensities were explored. METHOD Participants consisted of 415 individuals with dementia and 22 healthy controls. RESULTS CCMS participants, including healthy controls, had high levels of WM pathology as measured by Scheltens Ratings Scale score. While age did not significantly relate to WM pathology, higher Scheltens Ratings Scale scores were associated with lower MMSE findings (correlation between -0.14 and -0.22; p < .05). CONCLUSIONS WM pathology was common in this county-wide population sample of those ranging in age from 65 to 106. Increased WM burden was found to be significantly associated with decreased overall MMSE performance.
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Affiliation(s)
- Y H W Tsui-Caldwell
- Thomas J. Farrer Ph.D., 932 Morreene Road, Durham, NC 27710, USA, (919)-668-6802,
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Qiu J, Cheng HD, Dong T, Xiang L, Wang M, Xia L, Wang K. Prospective memory impairment in patients with white matter lesions. Int J Neurosci 2019; 129:438-446. [PMID: 30616434 DOI: 10.1080/00207454.2018.1538988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A vast majority of the episodic memory literature in white matter lesions (WML) had focused on "retrospective memory (RM)", little was known about prospective memory (PM) in WML patients. The aim of our study was to investigate the effect of WML patients on event-based prospective memory (EBPM) and time-based prospective memory (TBPM). In addition, our study attempted to understand the possible mechanisms of PM damage in WML patients. METHODS A total of 42 WML patients and 40 age and education level matched healthy controls were included. EBPM (an action whenever particular words were presented) and TBPM (an action at certain times) were performed to test the involvement of PM in WML. The extent of WML within cholinergic pathways were assessed using the cholinergic pathways hyperintensities scale (CHIPS). RESULTS A significant difference was found in the performance of Montreal Cognitive Assessment (MOCA) (21.8 ± 3.9 vs. 26.6 ± 1.7, p < 0.05) and TBPM (2.88 ± 1.21 vs. 4.27 ± 0.78, p < 0.05), but not Mini-Mental State Examination (MMSE) (26.9 ± 2.8 vs. 27.3 ± 1.2, p > 0.05) and EBPM (3.62 ± 1.25 vs.4.47 ± 1.11, p > 0.05) in WML patients compared with the healthy controls. Moreover, TBPM and MOCA scores were negatively correlated with CHIPS scores. CONCLUSIONS WML patients were impaired in TBPM but not in EBPM, supporting that EBPM and TBPM have different neural mechanisms. Our results demonstrated that WML are involved in the TBPM probably by affecting the central cholinergic pathway.
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Affiliation(s)
- Ju Qiu
- a Department of Neurology , The First Affiliated Hospital of Anhui Medical University , Hefei , Anhui Province , China.,b Anhui Province Key Laboratory of Cognition and Neuropsychiatry Disorder , Hefei , Anhui Province , China.,c Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health , Hefei , Anhui Province , China.,d Department of Medical Psychology , Anhui Psychologic Medicine Center, Anhui Medical University , Hefei , Anhui Province , China.,e Department of Neurology , The Second Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Huai-Dong Cheng
- f Department of Oncology , The Second Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Ting Dong
- g Department of Neurology , The First Affiliated Hospital of Anhui University of Chinese Medicine , Hefei , Anhui , China
| | - Li Xiang
- h Department of Radiology , The Second Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Min Wang
- e Department of Neurology , The Second Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Lan Xia
- e Department of Neurology , The Second Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Kai Wang
- a Department of Neurology , The First Affiliated Hospital of Anhui Medical University , Hefei , Anhui Province , China.,b Anhui Province Key Laboratory of Cognition and Neuropsychiatry Disorder , Hefei , Anhui Province , China.,c Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health , Hefei , Anhui Province , China.,d Department of Medical Psychology , Anhui Psychologic Medicine Center, Anhui Medical University , Hefei , Anhui Province , China
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11
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Yuan J, Feng L, Hu W, Zhang Y. Use of Multimodal Magnetic Resonance Imaging Techniques to Explore Cognitive Impairment in Leukoaraiosis. Med Sci Monit 2018; 24:8910-8915. [PMID: 30531675 PMCID: PMC6296345 DOI: 10.12659/msm.912153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Leukoaraiosis, also referred to as white-matter hyperintensities (WMHs) or age-related white matter changes, is the most frequently seen lesion on brain magnetic resonance images (MRI) in the elderly. LA is a subject of intense research interest, and is correlated with stroke, cognitive impairment or dementia, disturbances, affective disorders, and poor prognoses. Rapid advances in neuroimaging have enabled greater understanding of LA associated with aging-related cognitive decline or dementia. Recently, the techniques of multimodal MRI, such as structural MRI (sMRI), resting-state functional MRI (rs-MRI), cerebrovascular reactivity (CVR), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), and dynamic contrast-enhanced MRI (DCE-MRI), have been used to explore the underlying mechanism of cognitive impairment in patients with LA. These multimodal MRI techniques may provide further insights into the structural and functional changes of LA with cognitive dysfunction.
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Affiliation(s)
- Junliang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Li Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (mainland)
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yumei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (mainland)
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12
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Mascalchi M, Salvadori E, Toschi N, Giannelli M, Orsolini S, Ciulli S, Ginestroni A, Poggesi A, Giorgio A, Lorenzini F, Pasi M, De Stefano N, Pantoni L, Inzitari D, Diciotti S. DTI-derived indexes of brain WM correlate with cognitive performance in vascular MCI and small-vessel disease. A TBSS study. Brain Imaging Behav 2018; 13:594-602. [DOI: 10.1007/s11682-018-9873-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Using DTI to assess white matter microstructure in cerebral small vessel disease (SVD) in multicentre studies. Clin Sci (Lond) 2017; 131:1361-1373. [PMID: 28487471 PMCID: PMC5461938 DOI: 10.1042/cs20170146] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 12/22/2022]
Abstract
Diffusion tensor imaging (DTI) metrics such as fractional anisotropy (FA) and mean diffusivity (MD) have been proposed as clinical trial markers of cerebral small vessel disease (SVD) due to their associations with outcomes such as cognition. However, studies investigating this have been predominantly single-centre. As clinical trials are likely to be multisite, further studies are required to determine whether associations with cognition of similar strengths can be detected in a multicentre setting. One hundred and nine patients (mean age =68 years) with symptomatic lacunar infarction and confluent white matter hyperintensities (WMH) on MRI was recruited across six sites as part of the PRESERVE DTI substudy. After handling missing data, 3T-MRI scanning was available from five sites on five scanner models (Siemens and Philips), alongside neuropsychological and quality of life (QoL) assessments. FA median and MD peak height were extracted from DTI histogram analysis. Multiple linear regressions were performed, including normalized brain volume, WMH lesion load, and n° lacunes as covariates, to investigate the association of FA and MD with cognition and QoL. DTI metrics from all white matter were significantly associated with global cognition (standardized β =0.268), mental flexibility (β =0.306), verbal fluency (β =0.376), and Montreal Cognitive Assessment (MoCA) (β =0.273). The magnitudes of these associations were comparable with those previously reported from single-centre studies found in a systematic literature review. In this multicentre study, we confirmed associations between DTI parameters and cognition, which were similar in strength to those found in previous single-centre studies. The present study supports the use of DTI metrics as biomarkers of disease progression in multicentre studies.
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14
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Ogama N, Sakurai T, Nakai T, Niida S, Saji N, Toba K, Umegaki H, Kuzuya M. Impact of frontal white matter hyperintensity on instrumental activities of daily living in elderly women with Alzheimer disease and amnestic mild cognitive impairment. PLoS One 2017; 12:e0172484. [PMID: 28253275 PMCID: PMC5333806 DOI: 10.1371/journal.pone.0172484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/06/2017] [Indexed: 11/19/2022] Open
Abstract
Background Instrumental activities of daily living (IADL) start to decline during the progression of amnestic mild cognitive impairment (aMCI) to Alzheimer disease (AD). Cognitive and physical decline are involved in the loss of functional independence. However, little is known about AD-related neural change that leads to IADL impairment. The purpose of this study was to clarify the effects of regional white matter hyperintensity (WMH) on IADL impairment in persons with AD and aMCI. Methods The participants were 347 female subjects aged 65–85 years diagnosed with AD (n = 227), aMCI (n = 44) or normal cognition (n = 76). IADL was assessed by the Lawton Index. Cognition, mood and mobility function were evaluated by comprehensive geriatric assessment batteries. WMH and brain atrophy were analyzed with brain magnetic resonance imaging, using an automatic segmentation program. Regional WMH was measured in the frontal, temporal, occipital and parietal lobes. Results Ability to carry out IADL of shopping, food preparation, mode of transportation, responsibility for own medication, and ability to handle finances was obviously impaired in the early stage of AD. Frontal WMH was specifically associated with disability to do shopping and food preparation even after adjusting for several confounders including brain atrophy. Conclusions IADL subcategories were differentially impaired along with cognitive status in persons with AD and aMCI. Frontal WMH was an important predictor of impaired ability to do shopping and food preparation. A preventive strategy for WMH might lead to suppression of IADL disability and slow the progression of AD.
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Affiliation(s)
- Noriko Ogama
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
- * E-mail:
| | - Toshiharu Nakai
- NeuroImaging and Informatics, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Diciotti S, Orsolini S, Salvadori E, Giorgio A, Toschi N, Ciulli S, Ginestroni A, Poggesi A, De Stefano N, Pantoni L, Inzitari D, Mascalchi M. Resting state fMRI regional homogeneity correlates with cognition measures in subcortical vascular cognitive impairment. J Neurol Sci 2017; 373:1-6. [DOI: 10.1016/j.jns.2016.12.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/19/2016] [Accepted: 12/02/2016] [Indexed: 02/03/2023]
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16
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Perneczky R, Tene O, Attems J, Giannakopoulos P, Ikram MA, Federico A, Sarazin M, Middleton LT. Is the time ripe for new diagnostic criteria of cognitive impairment due to cerebrovascular disease? Consensus report of the International Congress on Vascular Dementia working group. BMC Med 2016; 14:162. [PMID: 27806707 PMCID: PMC5093932 DOI: 10.1186/s12916-016-0719-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/14/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Long before Alzheimer's disease was established as the leading cause of dementia in old age, cerebrovascular lesions were known to cause cognitive deterioration and associated disability. Since the middle of the last century, different diagnostic concepts for vascular dementia and related syndromes were put forward, yet no widely accepted diagnostic consensus exists to date. DISCUSSION Several international efforts, reviewed herein, are ongoing to define cognitive impairment due to cerebrovascular disease in its different stages and subtypes. The role of biomarkers is also being discussed, including cerebrospinal fluid proteins, structural and functional brain imaging, and genetic markers. The influence of risk factors, such as diet, exercise and different comorbidities, is emphasised by population-based research, and lifestyle changes are considered for the treatment and prevention of dementia. CONCLUSION To improve the diagnosis and management of vascular cognitive impairment, further progress has to be made in understanding the relevant pathomechanisms, including shared mechanisms with Alzheimer's disease; bringing together fragmented research initiatives in coordinated international programs; testing if known risk factors are modifiable in prospective interventional studies; and defining the pre-dementia and pre-clinical stages in line with the concept of mild cognitive impairment due to Alzheimer's disease.
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Affiliation(s)
- Robert Perneczky
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, Charing Cross Hospital, St Dunstan's Road, W6 8RP, London, UK. .,Department of Psychiatry and Psychotherapy, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany. .,Cognitive Impairment and Dementia Service, West London Mental Health NHS Trust, Lakeside Mental Health Unit, West Middlesex University Hospital, Twickenham Road, TW7 6FY, London, UK. .,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Nussbaumstr. 7, 80336, München, Germany.
| | - Oren Tene
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Haim Weizman St 6, Tel Aviv-Yafo, 64239, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 69978, Israel
| | - Johannes Attems
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, NE4 5PL, Newcastle upon Tyne, UK
| | - Panteleimon Giannakopoulos
- Department of Psychiatry, University of Geneva School of Medicine, 2 rue Verte, 1205, Geneva, Switzerland
| | - M Arfan Ikram
- Departments of Epidemiology, Radiology and Neurology, Erasmus MC, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Antonio Federico
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Marie Sarazin
- Unit of Neurology of Memory and Language, Centre de Psychiatrie et Neurosciences, INSERM UMR S894, Centre Hospitalier Sainte Anne and Université Paris Descartes, Sorbonne Paris Cité, 75013, Paris, France
| | - Lefkos T Middleton
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, Charing Cross Hospital, St Dunstan's Road, W6 8RP, London, UK.
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17
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Reginold W, Itorralba J, Luedke AC, Fernandez-Ruiz J, Reginold J, Islam O, Garcia A. Tractography at 3T MRI of Corpus Callosum Tracts Crossing White Matter Hyperintensities. AJNR Am J Neuroradiol 2016; 37:1617-22. [PMID: 27127001 DOI: 10.3174/ajnr.a4788] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/16/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The impact of white matter hyperintensities on the diffusion characteristics of crossing tracts is unclear. This study used quantitative tractography at 3T MR imaging to compare, in the same individuals, the diffusion characteristics of corpus callosum tracts that crossed white matter hyperintensities with the diffusion characteristics of corpus callosum tracts that did not pass through white matter hyperintensities. MATERIALS AND METHODS Brain T2 fluid-attenuated inversion recovery-weighted and diffusion tensor 3T MR imaging scans were acquired in 24 individuals with white matter hyperintensities. Tractography data were generated by the Fiber Assignment by Continuous Tracking method. White matter hyperintensities and corpus callosum tracts were manually segmented. In the corpus callosum, the fractional anisotropy, radial diffusivity, and mean diffusivity of tracts crossing white matter hyperintensities were compared with the fractional anisotropy, radial diffusivity, and mean diffusivity of tracts that did not cross white matter hyperintensities. The cingulum, long association fibers, corticospinal/bulbar tracts, and thalamic projection fibers were included for comparison. RESULTS Within the corpus callosum, tracts that crossed white matter hyperintensities had decreased fractional anisotropy compared with tracts that did not pass through white matter hyperintensities (P = .002). Within the cingulum, tracts that crossed white matter hyperintensities had increased radial diffusivity compared with tracts that did not pass through white matter hyperintensities (P = .001). CONCLUSIONS In the corpus callosum and cingulum, tracts had worse diffusion characteristics when they crossed white matter hyperintensities. These results support a role for white matter hyperintensities in the disruption of crossing tracts.
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Affiliation(s)
- W Reginold
- From the Departments of Medical Imaging (W.R.) Memory Clinics (W.R., A.G.), Division of Geriatric Medicine, Department of Medicine
| | - J Itorralba
- Centre for Neuroscience Studies (J.I., A.G., A.C.L.), Queen's University, Kingston, Ontario, Canada
| | - A C Luedke
- Centre for Neuroscience Studies (J.I., A.G., A.C.L.), Queen's University, Kingston, Ontario, Canada
| | - J Fernandez-Ruiz
- Facultad de Medicina, (J.F.-R.), Universidad Nacional Autonoma de Mexico, Coyoacán, Mexico
| | - J Reginold
- Life Sciences (J.R.), University of Toronto, Toronto, Ontario, Canada
| | - O Islam
- Department of Diagnostic Radiology (O.I.), Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - A Garcia
- Memory Clinics (W.R., A.G.), Division of Geriatric Medicine, Department of Medicine Centre for Neuroscience Studies (J.I., A.G., A.C.L.), Queen's University, Kingston, Ontario, Canada
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18
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Ciulli S, Citi L, Salvadori E, Valenti R, Poggesi A, Inzitari D, Mascalchi M, Toschi N, Pantoni L, Diciotti S. Prediction of Impaired Performance in Trail Making Test in MCI Patients With Small Vessel Disease Using DTI Data. IEEE J Biomed Health Inform 2016; 20:1026-33. [DOI: 10.1109/jbhi.2016.2537808] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Mascalchi M, Pantoni L, Giannelli M, Valenti R, Bianchi A, Pracucci G, Orsolini S, Ciulli S, Tessa C, Poggesi A, Pescini F, Inzitari D, Diciotti S. Diffusion Tensor Imaging to Map Brain Microstructural Changes in CADASIL. J Neuroimaging 2016; 27:85-91. [PMID: 27357066 DOI: 10.1111/jon.12374] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/19/2016] [Accepted: 05/31/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Diffusion tensor imaging (DTI) is sensitive to brain microstructural changes. The aims of this DTI study were to map voxelwise the spatial distribution of brain microstructural changes in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and to investigate any correlation between DTI-derived indices and extension of T2 hyperintensity. METHODS Eighteen patients with CADASIL and 18 age-, sex-, and education-level-matched healthy controls underwent magnetic resonance imaging at 3 T. Differences in DTI-derived indices (mean diffusivity [MD], fractional anisotropy [FA], axial [AD] and radial [RD] diffusivities, and mode of anisotropy [MO]) of brain white matter (WM) between CADASIL patients and healthy subjects were assessed through tract-based spatial statistics. Then, DTI-derived indices were correlated with the patient's score on the extended Fazekas visual scale of the T2 hyperintensity. RESULTS When compared to healthy controls, CADASIL patients showed extensive symmetric areas of increased MD/RD and decreased AD/FA/MO that involved almost the entire hemispheric cerebral WM (internal and external capsule, WM of the temporal poles, superior and inferior longitudinal fasciculus, inferior frontal-occipital fasciculus, uncinate fasciculus, cingulum, forceps major and minor, corticospinal tracts, and thalamic radiations), thalami, and corpus callosum. Additional areas of increased RD were observed in pons, midbrain, cerebellar peduncles, and cerebellar WM. Only FA was negatively correlated with extended Fazekas visual score. CONCLUSIONS Our results indicate that brain damage in CADASIL is associated with extensive microstructural changes implying impairment of intra- and inter-hemispheric cerebral, thalamocortical, and cerebrocerebellar connections. Severity of microstructural changes correlates with extension of T2 hyperintensity.
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Affiliation(s)
- Mario Mascalchi
- Neuroradiology Unit A. Meyer Children Hospital of Florence, Italy.,Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy
| | - Leonardo Pantoni
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Raffaella Valenti
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Andrea Bianchi
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy
| | - Giovanni Pracucci
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Stefano Orsolini
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Stefano Ciulli
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy.,Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Carlo Tessa
- Unit of Radiology, Versilia Hospital, Azienda USL 12 Viareggio, Lido di Camaiore (Lu), Italy
| | - Anna Poggesi
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Francesca Pescini
- Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domenico Inzitari
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
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20
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Tomimoto H. White matter integrity and cognitive dysfunction: Radiological and neuropsychological correlations. Geriatr Gerontol Int 2015; 15 Suppl 1:3-9. [DOI: 10.1111/ggi.12661] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Hidekazu Tomimoto
- Department of Neurology; Graduate School of Medicine; Mie University; Mie Japan
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21
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Banerjee G, Wilson D, Jäger HR, Werring DJ. Novel imaging techniques in cerebral small vessel diseases and vascular cognitive impairment. Biochim Biophys Acta Mol Basis Dis 2015; 1862:926-38. [PMID: 26687324 DOI: 10.1016/j.bbadis.2015.12.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/27/2022]
Abstract
Dementia is a global growing concern, affecting over 35 million people with a global economic impact of over $604 billion US. With an ageing population the number of people affected is expected double over the next two decades. Vascular cognitive impairment can be caused by various types of cerebrovascular disease, including cortical and subcortical infarcts, and the more diffuse white matter injury due to cerebral small vessel disease. Although this type of cognitive impairment is usually considered the second most common form of dementia after Alzheimer's disease, there is increasing recognition of the vascular contribution to neurodegeneration, with both pathologies frequently coexisting. The aim of this review is to highlight the recent advances in the understanding of vascular cognitive impairment, with a focus on small vessel diseases of the brain. We discuss recently identified small vessel imaging markers that have been associated with cognitive impairment, namely cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and microinfarcts. We will also consider quantitative techniques including diffusion tensor imaging, magnetic resonance perfusion imaging with arterial spin labelling, functional magnetic resonance imaging and positron emission tomography. As well as potentially shedding light on the mechanism by which cerebral small vessel diseases cause dementia, these novel imaging biomarkers are also of increasing relevance given their ability to guide diagnosis and reflect disease progression, which may in the future be useful for therapeutic interventions. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.
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Affiliation(s)
- Gargi Banerjee
- UCL Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, 10-12 Russell Square, London WC1B 3EE, UK
| | - Duncan Wilson
- UCL Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, 10-12 Russell Square, London WC1B 3EE, UK
| | - Hans R Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - David J Werring
- UCL Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, 10-12 Russell Square, London WC1B 3EE, UK
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22
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Ostojic J, Kozic D, Pavlovic A, Semnic M, Todorovic A, Petrovic K, Covickovic-Sternic N. Hippocampal diffusion tensor imaging microstructural changes in vascular dementia. Acta Neurol Belg 2015; 115:557-62. [PMID: 25555903 DOI: 10.1007/s13760-014-0419-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/21/2014] [Indexed: 02/07/2023]
Abstract
To explore microstructural integrity of hippocampus in vascular dementia (VD) using DTI. Twenty-five individuals with VD, without magnetic resonance imaging (MRI) evidence of gray matter pathology, and 25 matched healthy control (HC) individuals underwent a 3T MRI protocol including T2, FLAIR, and PD in the axial plane, 3D whole-brain T1-weighted with an isotropic resolution of 1 mm, and DTI acquired using 64 diffusion sensitizing directions, b value of 1,500 s/mm(2), 65 axial slices, isotropic resolution of 1.8 mm. Images were processed to obtain indices of microstructural variations of bilateral hippocampi. Mean diffusivity (MD) in the hippocampus of patients with VD was significantly increased (p < 0.05) bilaterally with respect to that of the group of HC examinees. In VD group left hippocampal MD (10(-6 )× mm(2)/s) was 833.4 ± 92.8; in HC group left MD was 699.8 ± 56. In VD group, right hippocampal MD was 859.1 ± 69.8; in HC group right MD was 730.4 ± 40.2. No group differences were found in hippocampal FA. DTI shows microstructural hippocampal damage in VD in patients with normal appearing gray matter structures on conventional MRI, indicating the need for further research on the link between VD and AD.
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Affiliation(s)
- Jelena Ostojic
- Center of Radiology, Clinical Center of Vojvodina, School of Medicine, University of Novi Sad, 1-7 Hajduk Veljkova Street, 21000, Novi Sad, Serbia.
| | - Dusko Kozic
- Diagnostic Imaging Center, Institute of Oncology, School of Medicine, University of Novi Sad, 4 Institutski put, 21204, Sremska Kamenica, Serbia.
| | - Aleksandra Pavlovic
- Clinic of Neurology, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6 Dr. Subotica Street, 11000, Belgrade, Serbia.
| | - Marija Semnic
- Clinic for Neurology, Clinical Center of Vojvodina, School of Medicine, University of Novi Sad, 1-7 Hajduk Veljkova Street, 21000, Novi Sad, Serbia.
| | - Aleksandar Todorovic
- Diagnostic Imaging Center, Institute of Oncology, School of Medicine, University of Novi Sad, 4 Institutski put, 21204, Sremska Kamenica, Serbia.
| | - Kosta Petrovic
- Center of Radiology, Clinical Center of Vojvodina, School of Medicine, University of Novi Sad, 1-7 Hajduk Veljkova Street, 21000, Novi Sad, Serbia.
| | - Nadezda Covickovic-Sternic
- Clinic of Neurology, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6 Dr. Subotica Street, 11000, Belgrade, Serbia.
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23
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Reginold W, Luedke AC, Tam A, Itorralba J, Fernandez-Ruiz J, Reginold J, Islam O, Garcia A. Cognitive Function and 3-Tesla Magnetic Resonance Imaging Tractography of White Matter Hyperintensities in Elderly Persons. Dement Geriatr Cogn Dis Extra 2015; 5:387-94. [PMID: 26628897 PMCID: PMC4662291 DOI: 10.1159/000439045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims This study used 3-Tesla magnetic resonance imaging (MRI) tractography to determine if there was an association between tracts crossing white matter hyperintensities (WMH) and cognitive function in elderly persons. Methods Brain T2-weighted fluid-attenuated inversion recovery (FLAIR) and diffusion tensor MRI scans were acquired in participants above the age of 60 years. Twenty-six persons had WMH identified on T2 FLAIR scans. They completed a battery of neuropsychological tests and were classified as normal controls (n = 15) or with Alzheimer's dementia (n = 11). Tractography was generated by the Fiber Assignment by Continuous Tracking method. All tracts that crossed WMH were segmented. The average fractional anisotropy and average mean diffusivity of these tracts were quantified. We studied the association between cognitive test scores with the average mean diffusivity and average fractional anisotropy of tracts while controlling for age, total WMH volume and diagnosis. Results An increased mean diffusivity of tracts crossing WMH was associated with worse performance on the Wechsler Memory Scale-III Longest Span Forward (p = 0.02). There was no association between the fractional anisotropy of tracts and performance on cognitive testing. Conclusion The mean diffusivity of tracts crossing WMH measured by tractography is a novel correlate of performance on the Wechsler Memory Scale-III Longest Span Forward in elderly persons.
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Affiliation(s)
- William Reginold
- Memory Clinics, Division of Geriatric Medicine, Department of Medicine, Ont., Canada
| | - Angela C Luedke
- Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | - Angela Tam
- Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | - Justine Itorralba
- Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | - Juan Fernandez-Ruiz
- Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | | | - Omar Islam
- Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | - Angeles Garcia
- Memory Clinics, Division of Geriatric Medicine, Department of Medicine, Ont., Canada ; Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
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24
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Microstructural White Matter Abnormalities and Cognitive Dysfunction in Subcortical Ischemic Vascular Disease: an Atlas-Based Diffusion Tensor Analysis Study. J Mol Neurosci 2015; 56:363-70. [DOI: 10.1007/s12031-015-0550-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/23/2015] [Indexed: 11/24/2022]
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25
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Mascalchi M, Ginestroni A, Toschi N, Poggesi A, Cecchi P, Salvadori E, Tessa C, Cosottini M, De Stefano N, Pracucci G, Pantoni L, Inzitari D, Diciotti S. The burden of microstructural damage modulates cortical activation in elderly subjects with MCI and leuko-araiosis. A DTI and fMRI study. Hum Brain Mapp 2014; 35:819-30. [PMID: 23225611 PMCID: PMC6869323 DOI: 10.1002/hbm.22216] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 09/27/2012] [Accepted: 10/03/2012] [Indexed: 12/11/2022] Open
Abstract
The term leuko-araiosis (LA) describes a common chronic affection of the cerebral white matter (WM) in the elderly due to small vessel disease with variable clinical correlates. To explore whether severity of LA entails some adaptive reorganization in the cerebral cortex we evaluated with functional MRI (fMRI) the cortical activation pattern during a simple motor task in 60 subjects with mild cognitive impairment and moderate or severe (moderate-to-severe LA group, n = 46) and mild (mild LA group, n = 14) LA extension on visual rating. The microstructural damage associated with LA was measured on diffusion tensor data by computation of the mean diffusivity (MD) of the cerebral WM and by applying tract based spatial statistics (TBSS). Subjects were examined with fMRI during continuous tapping of the right dominant hand with task performance measurement. Moderate-to-severe LA group showed hyperactivation of left primary sensorimotor cortex (SM1) and right cerebellum. Regression analyses using the individual median of WM MD as explanatory variable revealed a posterior shift of activation within the left SM1 and hyperactivation of the left SMA and paracentral lobule and of the bilateral cerebellar crus. These data indicate that brain activation is modulated by increasing severity of LA with a local remapping within the SM1 and increased activity in ipsilateral nonprimary sensorimotor cortex and bilateral cerebellum. These potentially adaptive changes as well lack of contralateral cerebral hemisphere hyperactivation are in line with sparing of the U fibers and brainstem and cerebellar WM tracts and the emerging microstructual damage of the corpus callosum revealed by TBSS with increasing severity of LA.
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Affiliation(s)
- Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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26
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Preserved transcallosal inhibition to transcranial magnetic stimulation in nondemented elderly patients with leukoaraiosis. BIOMED RESEARCH INTERNATIONAL 2013. [PMID: 23984349 DOI: 10.1155/2013/351680.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Structural corpus callosum (CC) changes in patients with leukoaraiosis (LA) are significantly associated with cognitive and motor impairment. The aim of this study is to investigate the transcallosal fibers functioning by means of transcranial magnetic stimulation (TMS) in elderly patients with LA. The resting motor threshold (rMT), the motor-evoked potentials (MEPs), and the controlateral (cSP) and ipsilateral silent periods (iSP) were determined using single-pulse TMS in 15 patients and 15 age-matched controls. The neuropsychological profile and the vascular burden at brain magnetic resonance imaging (MRI) were concomitantly explored. Patients reported abnormal scores at tests evaluating executive control functions. No significant difference was found in TMS measures of intra- and intercortical excitability. No CC lesion was evident at MRI. Transcallosal inhibitory mechanisms to TMS seem to be spared in LA patients, a finding which is in line with neuroimaging features and suggests a functional integrity of the CC despite the ischemic interruption of corticosubcortical loops implicated in cognition and behavior. The observed neurophysiological finding differs from that reported in degenerative dementia, even in the preclinical or early stage. In our group of patients, the pure extent of LA is more related to impairment of frontal lobe abilities rather than functional callosal changes.
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27
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Lanza G, Bella R, Giuffrida S, Cantone M, Pennisi G, Spampinato C, Giordano D, Malaguarnera G, Raggi A, Pennisi M. Preserved transcallosal inhibition to transcranial magnetic stimulation in nondemented elderly patients with leukoaraiosis. BIOMED RESEARCH INTERNATIONAL 2013; 2013:351680. [PMID: 23984349 PMCID: PMC3741902 DOI: 10.1155/2013/351680] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/24/2013] [Accepted: 07/14/2013] [Indexed: 02/07/2023]
Abstract
Structural corpus callosum (CC) changes in patients with leukoaraiosis (LA) are significantly associated with cognitive and motor impairment. The aim of this study is to investigate the transcallosal fibers functioning by means of transcranial magnetic stimulation (TMS) in elderly patients with LA. The resting motor threshold (rMT), the motor-evoked potentials (MEPs), and the controlateral (cSP) and ipsilateral silent periods (iSP) were determined using single-pulse TMS in 15 patients and 15 age-matched controls. The neuropsychological profile and the vascular burden at brain magnetic resonance imaging (MRI) were concomitantly explored. Patients reported abnormal scores at tests evaluating executive control functions. No significant difference was found in TMS measures of intra- and intercortical excitability. No CC lesion was evident at MRI. Transcallosal inhibitory mechanisms to TMS seem to be spared in LA patients, a finding which is in line with neuroimaging features and suggests a functional integrity of the CC despite the ischemic interruption of corticosubcortical loops implicated in cognition and behavior. The observed neurophysiological finding differs from that reported in degenerative dementia, even in the preclinical or early stage. In our group of patients, the pure extent of LA is more related to impairment of frontal lobe abilities rather than functional callosal changes.
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Affiliation(s)
- Giuseppe Lanza
- 1“G. F. Ingrassia” Department, Section of Neurosciences, University of Catania, 78 Via Santa Sofia, 95123 Catania, Italy
| | - Rita Bella
- 1“G. F. Ingrassia” Department, Section of Neurosciences, University of Catania, 78 Via Santa Sofia, 95123 Catania, Italy
- *Rita Bella:
| | - Salvatore Giuffrida
- 1“G. F. Ingrassia” Department, Section of Neurosciences, University of Catania, 78 Via Santa Sofia, 95123 Catania, Italy
| | - Mariagiovanna Cantone
- 2Department of Neurology I.C., Oasi Institute (IRCCS), 73 Via Conte Ruggiero, 94018 Troina, Italy
| | - Giovanni Pennisi
- 1“G. F. Ingrassia” Department, Section of Neurosciences, University of Catania, 78 Via Santa Sofia, 95123 Catania, Italy
| | - Concetto Spampinato
- 3Department of Electrical, Electronics and Informatics Engineering, University of Catania, 6 Viale Andrea Doria, 95125 Catania, Italy
| | - Daniela Giordano
- 3Department of Electrical, Electronics and Informatics Engineering, University of Catania, 6 Viale Andrea Doria, 95125 Catania, Italy
| | - Giulia Malaguarnera
- 1“G. F. Ingrassia” Department, Section of Neurosciences, University of Catania, 78 Via Santa Sofia, 95123 Catania, Italy
| | - Alberto Raggi
- 4Unit of Neurology, Morgagni-Pierantoni Hospital, 34 Via Carlo Forlanini, 47121 Forlì, Italy
| | - Manuela Pennisi
- 5Department of Chemistry, University of Catania, 6 Viale Andrea Doria, 95125 Catania, Italy
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28
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Identifying the neural correlates of executive functions in early cerebral microangiopathy: a combined VBM and DTI study. J Cereb Blood Flow Metab 2012; 32:1869-78. [PMID: 22781332 PMCID: PMC3463884 DOI: 10.1038/jcbfm.2012.96] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cerebral microangiopathy (CMA) has been associated with executive dysfunction and fronto-parietal neural network disruption. Advances in magnetic resonance imaging allow more detailed analyses of gray (e.g., voxel-based morphometry-VBM) and white matter (e.g., diffusion tensor imaging-DTI) than traditional visual rating scales. The current study investigated patients with early CMA and healthy control subjects with all three approaches. Neuropsychological assessment focused on executive functions, the cognitive domain most discussed in CMA. The DTI and age-related white matter changes rating scales revealed convergent results showing widespread white matter changes in early CMA. Correlations were found in frontal and parietal areas exclusively with speeded, but not with speed-corrected executive measures. The VBM analyses showed reduced gray matter in frontal areas. All three approaches confirmed the hypothesized fronto-parietal network disruption in early CMA. Innovative methods (DTI) converged with results from conventional methods (visual rating) while allowing greater spatial and tissue accuracy. They are thus valid additions to the analysis of neural correlates of cognitive dysfunction. We found a clear distinction between speeded and nonspeeded executive measures in relationship to imaging parameters. Cognitive slowing is related to disease severity in early CMA and therefore important for early diagnostics.
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29
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Alves GS, Sudo FK, Alves CEDO, Ericeira-Valente L, Moreira DM, Engelhardt E, Laks J. Diffusion tensor imaging studies in vascular disease: A review of the literature. Dement Neuropsychol 2012; 6:158-163. [PMID: 29213790 PMCID: PMC5618963 DOI: 10.1590/s1980-57642012dn06030008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cerebrovascular disease (CVD) is often present in old age and may be associated
with microstructural pathology of white matter (WM) and cognitive dysfunction.
The current review investigated the relationship between CVD, cognitive status
and WM integrity as assessed by diffusion tensor imaging (DTI).
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Affiliation(s)
- Gilberto Sousa Alves
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Felipe Kenji Sudo
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | | | | | - Denise Madeira Moreira
- Institute of Neurology, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Radiology Service of the Procardíaco Hospital, Rio de Janeiro RJ, Brazil
| | - Eliasz Engelhardt
- Institute of Neurology, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Universidade Estadual do Rio de Janeiro, Rio de Janeiro RJ, Brazil
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