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Schiavolin S, Camarda G, Mazzucchelli A, Mariniello A, Marinoni G, Storti B, Canavero I, Bersano A, Leonardi M. Cognitive and psychological characteristics in patients with Cerebral Amyloid Angiopathy: a literature review. Neurol Sci 2024; 45:3031-3049. [PMID: 38388894 DOI: 10.1007/s10072-024-07399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
AIM To review the current data on cognitive and psychological characteristics of patients with CAA and on the instruments used for their evaluation. METHODS A systematic search was performed in Embase, Scopus and PubMed with terms related to "cerebral amyloid angiopathy", "neuropsychological measures" and "patient-reported outcome measures" from January 2001 to December 2021. RESULTS Out of 2851 records, 18 articles were selected. The cognitive evaluation was present in all of which, while the psychological one only in five articles. The MMSE (Mini Mental State Examination), TMT (Trail Making Test), fluency test, verbal learning test, digit span, digit symbol and Rey figure tests were the most used cognitive tests, while executive function, memory, processing speed, visuospatial function, attention and language were the most frequent impaired cognitive functions. Depression was the most considered psychological factor usually measured with BDI (Beck Depression Inventory) and GDS (Geriatric Depression Scale). CONCLUSIONS The results of this study might be used in clinical practice as a guide to choose cognitive and psychological instruments and integrate them in the clinical evaluation. The results might also be used in the research field for studies investigating the impact of cognitive and psychological variables on the disease course and for consensus studies aimed at define a standardized evaluation of these aspects.
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Affiliation(s)
- Silvia Schiavolin
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giorgia Camarda
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
| | - Alessia Mazzucchelli
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Arianna Mariniello
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giulia Marinoni
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Benedetta Storti
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Canavero
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Bersano
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
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2
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Rasing I, Vlegels N, Schipper MR, Voigt S, Koemans EA, Kaushik K, van Dort R, van Harten TW, De Luca A, van Etten ES, van Zwet EW, van Buchem MA, Middelkoop HA, Biessels GJ, Terwindt GM, van Osch MJ, van Walderveen MA, Wermer MJ. Microstructural white matter damage on MRI is associated with disease severity in Dutch-type cerebral amyloid angiopathy. J Cereb Blood Flow Metab 2024:271678X241261771. [PMID: 38886875 DOI: 10.1177/0271678x241261771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Peak width of skeletonized mean diffusivity (PSMD) is an emerging diffusion-MRI based marker to study subtle early alterations to white matter microstructure. We assessed PSMD over the clinical continuum in Dutch-type hereditary CAA (D-CAA) and its association with other CAA-related MRI-markers and cognitive symptoms. We included (pre)symptomatic D-CAA mutation-carriers and calculated PSMD from diffusion-MRI data. Associations between PSMD-levels, cognitive performance and CAA-related MRI-markers were assessed with linear regression models. We included 59 participants (25/34 presymptomatic/symptomatic; mean age 39/58 y). PSMD-levels increased with disease severity and were higher in symptomatic D-CAA mutation-carriers (median [range] 4.90 [2.77-9.50]mm2/s × 10-4) compared with presymptomatic mutation-carriers (2.62 [1.96-3.43]mm2/s × 10-4) p = <0.001. PSMD was positively correlated with age, CAA-SVD burden on MRI (adj.B [confidence interval] = 0.42 [0.16-0.67], p = 0.002), with number of cerebral microbleeds (adj.B = 0.30 [0.08-0.53], p = 0.009), and with both deep (adj.B = 0.46 [0.22-0.69], p = <0.001) and periventricular (adj.B = 0.38 [0.13-0.62], p = 0.004) white matter hyperintensities. Increasing PSMD was associated with decreasing Trail Making Test (TMT)-A performance (B = -0.42 [-0.69-0.14], p = 0.04. In D-CAA mutation-carriers microstructural white matter damage is associated with disease phase, CAA burden on MRI and cognitive impairment as reflected by a decrease in information processing speed. PSMD, as a global measure of alterations to the white matter microstructure, may be a useful tool to monitor disease progression in CAA.
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Affiliation(s)
- Ingeborg Rasing
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Naomi Vlegels
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Manon R Schipper
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Emma A Koemans
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kanishk Kaushik
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosemarie van Dort
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thijs W van Harten
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto De Luca
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ellis S van Etten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik W van Zwet
- Department of Biostatistics, Leiden University Medical Center, Leiden, The Netherland
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Huub Am Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthias Jp van Osch
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Marieke Jh Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
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3
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De Kort AM, Kaushik K, Kuiperij HB, Jäkel L, Li H, Tuladhar AM, Terwindt GM, Wermer MJH, Claassen JAHR, Klijn CJM, Verbeek MM, Kessels RPC, Schreuder FHBM. The relation of a cerebrospinal fluid profile associated with Alzheimer's disease with cognitive function and neuropsychiatric symptoms in sporadic cerebral amyloid angiopathy. Alzheimers Res Ther 2024; 16:99. [PMID: 38704569 PMCID: PMC11069247 DOI: 10.1186/s13195-024-01454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Patients with sporadic cerebral amyloid angiopathy (sCAA) frequently report cognitive or neuropsychiatric symptoms. The aim of this study is to investigate whether in patients with sCAA, cognitive impairment and neuropsychiatric symptoms are associated with a cerebrospinal fluid (CSF) biomarker profile associated with Alzheimer's disease (AD). METHODS In this cross-sectional study, we included participants with sCAA and dementia- and stroke-free, age- and sex-matched controls, who underwent a lumbar puncture, brain MRI, cognitive assessments, and self-administered and informant-based-questionnaires on neuropsychiatric symptoms. CSF phosphorylated tau, total tau and Aβ42 levels were used to divide sCAA patients in two groups: CAA with (CAA-AD+) or without a CSF biomarker profile associated with AD (CAA-AD-). Performance on global cognition, specific cognitive domains (episodic memory, working memory, processing speed, verbal fluency, visuoconstruction, and executive functioning), presence and severity of neuropsychiatric symptoms, were compared between groups. RESULTS sCAA-AD+ (n=31; mean age: 72 ± 6; 42%, 61% female) and sCAA-AD- (n=23; 70 ± 5; 42% female) participants did not differ with respect to global cognition or type of affected cognitive domain(s). The number or severity of neuropsychiatric symptoms also did not differ between sCAA-AD+ and sCAA-AD- participants. These results did not change after exclusion of patients without prior ICH. CONCLUSIONS In participants with sCAA, a CSF biomarker profile associated with AD does not impact global cognition or specific cognitive domains, or the presence of neuropsychiatric symptoms.
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Affiliation(s)
- Anna M De Kort
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kanishk Kaushik
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - H Bea Kuiperij
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lieke Jäkel
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hao Li
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jurgen A H R Claassen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Catharina J M Klijn
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands.
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
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Barucci E, Salvadori E, Magi S, Squitieri M, Fiore GM, Ramacciotti L, Formelli B, Pescini F, Poggesi A. Cognitive profile in cerebral small vessel disease: comparison between cerebral amyloid angiopathy and hypertension-related microangiopathy. Sci Rep 2024; 14:5922. [PMID: 38467658 PMCID: PMC10928167 DOI: 10.1038/s41598-024-55719-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
Cerebral amyloid angiopathy (CAA) is recognized as a cause of cognitive impairment, but its cognitive profile needs to be characterized, also respect to hypertension-related microangiopathy (HA). We aimed at comparing difference or similarity of CAA and HA patients' cognitive profiles, and their associated factors. Participants underwent an extensive clinical, neuropsychological, and neuroimaging protocol. HA patients (n = 39) were more frequently males, with history of vascular risk factors than CAA (n = 32). Compared to HA, CAA patients presented worse performance at MoCA (p = 0.001) and semantic fluency (p = 0.043), and a higher prevalence of amnestic MCI (46% vs. 68%). In univariate analyses, multi-domain MCI was associated with worse performance at MoCA, Rey Auditory Verbal Learning Test (RAVLT), and semantic fluency in CAA patients, and with worse performance at Symbol Digit Modalities Test (SDMT) and phonemic fluency in HA ones. In multivariate models, multi-domain deficit remained as the only factor associated with RAVLT (β = - 0.574) in CAA, while with SDMT (β = - 0.364) and phonemic fluency (β = - 0.351) in HA. Our results highlight different patterns of cognitive deficits in CAA or HA patients. While HA patients' cognitive profile was confirmed as mainly attentional/executive, a complex cognitive profile, characterized also by deficit in semantic memory, seems the hallmark of CAA patients.
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Affiliation(s)
- Eleonora Barucci
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Emilia Salvadori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Simona Magi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Martina Squitieri
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Giulio Maria Fiore
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Lorenzo Ramacciotti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Benedetta Formelli
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesca Pescini
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
- Stroke Unit, Careggi University Hospital, Florence, Italy.
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5
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Walker L, Simpson H, Thomas AJ, Attems J. Prevalence, distribution, and severity of cerebral amyloid angiopathy differ between Lewy body diseases and Alzheimer's disease. Acta Neuropathol Commun 2024; 12:28. [PMID: 38360761 PMCID: PMC10870546 DOI: 10.1186/s40478-023-01714-7] [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: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 02/17/2024] Open
Abstract
Dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and Parkinson's disease (PD) collectively known as Lewy body diseases (LBDs) are neuropathologically characterised by α-synuclein deposits (Lewy bodies and Lewy neurites). However, LBDs also exhibit pathology associated with Alzheimer's disease (AD) (i.e. hyperphosphorylated tau and amyloid β (Aβ). Aβ can be deposited in the walls of blood vessels in the brains of individuals with AD, termed cerebral amyloid angiopathy (CAA). The aim of this study was to investigate the type and distribution of CAA in DLB, PDD, and PD and determine if this differs from AD. CAA type, severity, and topographical distribution was assessed in 94 AD, 30 DLB, 17 PDD, and 11 PD cases, and APOE genotype evaluated in a subset of cases where available. 96.3% AD cases, 70% DLB cases and 82.4% PDD cases exhibited CAA (type 1 or type 2). However only 45.5% PD cases had CAA. Type 1 CAA accounted for 37.2% of AD cases, 10% of DLB cases, and 5.9% of PDD cases, and was not observed in PD cases. There was a hierarchical topographical distribution in regions affected by CAA where AD and DLB displayed the same distribution pattern that differed from PDD and PD. APOE ε4 was associated with severity of CAA in AD cases. Topographical patterns and severity of CAA in DLB more closely resembled AD rather than PDD, and as type 1 CAA is associated with clinical dementia in AD, further investigations are warranted into whether the increased presence of type 1 CAA in DLB compared to PDD are related to the onset of cognitive symptoms and is a distinguishing factor between LBDs. Possible alignment of the the topographical distribution of CAA and microbleeds in DLB warrants further investigation. CAA in DLB more closely resembles AD rather than PDD or PD, and should be taken into consideration when stratifying patients for clinical trials or designing disease modifying therapies.
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Affiliation(s)
- Lauren Walker
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK.
| | - Harry Simpson
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Johannes Attems
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK
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6
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Perosa V, Zanon Zotin MC, Schoemaker D, Sveikata L, Etherton MR, Charidimou A, Greenberg SM, Viswanathan A. Association Between Hippocampal Volumes and Cognition in Cerebral Amyloid Angiopathy. Neurology 2024; 102:e207854. [PMID: 38165326 PMCID: PMC10870737 DOI: 10.1212/wnl.0000000000207854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Accumulating evidence suggests that gray matter atrophy, often considered a marker of Alzheimer disease (AD), can also result from cerebral small vessel disease (CSVD). Cerebral amyloid angiopathy (CAA) is a form of sporadic CSVD, diagnosed through neuroimaging criteria, that often co-occurs with AD pathology and leads to cognitive impairment. We sought to identify the role of hippocampal integrity in the development of cognitive impairment in a cohort of patients with possible and probable CAA. METHODS Patients were recruited from an ongoing CAA study at Massachusetts General Hospital. Composite scores defined performance in the cognitive domains of memory, language, executive function, and processing speed. Hippocampal subfields' volumes were measured from 3T MRI, using an automated method, and multivariate linear regression models were used to estimate their association with each cognitive domain and relationship to CAA-related neuroimaging markers. RESULTS One hundred twenty patients, 36 with possible (age mean [range]: 75.6 [65.6-88.9]), 67 with probable CAA (75.9 [59.0-94.0]), and 17 controls without cognitive impairment and CSVD (72.4 [62.5-82.7]; 76.4% female patients), were included in this study. We found a positive association between all investigated hippocampal subfields and memory and language, whereas specific subfields accounted for executive function (CA4 [Estimate = 5.43; 95% CI 1.26-9.61; p = 0.020], subiculum [Estimate = 2.85; 95% CI 0.67-5.02; p = 0.022]), and processing speed (subiculum [Estimate = 1.99; 95% CI 0.13-3.85; p = 0.036]). These findings were independent of other CAA-related markers, which did not have an influence on cognition in this cohort. Peak width of skeletonized mean diffusivity (PSMD), a measure of white matter integrity, was negatively associated with hippocampal subfields' volumes (CA3 [Estimate = -0.012; 95% CI -0.020 to -0.004; p = 0.034], CA4 [Estimate = -0.010; 95% CI -0.020 to -0.0007; p = 0.037], subiculum [Estimate = -0.019; 95% CI -0.042 to -0.0001; p = 0.003]). DISCUSSION These results suggest that hippocampal integrity is an independent contributor to cognitive impairment in patients with CAA and that it might be related to loss of integrity in the white matter. Further studies exploring potential causes and directionality of the relationship between white matter and hippocampal integrity may be warranted.
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Affiliation(s)
- Valentina Perosa
- From the J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Maria Clara Zanon Zotin
- From the J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Dorothee Schoemaker
- From the J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lukas Sveikata
- From the J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Mark R Etherton
- From the J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Andreas Charidimou
- From the J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
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7
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Chan E, Bonifacio GB, Harrison C, Banerjee G, Best JG, Sacks B, Harding N, Del Rocio Hidalgo Mas M, Jäger HR, Cipolotti L, Werring DJ. Domain-specific neuropsychological investigation of CAA with and without intracerebral haemorrhage. J Neurol 2023; 270:6124-6132. [PMID: 37672105 PMCID: PMC10632296 DOI: 10.1007/s00415-023-11977-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is associated with cognitive impairment, but the contributions of lobar intracerebral haemorrhage (ICH), underlying diffuse vasculopathy, and neurodegeneration, remain uncertain. We investigated the domain-specific neuropsychological profile of CAA with and without ICH, and their associations with structural neuroimaging features. METHODS Data were collected from patients with possible or probable CAA attending a specialist outpatient clinic. Patients completed standardised neuropsychological assessment covering seven domains. MRI scans were scored for markers of cerebral small vessel disease and neurodegeneration. Patients were grouped into those with and without a macro-haemorrhage (CAA-ICH and CAA-non-ICH). RESULTS We included 77 participants (mean age 72, 65% male). 26/32 (81%) CAA-non-ICH patients and 41/45 (91%) CAA-ICH patients were impaired in at least one cognitive domain. Verbal IQ and non-verbal IQ were the most frequently impaired, followed by executive functions and processing speed. We found no significant differences in the frequency of impairment across domains between the two groups. Medial temporal atrophy was the imaging feature most consistently associated with cognitive impairment (both overall and in individual domains) in both univariable and multivariable analyses. DISCUSSION Cognitive impairment is common in CAA, even in the absence of ICH, suggesting a key role for diffuse processes related to small vessel disease and/or neurodegeneration. Our findings indicate that neurodegeneration, possibly due to co-existing Alzheimer's disease pathology, may be the most important contributor. The observation that general intelligence is the most frequently affected domain suggests that CAA has a generalised rather than focal cognitive impact.
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Affiliation(s)
- Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK.
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK.
| | - Guendalina B Bonifacio
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Corin Harrison
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Gargi Banerjee
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan G Best
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Benjamin Sacks
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Nicola Harding
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Maria Del Rocio Hidalgo Mas
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - H Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - David J Werring
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
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8
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Theodorou A, Palaiodimou L, Papagiannopoulou G, Kargiotis O, Psychogios K, Safouris A, Bakola E, Chondrogianni M, Kotsali-Peteinelli V, Melanis K, Tsibonakis A, Andreadou E, Vasilopoulou S, Lachanis S, Velonakis G, Tzavellas E, Tzartos JS, Voumvourakis K, Paraskevas GP, Tsivgoulis G. Clinical Characteristics, Neuroimaging Markers, and Outcomes in Patients with Cerebral Amyloid Angiopathy: A Prospective Cohort Study. J Clin Med 2023; 12:5591. [PMID: 37685658 PMCID: PMC10488273 DOI: 10.3390/jcm12175591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Background and purpose: Sporadic cerebral amyloid angiopathy (CAA) is a small vessel disease, resulting from progressive amyloid-β deposition in the media/adventitia of cortical and leptomeningeal arterioles. We sought to assess the prevalence of baseline characteristics, clinical and radiological findings, as well as outcomes among patients with CAA, in the largest study to date conducted in Greece. Methods: Sixty-eight patients fulfilling the Boston Criteria v1.5 for probable/possible CAA were enrolled and followed for at least twelve months. Magnetic Resonance Imaging was used to assess specific neuroimaging markers. Data regarding cerebrospinal fluid biomarker profile and Apolipoprotein-E genotype were collected. Multiple logistic regression analyses were performed to identify predictors of clinical phenotypes. Cox-proportional hazard regression models were used to calculate associations with the risk of recurrent intracerebral hemorrhage (ICH). Results: Focal neurological deficits (75%), cognitive decline (57%), and transient focal neurological episodes (TFNEs; 21%) were the most common clinical manifestations. Hemorrhagic lesions, including lobar cerebral microbleeds (CMBs; 93%), cortical superficial siderosis (cSS; 48%), and lobar ICH (43%) were the most prevalent neuroimaging findings. cSS was independently associated with the likelihood of TFNEs at presentation (OR: 4.504, 95%CI:1.258-19.088), while multiple (>10) lobar CMBs were independently associated with cognitive decline at presentation (OR:5.418, 95%CI:1.316-28.497). cSS emerged as the only risk factor of recurrent ICH (HR:4.238, 95%CI:1.509-11.900) during a median follow-up of 20 months. Conclusions: cSS was independently associated with TFNEs at presentation and ICH recurrence at follow-up, while a higher burden of lobar CMBs with cognitive decline at baseline. These findings highlight the prognostic value of neuroimaging markers, which may influence clinical decision-making.
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Affiliation(s)
- Aikaterini Theodorou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Georgia Papagiannopoulou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Odysseas Kargiotis
- Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (O.K.); (K.P.); (A.S.)
| | - Klearchos Psychogios
- Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (O.K.); (K.P.); (A.S.)
| | - Apostolos Safouris
- Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (O.K.); (K.P.); (A.S.)
| | - Eleni Bakola
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Maria Chondrogianni
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Vasiliki Kotsali-Peteinelli
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Konstantinos Melanis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Athanasios Tsibonakis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Elissavet Andreadou
- First Department of Neurology, “Eginition” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (S.V.)
| | - Sofia Vasilopoulou
- First Department of Neurology, “Eginition” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (S.V.)
| | - Stefanos Lachanis
- Iatropolis Magnetic Resonance Diagnostic Centre, 15231 Athens, Greece;
| | - Georgios Velonakis
- Second Department of Radiology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Elias Tzavellas
- First Department of Psychiatry, “Aiginition” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - John S. Tzartos
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Konstantinos Voumvourakis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Georgios P. Paraskevas
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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9
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Pinho J, Almeida FC, Araújo JM, Machado Á, Costa AS, Silva F, Francisco A, Quintas-Neves M, Ferreira C, Soares-Fernandes JP, Oliveira TG. Sex-Specific Patterns of Cerebral Atrophy and Enlarged Perivascular Spaces in Patients with Cerebral Amyloid Angiopathy and Dementia. AJNR Am J Neuroradiol 2023; 44:792-798. [PMID: 37290817 PMCID: PMC10337609 DOI: 10.3174/ajnr.a7900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/07/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral amyloid angiopathy is characterized by amyloid β deposition in leptomeningeal and superficial cortical vessels. Cognitive impairment is common and may occur independent of concomitant Alzheimer disease neuropathology. It is still unknown which neuroimaging findings are associated with dementia in cerebral amyloid angiopathy and whether they are modulated by sex. This study compared MR imaging markers in patients with cerebral amyloid angiopathy with dementia or mild cognitive impairment or who are cognitively unimpaired and explored sex-specific differences. MATERIALS AND METHODS We studied 58 patients with cerebral amyloid angiopathy selected from the cerebrovascular and memory outpatient clinics. Clinical characteristics were collected from clinical records. Cerebral amyloid angiopathy was diagnosed on MR imaging on the basis of the Boston criteria. Visual rating scores for atrophy and other imaging features were independently assessed by 2 senior neuroradiologists. RESULTS Medial temporal lobe atrophy was higher for those with cerebral amyloid angiopathy with dementia versus those cognitively unimpaired (P = .015), but not for those with mild cognitive impairment. This effect was mainly driven by higher atrophy in men with dementia, compared with women with and without dementia (P = .034, P = .012; respectively) and with men without dementia (P = .012). Enlarged perivascular spaces in the centrum semiovale were more frequent in women with dementia versus men with and without dementia (P = .021, P = .011; respectively) and women without dementia (P = .011). CONCLUSIONS Medial temporal lobe atrophy was more prominent in men with dementia, whereas women showed a higher number of enlarged perivascular spaces in the centrum semiovale. Overall, this finding suggests differential pathophysiologic mechanisms with sex-specific neuroimaging patterns in cerebral amyloid angiopathy.
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Affiliation(s)
- J Pinho
- From the Department of Neurology (J.P., A.S.C.), University Hospital RWTH Aachen, Aachen, Germany
| | - F C Almeida
- Life and Health Sciences Research Institute (F.C.A., M.Q.-N., T.G.O.), School of Medicine
- Life and Health Sciences Research Institute/3Bs (F.C.A., M.Q.-N., T.G.O.), Portuguese Government Associate Laboratory, Braga/Guimarães, Portugal
- Department of Neuroradiology (F.C.A.), Centro Hospitalar Universitxrário do Porto, Porto, Portugal
| | - J M Araújo
- Departments of Neurology (J.M.A., Á.M., C.F.)
| | - Á Machado
- Departments of Neurology (J.M.A., Á.M., C.F.)
| | - A S Costa
- From the Department of Neurology (J.P., A.S.C.), University Hospital RWTH Aachen, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging (A.S.C.), Forschungszentrum Jülich and RWTH Aachen University, Aachen, Germany
| | - F Silva
- Algoritmi Center (F.S., A.F.), University of Minho, Braga, Portugal
| | - A Francisco
- Algoritmi Center (F.S., A.F.), University of Minho, Braga, Portugal
| | - M Quintas-Neves
- Life and Health Sciences Research Institute (F.C.A., M.Q.-N., T.G.O.), School of Medicine
- Life and Health Sciences Research Institute/3Bs (F.C.A., M.Q.-N., T.G.O.), Portuguese Government Associate Laboratory, Braga/Guimarães, Portugal
- Neuroradiology (M.Q.-N., J.P.S.-F., T.G.O.), Hospital de Braga, Braga, Portugal
| | - C Ferreira
- Departments of Neurology (J.M.A., Á.M., C.F.)
| | | | - T G Oliveira
- Life and Health Sciences Research Institute (F.C.A., M.Q.-N., T.G.O.), School of Medicine
- Life and Health Sciences Research Institute/3Bs (F.C.A., M.Q.-N., T.G.O.), Portuguese Government Associate Laboratory, Braga/Guimarães, Portugal
- Neuroradiology (M.Q.-N., J.P.S.-F., T.G.O.), Hospital de Braga, Braga, Portugal
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10
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Su W, Lu H, Li Q, Tang Z, Dang H, Han K, Li H, Liu Y, Zhang H. Characteristics of cognition impairment in patients after stroke based on the Wechsler Adult Intelligence Scale-Revised in China. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 37141150 DOI: 10.1080/23279095.2023.2205023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We aimed to explore the cognitive characteristics of patients with post-stroke cognition impairment (PSCI) on the basis of the Wechsler Adult Intelligence Scale-Revised in China (WAIS-RC) and the individual contribution of the subtests to WAIS score. We included 227 patients with PSCI who were assessed using the WAIS-RC. We described the characteristics and score distribution of the scale and subtests individually and compared them with those of the normal group to measure the damage degree of these patients. We performed item response theory analysis to explore the best criterion score for all dimensions that allowed ideal discrimination and difficulty for reflecting cognitive level. Finally, we analyzed the contribution of each dimension to the overall cognitive function. Patients with PSCI showed worse cognition levels than healthy individuals in terms of overall intelligence quotient (73.26-100, -1.78 SD), with a difference of 4.54-7.96 points in each dimension (-0.68 to -1.82 SD), and a range of 5-7 points is the appropriate range for reflecting cognitive ability in patients with PSCI. The average cognitive level of patients with PSCI was significantly inferior to normal people (-1.78 SD, 96.25%). Vocabulary contributes most to WAIS score.
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Affiliation(s)
- Wenlong Su
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, P.R. China
- School of Health and Life Science, University of Health and Rehabilitation Sciences, Qingdao City, P.R. China
| | - Haitao Lu
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, P.R. China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, P.R. China
| | - Qiaodan Li
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, P.R. China
| | - Zhiqing Tang
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, P.R. China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, P.R. China
| | - Hui Dang
- School of Health and Life Science, University of Health and Rehabilitation Sciences, Qingdao City, P.R. China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, P.R. China
- Cheeloo College of Medicine, Shandong University, Jinan, P.R. China
| | - Kaiyue Han
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, P.R. China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, P.R. China
| | - Hui Li
- School of Health and Life Science, University of Health and Rehabilitation Sciences, Qingdao City, P.R. China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, P.R. China
- Cheeloo College of Medicine, Shandong University, Jinan, P.R. China
| | - Ying Liu
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, P.R. China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, P.R. China
| | - Hao Zhang
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, P.R. China
- School of Health and Life Science, University of Health and Rehabilitation Sciences, Qingdao City, P.R. China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, P.R. China
- Cheeloo College of Medicine, Shandong University, Jinan, P.R. China
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11
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Sharrief A. Diagnosis and Management of Cerebral Small Vessel Disease. Continuum (Minneap Minn) 2023; 29:501-518. [PMID: 37039407 DOI: 10.1212/con.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Cerebral small vessel disease (CSVD) is a common neurologic condition that contributes to considerable mortality and disability because of its impact on ischemic and hemorrhagic stroke risk and dementia. While attributes of the disease have been recognized for over two centuries, gaps in knowledge remain related to its prevention and management. The purpose of this review is to provide an overview of the current state of knowledge for CSVD. LATEST DEVELOPMENTS CSVD can be recognized by well-defined radiographic criteria, but the pathogenic mechanism behind the disease is unclear. Hypertension control remains the best-known strategy for stroke prevention in patients with CSVD, and recent guidelines provide a long-term blood pressure target of less than 130/80 mm Hg for patients with ischemic and hemorrhagic stroke, including those with stroke related to CSVD. Cerebral amyloid angiopathy is the second leading cause of intracerebral hemorrhage and may be increasingly recognized because of newer, more sensitive imaging modalities. Transient focal neurologic episodes is a relatively new term used to describe "amyloid spells." Guidance on distinguishing these events from seizures and transient ischemic attacks has been published. ESSENTIAL POINTS CSVD is prevalent and will likely be encountered by all neurologists in clinical practice. It is important for neurologists to be able to recognize CSVD, both radiographically and clinically, and to counsel patients on the prevention of disease progression. Blood pressure control is especially relevant, and strategies are needed to improve blood pressure control for primary and secondary stroke prevention in patients with CSVD.
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Affiliation(s)
- Anjail Sharrief
- Associate Professor of Neurology, Department of Neurology, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas
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12
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Durrani R, Wang M, Cox E, Irving E, Saad F, McCreary CR, Beaudin AE, Gee M, Nelles K, Sajobi TT, Ismail Z, Camicioli R, Smith EE. Mediators of cognitive impairment in cerebral amyloid angiopathy. Int J Stroke 2023; 18:78-84. [PMID: 35473418 DOI: 10.1177/17474930221099352] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is associated with cognitive decline. CAA has diverse impacts on brain structure and function; however, the brain lesions that mediate the association of CAA with cognition are not understood well. AIMS To determine the degree to which CAA neuroimaging biomarkers mediate the association of CAA with cognitive dysfunction. METHODS We analyzed cross-sectional data of patients with probable CAA and controls without cognitive impairment from the Functional Assessment of Vascular Reactivity study. Neuropsychological tests were grouped into domains of memory, executive function, and processing speed. Candidate CAA neuroimaging biomarkers were pre-specified based on prior literature, consisting of white matter hyperintensity volume, peak width of skeletonized mean diffusivity (PSMD) on diffusion tensor magnetic resonance imaging (MRI), cerebrovascular reactivity (CVR), cortical thickness, and cortical thickness in a meta-region of interest typically affected by Alzheimer's disease (AD). Cognitive scores and neuroimaging markers were standardized and reported in relation to values in controls. Mediation analysis was used to estimate the total effect of CAA on cognition and the proportion of the total effect that was mediated by neuroimaging biomarkers, controlling for age, sex, and education. RESULTS There were 131 participants (67 CAA and 64 controls). Mean age was 72.1 ± 7.7 years, and 54.2% were women. As expected, compared to controls, CAA was associated with lower cognition. In mediation analyses, CAA had direct unmediated effects of 48%, 46%, and 52% on all three cognitive domains. The association of CAA with memory was partially mediated by CVR and PSMD, accounting for 18% and 36% of the total effect of CAA. The association of CAA with executive function was partially mediated by PSMD and mean cortical thickness in the AD meta-region of interest (ROI), accounting for 33% and 31% of the total effect of CAA. The association of CAA with processing speed was partially mediated by CVR and PSMD, accounting for 8% and 34% of the total effect of CAA. Among CAA participants, the presence of cortical superficial siderosis was associated with lower processing speed. CONCLUSION Altered white matter diffusivity (i.e. PSMD), CVR, and atrophy, taken together, account for about half the effect of CAA on cognition.
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Affiliation(s)
- Romella Durrani
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Emily Cox
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Elisabeth Irving
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Feryal Saad
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Cheryl R McCreary
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Andrew E Beaudin
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Myrlene Gee
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Krista Nelles
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology and Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, AB, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
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13
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Shaikh I, Beaulieu C, Gee M, McCreary CR, Beaudin AE, Valdés-Cabrera D, Smith EE, Camicioli R. Diffusion tensor tractography of the fornix in cerebral amyloid angiopathy, mild cognitive impairment and Alzheimer's disease. Neuroimage Clin 2022; 34:103002. [PMID: 35413649 PMCID: PMC9010796 DOI: 10.1016/j.nicl.2022.103002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/26/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
The fornix was delineated with deterministic tractography from diffusion tensor images (DTI). Fornix diffusion changes were found in the fornix in CAA, AD and MCI compared to controls. Higher fornix diffusivity correlated with smaller hippocampal volume and larger ventricles. Fornix diffusion measures correlated with cognitive measures in the combined disease groups.
Purpose Cerebral amyloid angiopathy (CAA) is a common neuropathological finding and clinical entity that occurs independently and with co-existent Alzheimer’s disease (AD) and small vessel disease. We compared diffusion tensor imaging (DTI) metrics of the fornix, the primary efferent tract of the hippocampus between CAA, AD and Mild Cognitive Impairment (MCI) and healthy controls. Methods Sixty-eight healthy controls, 32 CAA, 21 AD, and 26 MCI patients were recruited at two centers. Diffusion tensor images were acquired at 3 T with high spatial resolution and fluid-attenuated inversion recovery (FLAIR) to suppress cerebrospinal fluid (CSF) and minimize partial volume effects on the fornix. The fornix was delineated with deterministic tractography to yield mean diffusivity (MD), axial diffusivity (AXD), radial diffusivity (RD), fractional anisotropy (FA) and tract volume. Volumetric measurements of the hippocampus, thalamus, and lateral ventricles were obtained using T1-weighted MRI. Results Diffusivity (MD, AXD, and RD) of the fornix was highest in AD followed by CAA compared to controls; the MCI group was not significantly different from controls. FA was similar between groups. Fornix tract volume was ∼ 30% lower for all three patient groups compared to controls, but not significantly different between the patient groups. Thalamic and hippocampal volumes were preserved in CAA, but lower in AD and MCI compared to controls. Lateral ventricular volumes were increased in CAA, AD and MCI. Global cognition, memory, and executive function all correlated negatively with fornix diffusivity across the combined clinical group. Conclusion There were significant diffusion changes of the fornix in CAA, AD and MCI compared to controls, despite relatively intact thalamic and hippocampal volumes in CAA, suggesting the mechanisms for fornix diffusion abnormalities may differ in CAA compared to AD and MCI.
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Affiliation(s)
- Ibrahim Shaikh
- Department of Medicine, Division of Neurology and Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, AB, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Myrlene Gee
- Department of Medicine, Division of Neurology and Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, AB, Canada
| | - Cheryl R McCreary
- Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Andrew E Beaudin
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Diana Valdés-Cabrera
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Eric E Smith
- Department of Radiology, University of Calgary, Calgary, AB, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology and Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, AB, Canada.
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14
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Perosa V, Arts T, Assmann A, Mattern H, Speck O, Oltmer J, Heinze HJ, Düzel E, Schreiber S, Zwanenburg JJM. Pulsatility Index in the Basal Ganglia Arteries Increases with Age in Elderly with and without Cerebral Small Vessel Disease. AJNR Am J Neuroradiol 2022; 43:540-546. [PMID: 35332021 PMCID: PMC8993201 DOI: 10.3174/ajnr.a7450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease contributes to stroke and cognitive impairment and interacts with Alzheimer disease pathology. Because of the small dimensions of the affected vessels, in vivo characterization of blood flow properties is challenging but important to unravel the underlying mechanisms of the disease. MATERIALS AND METHODS A 2D phase-contrast sequence at 7T MR imaging was used to assess blood flow velocity and the pulsatility index of the perforating basal ganglia arteries. We included patients with cerebral amyloid angiopathy (n = 8; identified through the modified Boston criteria), hypertensive arteriopathy (n = 12; identified through the presence of strictly deep or mixed cerebral microbleeds), and age- and sex-matched controls (n = 28; no cerebral microbleeds). RESULTS Older age was related to a greater pulsatility index, irrespective of cerebral small vessel disease. In hypertensive arteriopathy, there was an association between lower blood flow velocity of the basal ganglia and the presence of peri-basal ganglia WM hyperintensities. CONCLUSIONS Our results suggest that age might be the driving factor for altered cerebral small vessel hemodynamics. Furthermore, this study puts cerebral small vessel disease downstream pathologies in the basal ganglia region in relation to blood flow characteristics of the basal ganglia microvasculature.
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Affiliation(s)
- V Perosa
- From the Department of Neurology (V.P., A.A., J.O., H.-J.H., S.S.)
- German Center for Neurodegenerative Diseases (V.P., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany
- J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - T Arts
- Department of Radiology (T.A., J.J.M.Z.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Assmann
- From the Department of Neurology (V.P., A.A., J.O., H.-J.H., S.S.)
| | | | - O Speck
- German Center for Neurodegenerative Diseases (V.P., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany
- Leibniz-Institute for Neurobiology (O.S., H.-J.H.), Magdeburg, Germany
- Center for Behavioral Brain Sciences (O.S., H.-J.H., E.D.), Magdeburg, Germany
| | - J Oltmer
- From the Department of Neurology (V.P., A.A., J.O., H.-J.H., S.S.)
| | - H-J Heinze
- From the Department of Neurology (V.P., A.A., J.O., H.-J.H., S.S.)
- German Center for Neurodegenerative Diseases (V.P., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany
- Leibniz-Institute for Neurobiology (O.S., H.-J.H.), Magdeburg, Germany
- Center for Behavioral Brain Sciences (O.S., H.-J.H., E.D.), Magdeburg, Germany
| | - E Düzel
- Institute of Cognitive Neurology and Dementia Research (E.D.), Ottovon-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (V.P., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany
- Center for Behavioral Brain Sciences (O.S., H.-J.H., E.D.), Magdeburg, Germany
- Institute of Cognitive Neuroscience (E.D.), University College London, London, UK
| | - S Schreiber
- From the Department of Neurology (V.P., A.A., J.O., H.-J.H., S.S.)
- German Center for Neurodegenerative Diseases (V.P., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany
| | - J J M Zwanenburg
- Department of Radiology (T.A., J.J.M.Z.), University Medical Center Utrecht, Utrecht, the Netherlands
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15
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Malhotra K, Theodorou A, Katsanos AH, Zompola C, Shoamanesh A, Boviatsis E, Paraskevas GP, Spilioti M, Cordonnier C, Werring DJ, Alexandrov AV, Tsivgoulis G. Prevalence of Clinical and Neuroimaging Markers in Cerebral Amyloid Angiopathy: A Systematic Review and Meta-Analysis. Stroke 2022; 53:1944-1953. [PMID: 35264008 DOI: 10.1161/strokeaha.121.035836] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist regarding the prevalence of clinical and neuroimaging manifestations among patients diagnosed with cerebral amyloid angiopathy (CAA). We sought to determine the prevalence of clinical phenotypes and radiological markers in patients with CAA. METHODS Systematic review and meta-analysis of studies including patients with CAA was conducted to primarily assess the prevalence of clinical phenotypes and neuroimaging markers as available in the included studies. Sensitivity analyses were performed based on the (1) retrospective or prospective study design and (2) probable or unspecified CAA status. We pooled the prevalence rates using random-effects models and assessed the heterogeneity using the Cochran Q and I2 statistics. RESULTS We identified 12 prospective and 34 retrospective studies including 7159 patients with CAA. The pooled prevalence rates were cerebral microbleeds (52% [95% CI, 43%-60%]; I2=93%), cortical superficial siderosis (49% [95% CI, 38%-59%]; I2=95%), dementia or mild cognitive impairment (50% [95% CI, 35%-65%]; I2=97%), intracerebral hemorrhage (ICH; 44% [95% CI, 27%-61%]; I2=98%), transient focal neurological episodes (48%; 10 studies [95% CI, 29%-67%]; I2=97%), lacunar infarcts (30% [95% CI, 25%-36%]; I2=78%), high grades of perivascular spaces located in centrum semiovale (56% [95% CI, 44%-67%]; I2=88%) and basal ganglia (21% [95% CI, 2%-51%]; I2=98%), and white matter hyperintensities with moderate or severe Fazekas score (53% [95% CI, 40%-65%]; I2=91%). The only neuroimaging marker that was associated with higher odds of recurrent ICH was cortical superficial siderosis (odds ratio, 1.57 [95% CI, 1.01-2.46]; I2=47%). Sensitivity analyses demonstrated a higher prevalence of ICH (53% versus 16%; P=0.03) and transient focal neurological episodes (57% versus 17%; P=0.03) among retrospective studies compared with prospective studies. No difference was documented between the prevalence rates based on the CAA status. CONCLUSIONS Approximately one-half of hospital-based cohort of CAA patients was observed to have cerebral microbleeds, cortical superficial siderosis, mild cognitive impairment, dementia, ICH, or transient focal neurological episodes. Cortical superficial siderosis was the only neuroimaging marker that was associated with higher odds of ICH recurrence. Future population-based studies among well-defined CAA cohorts are warranted to corroborate our findings.
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Affiliation(s)
- Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Aikaterini Theodorou
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.)
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.).,Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S.)
| | - Christina Zompola
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.)
| | - Ashkan Shoamanesh
- Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S.)
| | - Efstathios Boviatsis
- Department of Neurosurgery, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (E.B.)
| | - George P Paraskevas
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.)
| | - Martha Spilioti
- First Department of Neurology, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece (M.S.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience and Cognition, France (C.C.)
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W.)
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.).,Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G.T.)
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16
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Smith EE, Crites S, Wang M, Charlton A, Zwiers A, Sekhon R, Sajobi T, Camicioli R, McCreary CR, Frayne R, Ismail Z. Cerebral Amyloid Angiopathy Is Associated With Emotional Dysregulation, Impulse Dyscontrol, and Apathy. J Am Heart Assoc 2021; 10:e022089. [PMID: 34755541 PMCID: PMC8751932 DOI: 10.1161/jaha.121.022089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cerebral amyloid angiopathy (CAA) causes cognitive decline, but it is not known whether it is associated with neuropsychiatric symptoms (NPS). Methods and Results Participants with CAA, mild cognitive impairment, mild dementia due to Alzheimer's disease, and normal cognition were recruited from stroke and dementia clinics and community advertising. NPS were captured using the Neuropsychiatric Inventory Questionnaire short form. The number and total severity (number multiplied by severity of each symptom [mild, moderate, or severe]) of NPS were analyzed using generalized linear regression with a negative binomial link and multiple linear regression, adjusting for age, sex, and education. A total of 109 participants (43 with CAA, 15 with Alzheimer's disease, 28 with mild cognitive impairment, and 23 with normal cognition) (mean age 71.1 [SD=7.6]; 53.2% male) were included. The most frequent NPS in CAA were depression/dysphoria (48.8%), irritability/lability (37.2%), agitation/aggression (37.2%), apathy/indifference (34.9%), and anxiety (32.6%). In adjusted models, patients with CAA had 3.2 times (95% CI, 1.7-6.0) more NPS symptoms and 3.1 units (95% CI, 1.0-5.1) higher expected severity score. The number of NPS was similar to patients with mild cognitive impairment (3.2 times higher than controls) but less than in patients with Alzheimer's disease dementia (4.1 times higher than controls). Within patients with CAA, there were 1.20 times (95% CI, 1.01-1.32) more NPS per 1% increase in white matter hyperintensity as a percentage of intracranial volume. Conclusions NPS are common in CAA, with a similar prevalence as in mild cognitive impairment. The association of the total number of NPS with higher white matter hyperintensity volume suggests that white matter damage may underlie some of these symptoms.
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Affiliation(s)
- Eric E Smith
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Hotchkiss Brain Institute Calgary Alberta Canada
| | | | - Meng Wang
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Alberta Canada
| | - Anna Charlton
- Department of Clinical Neurosciences University of Calgary Alberta Canada
| | - Angela Zwiers
- Department of Clinical Neurosciences University of Calgary Alberta Canada
| | - Ramnik Sekhon
- Department of Clinical Neurosciences University of Calgary Alberta Canada
| | - Tolulope Sajobi
- Hotchkiss Brain Institute Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Alberta Canada
| | - Richard Camicioli
- Department of Medicine (Neurology) University of Alberta Edmonton Alberta Canada
| | - Cheryl R McCreary
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Hotchkiss Brain Institute Calgary Alberta Canada.,Department of Radiology University of Calgary Alberta Canada
| | - Richard Frayne
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Hotchkiss Brain Institute Calgary Alberta Canada.,Department of Radiology University of Calgary Alberta Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences University of Calgary Alberta Canada.,Hotchkiss Brain Institute Calgary Alberta Canada.,Department of Psychiatry University of Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Alberta Canada
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17
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Su Y, Fu J, Zhang Y, Xu J, Dong Q, Cheng X. Visuospatial dysfunction is associated with posterior distribution of white matter damage in non-demented cerebral amyloid angiopathy. Eur J Neurol 2021; 28:3113-3120. [PMID: 34157199 DOI: 10.1111/ene.14993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral amyloid angiopathy (CAA) is a well-recognized contributor to cognitive decline in the elderly. The posterior cortical predilection of CAA pathology would cause visuospatial dysfunction, which is still underexplored. We aimed to investigate whether the visuospatial dysfunction in CAA is associated with the posterior distribution of small vessel disease (SVD) imaging markers. METHODS We recruited 60 non-demented CAA cases from a Chinese prospective cohort and 30 cases with non-CAA SVD as controls. We used the Visual Object and Space Perception (VOSP) battery to evaluate visuospatial abilities, and multivariable regression models to assess their associations with SVD imaging markers. RESULTS There was visuospatial dysfunction, especially visual object perception impairment, in CAA compared to controls (Z-score of VOSP: -0.11 ± 0.66 vs. 0.22 ± 0.54, p = 0.023). The VOSP score in CAA was independently related to the fronto-occipital gradient of white matter hyperintensity volumes (coefficient = 0.03, 95% confidence interval [CI] = 0.003-0.05, p = 0.030) and mean fractional anisotropy values on diffusion tensor imaging (coefficient = 4.72, 95% CI = 0.97-8.48, p = 0.015), but not the severity of global SVD imaging markers or the gradient of lobar cerebral microbleeds with adjustments for age and global cognition score. CONCLUSIONS This finding suggests that the damage of posterior white matter rather than global disease severity may be a major contributor to visuospatial dysfunction in CAA.
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Affiliation(s)
- Ya Su
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiayu Fu
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanrong Zhang
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiajie Xu
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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18
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Zanon Zotin MC, Sveikata L, Viswanathan A, Yilmaz P. Cerebral small vessel disease and vascular cognitive impairment: from diagnosis to management. Curr Opin Neurol 2021; 34:246-257. [PMID: 33630769 PMCID: PMC7984766 DOI: 10.1097/wco.0000000000000913] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW We present recent developments in the field of small vessel disease (SVD)-related vascular cognitive impairment, including pathological mechanisms, updated diagnostic criteria, cognitive profile, neuroimaging markers and risk factors. We further address available management and therapeutic strategies. RECENT FINDINGS Vascular and neurodegenerative pathologies often co-occur and share similar risk factors. The updated consensus criteria aim to standardize vascular cognitive impairment (VCI) diagnosis, relying strongly on cognitive profile and MRI findings. Aggressive blood pressure control and multidomain lifestyle interventions are associated with decreased risk of cognitive impairment, but disease-modifying treatments are still lacking. Recent research has led to a better understanding of mechanisms leading to SVD-related cognitive decline, such as blood-brain barrier dysfunction, reduced cerebrovascular reactivity and impaired perivascular clearance. SUMMARY SVD is the leading cause of VCI and is associated with substantial morbidity. Tackling cardiovascular risk factors is currently the most effective approach to prevent cognitive decline in the elderly. Advanced imaging techniques provide tools for early diagnosis and may play an important role as surrogate markers for cognitive endpoints in clinical trials. Designing and testing disease-modifying interventions for VCI remains a key priority in healthcare.
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Affiliation(s)
- Maria Clara Zanon Zotin
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Center for Imaging Sciences and Medical Physics. Department of Medical Imaging, Hematology and Clinical Oncology. Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lukas Sveikata
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospital, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Anand Viswanathan
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Pinar Yilmaz
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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19
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Bergeret S, Queneau M, Rodallec M, Curis E, Dumurgier J, Hugon J, Paquet C, Farid K, Baron JC. [ 18 F]FDG PET may differentiate cerebral amyloid angiopathy from Alzheimer's disease. Eur J Neurol 2021; 28:1511-1519. [PMID: 33460498 DOI: 10.1111/ene.14743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is a frequent cause of both intracerebral hemorrhage (ICH) and cognitive impairment in the elderly. Diagnosis relies on the Boston criteria, which use magnetic resonance imaging markers including ≥2 exclusively lobar cerebral microbleeds (lCMBs). Although amyloid positron emission tomography (PET) may provide molecular diagnosis, its specificity relative to Alzheimer's disease (AD) is limited due to the prevalence of positive amyloid PET in cognitively normal elderly. Using early-phase 11 C-Pittsburgh compound B as surrogate for tissue perfusion, a significantly lower occipital/posterior cingulate (O/PC) tracer uptake ratio in probable CAA relative to AD was recently reported, consistent with histopathological lesion distribution. We tested whether this finding could be reproduced using [18 F]fluorodeoxyglucose (FDG)-PET, a widely available modality that correlates well with early-phase amyloid PET in both healthy subjects and AD. METHODS From a large memory clinic database, we retrospectively included 14 patients with probable CAA (Boston criteria) and 21 patients with no lCMB fulfilling AD criteria including cerebrospinal fluid biomarkers. In all, [18 F]FDG-PET/computed tomography (CT) was available as part of routine care. No subject had a clinical history of ICH. Regional standardized [18 F]FDG uptake values normalized to the pons (standard uptake value ratio [SUVr]) were obtained, and the O/PC ratio was calculated. RESULTS The SUVr O/PC ratio was significantly lower in CAA versus AD (1.02 ± 0.14 vs. 1.19 ± 0.18, respectively; p = 0.024). CONCLUSIONS Despite the small sample, our findings are consistent with the previous early-phase amyloid PET study. Thus, [18 F]FDG-PET may help differentiate CAA from AD, particularly in cases of amyloid PET positivity. Larger prospective studies, including in CAA-related ICH, are however warranted.
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Affiliation(s)
- Sébastien Bergeret
- Department of Nuclear Medicine, CHU French West Indies, Fort-de-France, France
| | - Mathieu Queneau
- Department of Nuclear Medicine, Centre Cardiologique du Nord, Saint-Denis, France
| | - Mathieu Rodallec
- Department of Radiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Emmanuel Curis
- Laboratoire de Biomathématiques, EA 7537 "BioSTM", Faculté de Pharmacie, Université de Paris, Paris, France.,Service de Biostatistiques et d'Information Médicale, Hôpital Saint-Louis, APHP, Paris, France
| | - Julien Dumurgier
- INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France
| | - Jacques Hugon
- INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France.,Cognitive Neurology Center, APHP, Saint-Louis Lariboisière Fernand-Widal Hospital Group, Paris, France
| | - Claire Paquet
- INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France.,Cognitive Neurology Center, APHP, Saint-Louis Lariboisière Fernand-Widal Hospital Group, Paris, France
| | - Karim Farid
- Department of Nuclear Medicine, CHU French West Indies, Fort-de-France, France.,INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France
| | - Jean-Claude Baron
- Department of Neurology, Sainte-Anne Hospital, Université de Paris, Paris, France.,INSERM U1266: Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France
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20
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Cognitive Impairment After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 148:141-162. [PMID: 33482414 DOI: 10.1016/j.wneu.2021.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The present systematic review and meta-analysis analyzes the available clinical literature on post-intracerebral hemorrhage (ICH) cognitive impairment. METHODS We conducted a systematic review with meta-analysis following PRISMA guidelines. A search of bibliographic databases up to July 31, 2020 yielded 2155 studies. Twenty articles were included in our final qualitative systematic review and 18 articles in quantitative meta-analysis. RESULTS Based on analysis of data from 18 studies (3270 patients), we found prevalence of post-ICH cognitive impairment to be 46% (confidence interval, 35.9-55.9), with a follow-up duration ranging from 8 days to 4 years. The estimated pooled prevalence of cognitive decline decreased over longitudinal follow-up, from 55% (range, 37.7%-71.15%) within 6 months of ICH to 35% (range, 27%-42.7%) with >6 months to 4 years follow-up after ICH. The modalities used to evaluate cognitive performance after ICH in studies varied widely, ranging from global cognitive measures to domain-specific testing. The cognitive domain most commonly affected included nonverbal IQ, information processing speed, executive function, memory, language, and visuoconstructive abilities. Prognostic factors for poor cognitive performance included severity of cortical atrophy, age, lobar ICH location, and higher number of hemorrhages at baseline. CONCLUSIONS The prevalence of post-ICH cognitive impairment is high. Despite the heterogeneity among studies, the present study identified cognitive domains most commonly affected and predictors of cognitive impairment after ICH. In future, prospective cohort studies with larger sample sizes and standardized cognitive domains testing could more accurately determine prevalence and prognostic factors of post-ICH cognitive decline.
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21
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Hernandez I, Gelpi E, Molina-Porcel L, Bernal S, Rodríguez-Santiago B, Dols-Icardo O, Ruiz A, Alcolea D, Boada M, Lleó A, Clarimón J. Heterozygous APOE Christchurch in familial Alzheimer's disease without mutations in other Mendelian genes. Neuropathol Appl Neurobiol 2020; 47:579-582. [PMID: 33095930 DOI: 10.1111/nan.12670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 01/04/2023]
Abstract
We present the clinical and neuropathological findings of a patient with early onset Alzheimer's dementia (AD), heterozygous carrier of the rare Apolipoprotein E Christchurch (APOEch) variant. The patient did not harbor any pathogenic mutation in known Mendelian genes related to AD or other neurodegenerative disorders. A sibling of this patient, also carrying the APOEch variant, developed AD at the age of 66 years old. Our data suggest a possible deleterious effect of this variant, which contrast with the protective role that has been previously shown in a subject homozygous for the APOEch with he Paisa PSEN1 mutation.
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Affiliation(s)
- Isabel Hernandez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria.,Neurological Tissue Bank of the Biobank of Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS, Barcelona, Spain
| | - Laura Molina-Porcel
- Neurological Tissue Bank of the Biobank of Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS, Barcelona, Spain
| | - Sara Bernal
- Genetics Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U705), IICS, Madrid, Spain
| | - Benjamín Rodríguez-Santiago
- Genetics Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U705), IICS, Madrid, Spain
| | - Oriol Dols-Icardo
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain.,Memory Unit, Neurology Department, Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Agustín Ruiz
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Daniel Alcolea
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain.,Memory Unit, Neurology Department, Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Lleó
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain.,Memory Unit, Neurology Department, Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Clarimón
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain.,Memory Unit, Neurology Department, Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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22
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Hansen D, Ling H, Lashley T, Foley JA, Strand C, Eid TM, Holton JL, Warner TT. Novel clinicopathological characteristics differentiate dementia with Lewy bodies from Parkinson's disease dementia. Neuropathol Appl Neurobiol 2020; 47:143-156. [PMID: 32720329 DOI: 10.1111/nan.12648] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 01/09/2023]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) known as Lewy body dementias have overlapping clinical and neuropathological features. Neuropathology in both includes combination of Lewy body and Alzheimer's disease (AD) pathology. Cerebral amyloid angiopathy (CAA), often seen in AD, is increasingly recognized for its association with dementia. AIMS This study investigated clinical and neuropathological differences between DLB and PDD. METHODS 52 PDD and 16 DLB cases from the Queen Square Brain Bank (QSBB) for Neurological disorders were included. Comprehensive clinical data of motor and cognitive features were obtained from medical records. Neuropathological assessment included examination of CAA, Lewy body and AD pathology. RESULTS CAA was more common in DLB than in PDD (P = 0.003). The severity of CAA was greater in DLB than in PDD (P = 0.009), with significantly higher CAA scores in the parietal lobe (P = 0.043), and the occipital lobe (P = 0.008), in DLB than in PDD. The highest CAA scores were observed in cases with APOE ε4/4 and ε2/4. Survival analysis showed worse prognosis in DLB, as DLB reached each clinical milestone sooner than PDD. Absence of dyskinesia in DLB is linked to the significantly lower lifetime cumulative dose of levodopa in comparison with PDD. CONCLUSIONS This is the first study which identified prominent concurrent CAA pathology as a pathological substrate of DLB. More prominent CAA and rapid disease progression as measured by clinical milestones distinguish DLB from PDD.
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Affiliation(s)
- D Hansen
- Reta Lila Weston Institute, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - H Ling
- Reta Lila Weston Institute, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T Lashley
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - J A Foley
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - C Strand
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T M Eid
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - J L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T T Warner
- Reta Lila Weston Institute, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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23
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Arberry J, Singh S, Mizoguchi RA. Cerebral amyloid angiopathy vs Alzheimer’s dementia: Diagnostic conundrum. Artif Intell Med Imaging 2020; 1:65-69. [DOI: 10.35711/aimi.v1.i1.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diagnosis of a dementia subtype can be complex and often requires comprehensive cognitive assessment and dedicated neuroimaging. Clinicians are prone to cognitive biases when reviewing such images. We present a case of cognitive impairment and demonstrate that initial imaging may have resulted in misleading the diagnosis due to such cognitive biases.
CASE SUMMARY A 76-year-old man with no cognitive impairment presented with acute onset word finding difficulty with unremarkable blood tests and neurological examination. Magnetic resonance imaging (MRI) demonstrated multiple foci of periventricular and subcortical microhaemorrhage, consistent with cerebral amyloid angiopathy (CAA). Cognitive assessment of this patient demonstrated marked impairment mainly in verbal fluency and memory. However, processing speed and executive function are most affected in CAA, whereas episodic memory is relatively preserved, unlike in other causes of cognitive impairment, such as Alzheimer’s dementia (AD). This raised the question of an underlying diagnosis of dementia. Repeat MRI with dedicated coronal views demonstrated mesial temporal lobe atrophy which is consistent with AD.
CONCLUSION MRI brain can occasionally result in diagnostic overshadowing, and the application of artificial intelligence to medical imaging may overcome such cognitive biases.
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Affiliation(s)
- Jamie Arberry
- Chelsea and Westminster Hospital, London SW10 9NH, United Kingdom
| | - Sarneet Singh
- Chelsea and Westminster Hospital, London SW10 9NH, United Kingdom
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24
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Pongpitakmetha T, Fotiadis P, Pasi M, Boulouis G, Xiong L, Warren AD, Schwab KM, Rosand J, Gurol ME, Greenberg SM, Viswanathan A, Charidimou A. Cortical superficial siderosis progression in cerebral amyloid angiopathy: Prospective MRI study. Neurology 2020; 94:e1853-e1865. [PMID: 32284360 DOI: 10.1212/wnl.0000000000009321] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 11/26/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the prevalence, predictors, and clinical relevance of cortical superficial siderosis (cSS) progression in cerebral amyloid angiopathy (CAA). METHODS Consecutive patients with symptomatic CAA meeting Boston criteria in a prospective cohort underwent baseline and follow-up MRI within 1 year. cSS progression was evaluated on an ordinal scale and categorized into mild (score 1-2 = cSS extension within an already present cSS focus or appearance of 1 new cSS focus) and severe progression (score 3-4 = appearance of ≥2 new cSS foci). Binominal and ordinal multivariable logistic regression were used to determine cSS progression predictors. We investigated future lobar intracerebral hemorrhage (ICH) risk in survival analysis models. RESULTS We included 79 patients with CAA (mean age, 69.2 years), 56 (71%) with lobar ICH at baseline. cSS progression was detected in 23 (29%) patients: 15 (19%) patients had mild and 8 (10%) severe progression. In binominal multivariable logistic regression, ICH presence (odds ratio [OR], 7.54; 95% confidence interval [CI], 1.75-53.52; p = 0.016) and baseline cSS (OR, 10.41; 95% CI, 2.84-52.83; p = 0.001) were independent predictors of cSS progression. In similar models, presence of disseminated (but not focal) cSS at baseline (OR, 5.58; 95% CI, 1.81-19.41; p = 0.004) was an independent predictor of cSS progression. Results were similar in ordinal multivariable logistic regression models. In multivariable Cox regression analysis, severe cSS progression was independently associated with increased future ICH risk (HR, 5.90; 95% CI, 1.30-26.68; p = 0.021). CONCLUSIONS cSS evolution on MRI is common in patients with symptomatic CAA and might be a potential biomarker for assessing disease severity and future ICH risk. External validation of these findings is warranted.
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Affiliation(s)
- Thanakit Pongpitakmetha
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Panagiotis Fotiadis
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Marco Pasi
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Gregoire Boulouis
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Li Xiong
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Andrew D Warren
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Kristin M Schwab
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Jonathan Rosand
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - M Edip Gurol
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand
| | - Andreas Charidimou
- From the Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology (T.P., P.F., M.P., G.B., L.X., A.D.W., K.M.S., J.R., M.E.G., S.M.G., A.V., A.C.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, and MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (J.R.), Harvard Medical School, Boston; and Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University, Bangkok, Thailand.
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25
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Perosa V, Priester A, Ziegler G, Cardenas-Blanco A, Dobisch L, Spallazzi M, Assmann A, Maass A, Speck O, Oltmer J, Heinze HJ, Schreiber S, Düzel E. Hippocampal vascular reserve associated with cognitive performance and hippocampal volume. Brain 2020; 143:622-634. [PMID: 31994699 PMCID: PMC7009470 DOI: 10.1093/brain/awz383] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/12/2019] [Accepted: 10/07/2019] [Indexed: 01/14/2023] Open
Abstract
Medial temporal lobe dependent cognitive functions are highly vulnerable to hypoxia in the hippocampal region, yet little is known about the relationship between the richness of hippocampal vascular supply and cognition. Hippocampal vascularization patterns have been categorized into a mixed supply from both the posterior cerebral artery and the anterior choroidal artery or a single supply by the posterior cerebral artery only. Hippocampal arteries are small and affected by pathological changes when cerebral small vessel disease is present. We hypothesized, that hippocampal vascularization patterns may be important trait markers for vascular reserve and modulate (i) cognitive performance; (ii) structural hippocampal integrity; and (iii) the effect of cerebral small vessel disease on cognition. Using high-resolution 7 T time-of-flight angiography we manually classified hippocampal vascularization patterns in older adults with and without cerebral small vessel disease in vivo. The presence of a mixed supplied hippocampus was an advantage in several cognitive domains, including verbal list learning and global cognition. A mixed supplied hippocampus also was an advantage for verbal memory performance in cerebral small vessel disease. Voxel-based morphometry showed higher anterior hippocampal grey matter volume in mixed, compared to single supply. We discuss that a mixed hippocampal supply, as opposed to a single one, may increase the reliability of hippocampal blood supply and thereby provide a hippocampal vascular reserve that protects against cognitive impairment.
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Affiliation(s)
- Valentina Perosa
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Anastasia Priester
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Gabriel Ziegler
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Arturo Cardenas-Blanco
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Laura Dobisch
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Marco Spallazzi
- Department of Neurology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Anne Assmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Anne Maass
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Oliver Speck
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Leibniz-Institute for Neurobiology (LIN), Magdeburg, Germany
- Institute of Physics, Otto-von-Guericke University, Magdeburg, Germany
| | - Jan Oltmer
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Leibniz-Institute for Neurobiology (LIN), Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Emrah Düzel
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, UK
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26
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De Guio F, Duering M, Fazekas F, De Leeuw FE, Greenberg SM, Pantoni L, Aghetti A, Smith EE, Wardlaw J, Jouvent E. Brain atrophy in cerebral small vessel diseases: Extent, consequences, technical limitations and perspectives: The HARNESS initiative. J Cereb Blood Flow Metab 2020; 40:231-245. [PMID: 31744377 PMCID: PMC7370623 DOI: 10.1177/0271678x19888967] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Brain atrophy is increasingly evaluated in cerebral small vessel diseases. We aim at systematically reviewing the available data regarding its extent, correlates and cognitive consequences. Given that in this context, brain atrophy measures might be biased, the first part of the review focuses on technical aspects. Thereafter, data from the literature are analyzed in light of these potential limitations, to better understand the relationships between brain atrophy and other MRI markers of cerebral small vessel diseases. In the last part, we review the links between brain atrophy and cognitive alterations in patients with cerebral small vessel diseases.
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Affiliation(s)
- François De Guio
- Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), APHP, Lariboisière Hospital, Paris, DHU NeuroVasc, Univ Paris Diderot, and U1141 INSERM, France
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Frank-Erik De Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University, Nijmegen, The Netherlands
| | - Steven M Greenberg
- Department of Neurology, Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Leonardo Pantoni
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Agnès Aghetti
- Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), APHP, Lariboisière Hospital, Paris, DHU NeuroVasc, Univ Paris Diderot, and U1141 INSERM, France
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, Edinburgh Imaging, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Eric Jouvent
- Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), APHP, Lariboisière Hospital, Paris, DHU NeuroVasc, Univ Paris Diderot, and U1141 INSERM, France
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27
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Donnellan C, Werring D. Cognitive impairment before and after intracerebral haemorrhage: a systematic review. Neurol Sci 2019; 41:509-527. [PMID: 31802344 DOI: 10.1007/s10072-019-04150-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/12/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION There is increasing interest in understanding cognitive dysfunction before and after Intracerebral haemorrhage (ICH), given the higher prevalence of dementia reported (ranging from 5 to 44%) for this stroke type. Much of the evidence to date examining cognitive impairment associated with cerebrovascular disease has tended to focus more on ischaemic stroke. The aim of this review was to identify and quantify studies that focused on cognitive dysfunction pre and post ICH. METHODS We conducted a systematic search using databases PubMed, Science Direct, Scopus and PsycINFO to identify studies that exclusively assessed cognitive function pre and post ICH. Studies were included in the review if used a measure of global cognition and/or a neuropsychological battery to assess cognitive function. Nineteen studies were deemed relevant for inclusion, where n = 8 studies examined cognitive impairment pre ICH and n = 11 post ICH. RESULTS Prevalence of cognitive impairment ranged between 9-29% for pre ICH and 14-88% for post ICH. Predictive factors identified for pre and post ICH were previous stroke, ICH volume and location and markers of cerebral amyloid angiopathy (CAA). Most common cognitive domains affected post ICH were information processing speed, executive function, memory, language and visuo-spatial abilities. Most common cognitive assessments tools were the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) for pre-existing cognitive impairment and the Mini-Mental State Examination for global cognition post ICH and the Trail Making Test where neuropsychological tests were used. CONCLUSION Cognitive impairment and dementia affected almost one-third of patients, whether assessed pre or post ICH.
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Affiliation(s)
- Claire Donnellan
- School of Nursing and Midwifery, Faculty of Health Sciences, University of Dublin Trinity College, 2 Clare Street, Dublin 2, Ireland.
| | - David Werring
- Stroke Research Centre, UCL Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
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28
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Boomsma JMF, Exalto LG, Barkhof F, van den Berg E, de Bresser J, Heinen R, Leeuwis AE, Prins ND, Scheltens P, Weinstein HC, van der Flier WM, Biessels GJ. How Do Different Forms of Vascular Brain Injury Relate to Cognition in a Memory Clinic Population: The TRACE-VCI Study. J Alzheimers Dis 2019; 68:1273-1286. [PMID: 30909212 DOI: 10.3233/jad-180696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Memory clinic patients frequently present with different forms of vascular brain injury due to different etiologies, often co-occurring with Alzheimer's disease (AD) pathology. OBJECTIVE We studied how cognition was affected by different forms of vascular brain injury, possibly in interplay with AD pathology. METHODS We included 860 memory clinic patients with vascular brain injury on magnetic resonance imaging (MRI), receiving a standardized evaluation including cerebrospinal fluid (CSF) biomarker analyses (n = 541). The cognitive profile of patients with different forms of vascular brain injury on MRI (moderate/severe white matter hyperintensities (WMH) (n = 398), microbleeds (n = 368), lacunar (n = 188) and non-lacunar (n = 96) infarct(s), macrobleeds (n = 16)) was assessed by: 1) comparison of all these different forms of vascular brain injury with a reference group (patients with only mild WMH (n = 205) without other forms of vascular brain injury), using linear regression analyses also stratified for CSF biomarker AD profile and 2) multivariate linear regression analysis. RESULTS The cognitive profile was remarkably similar across groups. Compared to the reference group effect sizes on all domains were <0.2 with narrow 95% confidence intervals, except for non-lacunar infarcts on information processing speed (age, sex, and education adjusted mean difference from reference group (β: - 0.26, p = 0.05). Results were similar in the presence (n = 300) or absence (n = 241) of biomarker co-occurring AD pathology. In multivariate linear regression analysis, higher WMH burden was related to a slightly worse performance on attention and executive functioning (β: - 0.08, p = 0.02) and working memory (β: - 0.08, p = 0.04). CONCLUSION Although different forms of vascular brain injury have different etiologies and different patterns of cerebral damage, they show a largely similar cognitive profile in memory clinic patients regardless of co-occurring AD pathology.
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Parfenov VA, Ostroumova OD, Ostroumova TM, Kochetkov AI, Fateeva VV, Khacheva KK, Khakimova GR, Epstein OI. Vascular cognitive impairment: pathophysiological mechanisms, insights into structural basis, and perspectives in specific treatments. Neuropsychiatr Dis Treat 2019; 15:1381-1402. [PMID: 31190841 PMCID: PMC6535085 DOI: 10.2147/ndt.s197032] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/14/2019] [Indexed: 01/19/2023] Open
Abstract
Vascular cognitive impairment (VCI) and vascular dementia are the most common forms of cognitive disorder associated with cerebrovascular disease and related to increased morbidity and mortality among the older population. Growing evidence suggests the contribution of blood-pressure variability, cardiac arrhythmia, hyperactivation of the renin-angiotensin-aldosterone system, endothelial dysfunction, vascular remodeling and stiffness, different angiopathies, neural tissue homeostasis, and systemic metabolic disorders to the pathophysiology of VCI. In this review, we focus on factors contributing to cerebrovascular disease, neurovascular unit alterations, and novel approaches to cognitive improvement in patients with cognitive decline. One of the important factors associated with the neuronal causes of VCI is the S100B protein, which can affect the expression of cytokines in the brain, support homeostasis, and regulate processes of differentiation, repair, and apoptosis of the nervous tissue. Since the pathological basis of VCI is complex and diverse, treatment affecting the mechanisms of cognitive disorders should be developed. The prospective role of a novel complex drug consisting of released-active antibodies to S100 and to endothelial NO synthase in VCI treatment is highlighted.
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Affiliation(s)
- Vladimir A Parfenov
- Department of Neurology, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Olga D Ostroumova
- Laboratory of Clinical Pharmacology and therapy, Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Russian Clinical and Research Center of Gerontology, Moscow, Russia.,Department of Clinical Pharmacology, Internal Medicine and Propaedeutics I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana M Ostroumova
- Department of Neurology, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Alexey I Kochetkov
- Laboratory of Clinical Pharmacology and therapy, Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Russian Clinical and Research Center of Gerontology, Moscow, Russia
| | - Victoria V Fateeva
- Medical Information Department, OOO NPF Materia Medica Holding, Moscow, Russian Federation
| | - Kristina K Khacheva
- Medical Information Department, OOO NPF Materia Medica Holding, Moscow, Russian Federation
| | - Gulnara R Khakimova
- Research and Analytical Division of Scientific Research and Development Department, Moscow, Russian Federation
| | - Oleg I Epstein
- Laboratory of Physiologicaly Active Substances, Department of Molecular and Cellular Pathophysiology, Research Institute of General Pathology and Pathophysiology, Moscow, Russian Federation
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30
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Domain-specific characterisation of early cognitive impairment following spontaneous intracerebral haemorrhage. J Neurol Sci 2018; 391:25-30. [DOI: 10.1016/j.jns.2018.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/29/2018] [Accepted: 05/18/2018] [Indexed: 01/02/2023]
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Abstract
PURPOSE OF REVIEW Cerebral amyloid angiopathy (CAA) is diagnosed primarily as a cause of lobar intracerebral hemorrhages (ICH) in elderly patients. With improving MRI techniques, however, the role of CAA in causing other symptoms has become clear. Recognizing the full clinical spectrum of CAA is important for diagnosis and treatment. In this review we summarize recent insights in clinical CAA features, MRI biomarkers, and management. RECENT FINDINGS The rate of ICH recurrence in CAA is among the highest of all stroke subtypes. Cortical superficial siderosis (cSS) and cortical subarachnoid hemorrhage (cSAH) are important imaging predictors for recurrent ICH. CAA also causes cognitive problems in multiple domains. In patients with nondemented CAA, the risk of developing dementia is high especially after ICH. CAA pathology probably starts years before the first clinical manifestations. The first signs in hereditary CAA are white matter lesions, cortical microinfarcts, and impaired occipital cerebral vasoreactivity. Visible centrum semiovale perivascular spaces, lobar located lacunes, and cortical atrophy are new nonhemorrhagic MRI markers. SUMMARY CAA should be in the differential diagnosis of elderly patients with lobar ICH but also in those with cognitive decline and episodic transient neurological symptoms. Physicians should be aware of the cognitive effects of CAA. In patients with a previous ICH, cSS, or cSAH, anticoagulation should be considered risky. The increasing number of MRI markers may help to discriminate CAA from other small vessel diseases and dementia subtypes.
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32
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Reversible sub-acute cognitive deterioration in cerebral amyloid angiopathy: A case report. J Neurol Sci 2018; 385:215-216. [PMID: 29406906 DOI: 10.1016/j.jns.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 11/22/2022]
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Xiong L, Boulouis G, Charidimou A, Roongpiboonsopit D, Jessel MJ, Pasi M, Reijmer YD, Fotiadis P, Ayres A, Merrill E, Schwab K, Blacker D, Gurol ME, Greenberg SM, Viswanathan A. Dementia incidence and predictors in cerebral amyloid angiopathy patients without intracerebral hemorrhage. J Cereb Blood Flow Metab 2018; 38:241-249. [PMID: 28318355 PMCID: PMC5951014 DOI: 10.1177/0271678x17700435] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is a common cause of cognitive impairment in older individuals. This study aimed to investigate predictors of dementia in CAA patients without intracerebral hemorrhage (ICH). A total of 158 non-demented patients from the Stroke Service or the Memory Clinic who met the modified Boston Criteria for probable CAA were included. At baseline, neuroimaging markers, including lobar microbleeds (cerebral microbleeds (CMBs)), white matter hyperintensities (WMH), cortical superficial siderosis (cSS), magnetic resonance imaging (MRI)-visible centrum semiovale perivascular spaces (CSO-PVS), lacunes, and medial temporal atrophy (MTA) were assessed. The overall burden of small vessel disease (SVD) for CAA was calculated by a cumulative score based on CMB number, WMH severity, cSS presence and extent and CSO-PVS severity. The estimated cumulative dementia incidence at 1 year was 14% (95% confidence interval (CI): 5%-23%), and 5 years 73% (95% CI: 55%, 84%). Age (hazard ratio (HR) 1.05 per year, 95% CI: 1.01-1.08, p = 0.007), presence of MCI status (HR 3.40, 95% CI: 1.97-6.92, p < 0.001), MTA (HR 1.71 per point, 95% CI: 1.26-2.32, p = 0.001), and SVD score (HR 1.23 per point, 95% CI: 1.20-1.48, p = 0.030) at baseline were independent predictors for dementia conversion in these patients. Cognitive deterioration of CAA patients appears attributable to cumulative changes, from both vasculopathic and neurodegenerative lesions.
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Affiliation(s)
- Li Xiong
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | | | | | - Duangnapa Roongpiboonsopit
- 1 Department of Neurology, Harvard Medical School, Boston, USA.,2 Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Marco Pasi
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | - Yael D Reijmer
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | | | - Alison Ayres
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | - Emily Merrill
- 3 MIND Informatics, Harvard Medical School, Boston, USA
| | - Kristin Schwab
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | - Deborah Blacker
- 4 Department of Psychiatry, Harvard Medical School, Boston, USA
| | - M Edip Gurol
- 1 Department of Neurology, Harvard Medical School, Boston, USA
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34
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Banerjee G, Wilson D, Ambler G, Osei-Bonsu Appiah K, Shakeshaft C, Lunawat S, Cohen H, Yousry T, Lip GYH, Muir KW, Brown MM, Al-Shahi Salman R, Jäger HR, Werring DJ. Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy. Stroke 2017; 49:40-45. [PMID: 29247143 PMCID: PMC5753815 DOI: 10.1161/strokeaha.117.019409] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 11/22/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Although the association between cerebral amyloid angiopathy (CAA) and cognitive impairment is increasingly recognized, it is not clear whether this is because of the impact of recurrent intracerebral hemorrhage (ICH) events, disruptions caused by cerebral small vessel damage, or both. We investigated this by considering whether cognitive impairment before ICH was associated with neuroimaging features of CAA on magnetic resonance imaging. Methods— We studied 166 patients with neuroimaging-confirmed ICH recruited to a prospective multicentre observational study. Preexisting cognitive impairment was determined using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Magnetic resonance imaging markers of cerebral small vessel disease, including CAA, were rated by trained observers according to consensus guidelines. Results— The prevalence of cognitive impairment before ICH was 24.7% (n=41) and, in adjusted analyses, was associated with fulfilling the modified Boston criteria for probable CAA at presentation (odds ratio, 4.01; 95% confidence interval, 1.53–10.51; P=0.005) and a higher composite CAA score (for each point increase, odds ratio, 1.42; 95% confidence interval, 1.03–1.97; P=0.033). We also found independent associations between pre-ICH cognitive decline and the presence of cortical superficial siderosis, strictly lobar microbleeds, and lobar ICH location, but not with other neuroimaging markers, or a composite small vessel disease score. Conclusions— CAA (defined using magnetic resonance imaging markers) is associated with cognitive decline before symptomatic ICH. This provides evidence that small vessel disruption in CAA makes an independent contribution to cognitive impairment, in addition to effects due to brain injury caused directly by ICH. Clinical Trial Registration— URL: https://www.clinicaltrials.gov. Unique identifier: NCT02513316.
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Affiliation(s)
- Gargi Banerjee
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Duncan Wilson
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Gareth Ambler
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Karen Osei-Bonsu Appiah
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Clare Shakeshaft
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Surabhika Lunawat
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Hannah Cohen
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Tarek Yousry
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Gregory Y H Lip
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Keith W Muir
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Martin M Brown
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Rustam Al-Shahi Salman
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Hans Rolf Jäger
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - David J Werring
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.).
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35
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Distinctive Clinical Effects of Haemorrhagic Markers in Cerebral Amyloid Angiopathy. Sci Rep 2017; 7:15984. [PMID: 29167486 PMCID: PMC5700189 DOI: 10.1038/s41598-017-16298-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/10/2017] [Indexed: 01/12/2023] Open
Abstract
Restricted lobar cerebral microbleeds (CMBs) and cortical superficial siderosis (CSS) are the characteristic markers of cerebral amyloid angiopathy (CAA). However, their effects on clinical features has not been evaluated well. The purpose of this study is to investigate the clinical implication of these markers in clinical-radiologically diagnosed CAA. A total of 372 patients with possible or probable CAA who met the modified Boston criteria were recruited in a memory clinic setting. Cortical thickness was measured using surface based methods. Presence of restricted multiple lobar CMBs were independently associated with cortical thinning across the entire cortical regions while presence of CSS was independently associated with cortical thinning primarily in the bilateral frontal region. Presence of restricted multiple lobar CMBs was associated with impairment in all cognitive domains such as attention, language, visuospatial, memory and frontal executive functions while presence of CSS was associated with attention and frontal dysfunction. The relationships of restricted multiple lobar CMBs or CSS with cognitive impairment were partially mediated by thinning in the corresponding cortical regions. Our findings suggested that restricted multiple lobar CMBs and CSS affect distinctive clinical features, providing new insights into potential mechanisms in CAA.
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36
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Planton M, Raposo N, Albucher JF, Pariente J. Cerebral amyloid angiopathy-related cognitive impairment: The search for a specific neuropsychological pattern. Rev Neurol (Paris) 2017; 173:562-565. [DOI: 10.1016/j.neurol.2017.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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37
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Banerjee G, Carare R, Cordonnier C, Greenberg SM, Schneider JA, Smith EE, Buchem MV, Grond JVD, Verbeek MM, Werring DJ. The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice. J Neurol Neurosurg Psychiatry 2017; 88:982-994. [PMID: 28844070 PMCID: PMC5740546 DOI: 10.1136/jnnp-2016-314697] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/26/2017] [Accepted: 05/18/2017] [Indexed: 12/29/2022]
Abstract
Cerebral amyloid angiopathy (CAA) has never been more relevant. The last 5 years have seen a rapid increase in publications and research in the field, with the development of new biomarkers for the disease, thanks to advances in MRI, amyloid positron emission tomography and cerebrospinal fluid biomarker analysis. The inadvertent development of CAA-like pathology in patients treated with amyloid-beta immunotherapy for Alzheimer's disease has highlighted the importance of establishing how and why CAA develops; without this information, the use of these treatments may be unnecessarily restricted. Our understanding of the clinical and radiological spectrum of CAA has continued to evolve, and there are new insights into the independent impact that CAA has on cognition in the context of ageing and intracerebral haemorrhage, as well as in Alzheimer's and other dementias. While the association between CAA and lobar intracerebral haemorrhage (with its high recurrence risk) is now well recognised, a number of management dilemmas remain, particularly when considering the use of antithrombotics, anticoagulants and statins. The Boston criteria for CAA, in use in one form or another for the last 20 years, are now being reviewed to reflect these new wide-ranging clinical and radiological findings. This review aims to provide a 5-year update on these recent advances, as well as a look towards future directions for CAA research and clinical practice.
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Affiliation(s)
- Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Roxana Carare
- Division of Clinical Neurosciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Charlotte Cordonnier
- Department of Neurology, Université de Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Steven M Greenberg
- J P Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie A Schneider
- Departments of Pathology and Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel M Verbeek
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Departments of Neurology and Laboratory Medicine, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
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38
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Smith EE. Cerebral amyloid angiopathy as a cause of neurodegeneration. J Neurochem 2017; 144:651-658. [PMID: 28833176 DOI: 10.1111/jnc.14157] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 02/04/2023]
Abstract
Sporadic, age-related cerebral amyloid angiopathy (CAA) is most commonly recognized clinically as a cause of hemorrhagic stroke and transient focal neurological episodes in older persons. But a growing body of research in the last 5 years shows that the pathophysiology of CAA is much more complex than previously believed, leading to many different types of brain injury. CAA has now been linked with brain atrophy in regions remote from those directly affected by intracerebral hematomas, and with risk for progressive cognitive decline in the absence of new hemorrhagic strokes. Therefore, CAA is associated with features - brain atrophy and progressive cognitive decline - that are typically considered hallmarks of neurodegenerative disease. Although CAA is usually accompanied by some degree of Alzheimer's disease pathology, the profiles of cortical thinning and cognitive impairment do not fully overlap with those seen in Alzheimer's disease, suggesting that there are CAA-specific pathways of neurodegeneration. CAA-related brain ischemia may be an important mechanism that leads to brain injury, cortical disconnection, and cognitive impairment. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Eric E Smith
- Associate Professor of Neurology, University of Calgary, Health Sciences Centre, Calgary, Alberta, Canada
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39
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Charidimou A, Boulouis G, Gurol ME, Ayata C, Bacskai BJ, Frosch MP, Viswanathan A, Greenberg SM. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain 2017; 140:1829-1850. [PMID: 28334869 DOI: 10.1093/brain/awx047] [Citation(s) in RCA: 296] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/17/2017] [Indexed: 12/27/2022] Open
Abstract
Sporadic cerebral amyloid angiopathy is a common, well-defined small vessel disease and a largely untreatable cause of intracerebral haemorrhage and contributor to age-related cognitive decline. The term 'cerebral amyloid angiopathy' now encompasses not only a specific cerebrovascular pathological finding, but also different clinical syndromes (both acute and progressive), brain parenchymal lesions seen on neuroimaging and a set of diagnostic criteria-the Boston criteria, which have resulted in increasingly detected disease during life. Over the past few years, it has become clear that, at the pathophysiological level, cerebral amyloid angiopathy appears to be in part a protein elimination failure angiopathy and that this dysfunction is a feed-forward process, which potentially leads to worsening vascular amyloid-β accumulation, activation of vascular injury pathways and impaired vascular physiology. From a clinical standpoint, cerebral amyloid angiopathy is characterized by individual focal lesions (microbleeds, cortical superficial siderosis, microinfarcts) and large-scale alterations (white matter hyperintensities, structural connectivity, cortical thickness), both cortical and subcortical. This review provides an interdisciplinary critical outlook on various emerging and changing concepts in the field, illustrating mechanisms associated with amyloid cerebrovascular pathology and neurological dysfunction.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian J Bacskai
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Matthew P Frosch
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA.,C.S. Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.,Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
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40
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Planton M, Saint-Aubert L, Raposo N, Branchu L, Lyoubi A, Bonneville F, Albucher JF, Olivot JM, Péran P, Pariente J. High prevalence of cognitive impairment after intracerebral hemorrhage. PLoS One 2017; 12:e0178886. [PMID: 28570698 PMCID: PMC5453588 DOI: 10.1371/journal.pone.0178886] [Citation(s) in RCA: 26] [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: 02/06/2017] [Accepted: 05/19/2017] [Indexed: 12/31/2022] Open
Abstract
Background Cognitive impairment seems to be frequent in intracerebral hemorrhage (ICH) survivors, but remains widely understudied. In this study, we investigated the frequency and patterns of vascular cognitive disorders (VCDs) in patients with cerebral amyloid angiopathy (CAA)-related and deep ICH compared to patients with mild cognitive impairment due to Alzheimer’s disease (MCI-AD) and healthy controls. Methods We prospectively recruited 20 patients with CAA-related lobar ICH, 20 with deep ICH, 20 with MCI-AD and 17 healthy controls. Patients with cognitive decline pre-ICH were excluded from the analysis. Each participant underwent a comprehensive neuropsychological assessment and a structural brain MRI. Cognitive assessment was performed at a median delay of 4 months after the acute phase in ICH patients, and more than 6 months after the first complaint in MCI-AD patients. Cognitive profiles were compared between groups. The prevalence of VCDs in the ICH groups was estimated using the recent VASCOG criteria. Results “Mild” and “major VCDs” were respectively observed in 87.5% and 2.5% of all ICH patients. Every patient in the CAA group had mild VCDs. No significant difference was observed in cognitive functioning between CAA-related and deep ICH patients. The most impaired process in the CAA group was naming, with a mean (±standard deviation) z-score of -5.2 ±5.5, followed by processing speed (-4.1±3.3), executive functioning (-2.6 ±2.5), memory (-2.4 ±3.5) and attention (-0.9 ±1.3). This cognitive pattern was different from the MCI-AD patients, but the groups were only different in gestural praxis, and by construction, in memory processes. Conclusions VCDs are frequent after ICH. Cognitive patterns of patients with deep or CAA-related ICH did not differ, but there was impaired performance in specific domains distinct from the effects of Alzheimer’s disease. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01619709.
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Affiliation(s)
- Mélanie Planton
- Department of Neurology, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
- * E-mail:
| | - Laure Saint-Aubert
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Nicolas Raposo
- Department of Neurology, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Laura Branchu
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Aicha Lyoubi
- Department of Neurology, Groupe Hospitalier Lariboisière-Fernand-Widal, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Fabrice Bonneville
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Jean-François Albucher
- Department of Neurology, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Jean-Marc Olivot
- Department of Neurology, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Patrice Péran
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Jérémie Pariente
- Department of Neurology, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
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Clinical presentations and epidemiology of vascular dementia. Clin Sci (Lond) 2017; 131:1059-1068. [DOI: 10.1042/cs20160607] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/27/2016] [Accepted: 02/15/2017] [Indexed: 11/17/2022]
Abstract
Cerebrovascular and cardiovascular diseases cause vascular brain injury that can lead to vascular cognitive impairment (VCI). VCI is the second most common neuropathology of dementia and mild cognitive impairment (MCI), accounting for up to one-third of the population risk. It is frequently present along with other age-related pathologies such as Alzheimer's disease (AD). Multiple etiology dementia with both VCI and AD is the single most common cause of later life dementia. There are two main clinical syndromes of VCI: post-stroke VCI in which cognitive impairment is the immediate consequence of a recent stroke and VCI without recent stroke in which cognitive impairment is the result of covert vascular brain injury detected only on neuroimaging or neuropathology. VCI is a syndrome that can result from any cause of infarction, hemorrhage, large artery disease, cardioembolism, small vessel disease, or other cerebrovascular or cardiovascular diseases. Secondary prevention of further vascular brain injury may improve outcomes in VCI.
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Carmona-Iragui M, Balasa M, Benejam B, Alcolea D, Fernández S, Videla L, Sala I, Sánchez-Saudinós MB, Morenas-Rodriguez E, Ribosa-Nogué R, Illán-Gala I, Gonzalez-Ortiz S, Clarimón J, Schmitt F, Powell DK, Bosch B, Lladó A, Rafii MS, Head E, Molinuevo JL, Blesa R, Videla S, Lleó A, Sánchez-Valle R, Fortea J. Cerebral amyloid angiopathy in Down syndrome and sporadic and autosomal-dominant Alzheimer's disease. Alzheimers Dement 2017; 13:1251-1260. [PMID: 28463681 DOI: 10.1016/j.jalz.2017.03.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/10/2017] [Accepted: 03/17/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We aimed to investigate if cerebral amyloid angiopathy (CAA) is more frequent in genetically determined than in sporadic early-onset forms of Alzheimer's disease (AD) (early-onset AD [EOAD]). METHODS Neuroimaging features of CAA, apolipoprotein (APOE), and cerebrospinal fluid amyloid β (Aβ) 40 levels were studied in subjects with Down syndrome (DS, n = 117), autosomal-dominant AD (ADAD, n = 29), sporadic EOAD (n = 42), and healthy controls (n = 68). RESULTS CAA was present in 31%, 38%, and 12% of cognitively impaired DS, symptomatic ADAD, and sporadic EOAD subjects and in 13% and 4% of cognitively unimpaired DS individuals and healthy controls, respectively. APOE ε4 genotype was borderline significantly associated with CAA in sporadic EOAD (P = .06) but not with DS or ADAD. There were no differences in Aβ040 levels between groups or between subjects with and without CAA. DISCUSSION CAA is more frequently found in genetically determined AD than in sporadic EOAD. Cerebrospinal fluid Aβ40 levels are not a useful biomarker for CAA in AD.
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Affiliation(s)
- María Carmona-Iragui
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain; Global Brain Health Institute, Trinity College Dublin, College Green, Dublin, Ireland
| | - Mircea Balasa
- Global Brain Health Institute, Trinity College Dublin, College Green, Dublin, Ireland; Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Department, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Bessy Benejam
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Daniel Alcolea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Laura Videla
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Isabel Sala
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - María Belén Sánchez-Saudinós
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Estrella Morenas-Rodriguez
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Roser Ribosa-Nogué
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Ignacio Illán-Gala
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Sofía Gonzalez-Ortiz
- Department of Radiology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Clarimón
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Frederick Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - David K Powell
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Beatriz Bosch
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Department, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Albert Lladó
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Department, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Michael S Rafii
- Adult Down Syndrome Clinic, Department of Neuroscience, University of California, San Diego, CA, USA; Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Elizabeth Head
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - José Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Department, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; BarcelonaBeta Brain Research Center, Fundació Pasqual Maragall, Universitat Pompeu Fabra, Barcelona, Spain
| | - Rafael Blesa
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Sebastián Videla
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain; Faculty of Health and Life Sciences, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Department, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain.
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Valenti R, Charidimou A, Xiong L, Boulouis G, Fotiadis P, Ayres A, Riley G, Kuijf HJ, Reijmer YD, Pantoni L, Gurol ME, Davidsdottir S, Greenberg SM, Viswanathan A. Visuospatial Functioning in Cerebral Amyloid Angiopathy: A Pilot Study. J Alzheimers Dis 2017; 56:1223-1227. [DOI: 10.3233/jad-160927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Raffaella Valenti
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Andreas Charidimou
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Li Xiong
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Gregoire Boulouis
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Panagiotis Fotiadis
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Alison Ayres
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Grace Riley
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Hugo J. Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yael D. Reijmer
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Leonardo Pantoni
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - M. Edip Gurol
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Sigurros Davidsdottir
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M. Greenberg
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
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Boulouis G, Charidimou A, Jessel MJ, Xiong L, Roongpiboonsopit D, Fotiadis P, Pasi M, Ayres A, Merrill ME, Schwab KM, Rosand J, Gurol ME, Greenberg SM, Viswanathan A. Small vessel disease burden in cerebral amyloid angiopathy without symptomatic hemorrhage. Neurology 2017; 88:878-884. [PMID: 28130469 DOI: 10.1212/wnl.0000000000003655] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/12/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Cerebral amyloid angiopathy (CAA) is a common age-related small vessel disease (SVD). Patients without intracerebral hemorrhage (ICH) typically present with transient focal neurologic episodes (TFNEs) or cognitive symptoms. We sought to determine if SVD lesion burden differed between patients with CAA first presenting with TFNEs vs cognitive symptoms. METHODS A total of 647 patients presenting either to a stroke department (n = 205) or an outpatient memory clinic (n = 442) were screened for eligibility. Patients meeting modified Boston criteria for probable CAA were included and markers of SVD were quantified, including cerebral microbleeds (CMBs), perivascular spaces, cortical superficial siderosis (cSS), and white matter hyperintensities (WMHs). Patients were classified according to presentation symptoms (TFNEs vs cognitive). Total CAA-SVD burden was assessed using a validated summary score. Individual neuroimaging markers and total SVD burden were compared between groups using univariable and multivariable models. RESULTS There were 261 patients with probable CAA included. After adjustment for confounders, patients first seen for TFNEs (n = 97) demonstrated a higher prevalence of cSS (p < 0.0001), higher WMH volumes (p = 0.03), and a trend toward higher CMB counts (p = 0.09). The total SVD summary score was higher in patients seen for TFNEs (adjusted odds ratio per additional score point 1.46, 95% confidence interval 1.16-1.84, p = 0.013). CONCLUSIONS Patients with probable CAA without ICH first evaluated for TFNEs bear a higher burden of structural MRI SVD-related damage compared to those first seen for cognitive symptoms. This study sheds light on neuroimaging profile differences across clinical phenotypes of patients with CAA without ICH.
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Affiliation(s)
- Gregoire Boulouis
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand.
| | - Andreas Charidimou
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Michael J Jessel
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Li Xiong
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Duangnapa Roongpiboonsopit
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Panagiotis Fotiadis
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Marco Pasi
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Alison Ayres
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - M Emily Merrill
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Kristin M Schwab
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Jonathan Rosand
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - M Edip Gurol
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (G.B., A.C., M.J.J., L.X., D.R., P.F., M.P., A.A., K.M.S., J.R., M.E.G., S.M.G., A.V.), MIND Informatics, Massachusetts General Hospital Biomedical Informatics Core (M.E.M., J.R.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA; Neuroradiology Department (G.B.), Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France; and Faculty of Medicine (D.R.), Naresuan University, Phitsanulok, Thailand
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Case NF, Charlton A, Zwiers A, Batool S, McCreary CR, Hogan DB, Ismail Z, Zerna C, Coutts SB, Frayne R, Goodyear B, Haffenden A, Smith EE. Cerebral Amyloid Angiopathy Is Associated With Executive Dysfunction and Mild Cognitive Impairment. Stroke 2016; 47:2010-6. [PMID: 27338926 DOI: 10.1161/strokeaha.116.012999] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/17/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Autopsy studies suggest that cerebral amyloid angiopathy (CAA) is associated with cognitive impairment and risk for dementia. We analyzed neuropsychological test data from a prospective cohort study of patients with CAA to identify the prevalence of cognitive impairment and its associations with brain magnetic resonance imaging features and the apolipoprotein E genotype. METHODS Data were analyzed from 34 CAA, 16 Alzheimer's disease, 69 mild cognitive impairment, and 27 ischemic stroke participants. Neuropsychological test results were expressed as z scores in relation to normative data provided by the test manuals and then grouped into domains of memory, executive function, and processing speed. RESULTS Mean test scores in CAA participants were significantly lower than norms for memory (-0.44±1.03; P=0.02), executive function (-1.14±1.07; P<0.001), and processing speed (-1.06±1.12; P<0.001). Twenty-seven CAA participants (79%) had mild cognitive impairment based on low cognitive performance accompanied by cognitive concerns. CAA participants had similarly low executive function scores as Alzheimer's disease, but relatively preserved memory. CAA participants' scores were lower than those of ischemic stroke controls for executive function and processing speed. Lower processing speed scores in CAA were associated with higher magnetic resonance imaging white matter hyperintensity volume. There were no associations with the apolipoprotein E ε4 allele. CONCLUSIONS Mild cognitive impairment is very prevalent in CAA. The overall cognitive profile of CAA is more similar to that seen in vascular cognitive impairment rather than Alzheimer's disease. White matter ischemic lesions may underlie some of the impaired processing speed in CAA.
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Affiliation(s)
- Nevicia F Case
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Anna Charlton
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Angela Zwiers
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Saima Batool
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Cheryl R McCreary
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - David B Hogan
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Zahinoor Ismail
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Charlotte Zerna
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Shelagh B Coutts
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Richard Frayne
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Brad Goodyear
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Angela Haffenden
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Eric E Smith
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.).
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