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Lawson B, Martin J, Aarabi A, Ouin E, Tasseel-Ponche S, Barbay M, Andriuta D, Roussel M, Godefroy O. Poststroke cognitive outcome is better accounted for by white matter abnormalities automated segmentation than visual analysis. Rev Neurol (Paris) 2024:S0035-3787(24)00557-5. [PMID: 39004559 DOI: 10.1016/j.neurol.2024.06.004] [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: 01/11/2023] [Revised: 04/06/2024] [Accepted: 06/11/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND AND AIMS The association between white matter abnormalities (WMA) and cognitive decline previously reported in poststroke patients has been mainly documented using visual scales. However, automated segmentation of WMA provides a precise determination of the volume of WMA. Nonetheless, it is rarely used in the stroke population and its potential advantage over visual scales is still unsettled. The objective of this study was to examine whether automated segmentation of WMA provides a better account than the visual Fazekas and Wahlund scales of the decline in executive functions and processing speed in stroke patients. METHODS The analyses were conducted on the 358 patients of the GRECogVASC cohort with an MRI performed at six months poststroke in the Amiens center. WMA were visually analyzed using the Fazekas (subcortical abnormalities) and Wahlund scales. Segmentation was performed using LST (3.0.3). Following preliminary studies to determine the optimal segmentation threshold, we examined the relationship between cognitive status and WMA volume computed at each threshold using receiver operating characteristic (ROC) curves. Finally, we assessed the ability of both Fazekas and Wahlund visual scores and WMA volume to account for cognitive scores by using a bivariate Pearson correlation analysis, comparing correlation coefficients with the Fisher transformation and repeating correlation analysis after adjustment for the lesion volume. RESULTS Increasing the threshold led to an underestimation of WMA (P=0.0001) (significant for a threshold ≥0.2) and an improvement in correct rejection of signal changes in the stroke cavity (P=0.02) (significant for a threshold ≤0.5), susceptibility artifacts (P=0.002) (significant for a threshold ≤0.6), and corticospinal degeneration (P=0.03) (significant for a threshold ≤0.5). WMA volume decreased with increasing threshold (P=0.0001). Areas under the curve (AUC) did not differ according to the threshold (processing speed: P=0.85, executive cognitive functions: P=0.7). Correlation coefficients between cognitive scores and WMA were higher for WMA volume than the Fazekas (processing speed: Z=-3.442, P=0.001; executive functions: Z=-2.751, P=0.006) and Wahlund scores (processing speed: Z=-3.615, P=0.0001; executive functions: Z=-2.769, P=0.006). Adjustment for lesion volume did not alter the correlations with WMA volume (processing speed: r=-0.327 [95%CI: -0.416; -0.223], P=0.0001; executive functions: r=-0.262 [95%CI: -0.363; -0.150], P=0.0001). CONCLUSION This study shows that WMA volume assessed by automated segmentation provides a better account of cognitive disorders than visual analysis. This should favor its wider use to refine imaging determinants of poststroke cognitive disorders.
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Affiliation(s)
- B Lawson
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - J Martin
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - A Aarabi
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - E Ouin
- Departments of Neurology, Amiens University Hospital, Amiens, France
| | - S Tasseel-Ponche
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - M Barbay
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - D Andriuta
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - M Roussel
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France
| | - O Godefroy
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, Amiens, France.
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Sperber C, Hakim A, Gallucci L, Arnold M, Umarova RM. Cerebral small vessel disease and stroke: Linked by stroke aetiology, but not stroke lesion location or size. J Stroke Cerebrovasc Dis 2024; 33:107589. [PMID: 38244646 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107589] [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: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Cerebral small vessel disease (SVD) has previously been associated with worse stroke outcome, vascular dementia, and specific post-stroke cognitive deficits. The underlying causal mechanisms of these associations are not yet fully understood. We investigated whether a relationship between SVD and certain stroke aetiologies or a specific stroke lesion anatomy provides a potential explanation. METHODS In a retrospective observational study, we examined 859 patients with first-ever, non-SVD anterior circulation ischemic stroke (age = 69.0±15.2). We evaluated MRI imaging markers to assess an SVD burden score and mapped stroke lesions on diffusion-weighted MRI. We investigated the association of SVD burden with i) stroke aetiology, and ii) lesion anatomy using topographical statistical mapping. RESULTS With increasing SVD burden, stroke of cardioembolic aetiology was more frequent (ρ = 0.175; 95 %-CI = 0.103;0.244), whereas cervical artery dissection (ρ = -0.143; 95 %-CI = -0.198;-0.087) and a patent foramen ovale (ρ = -0.165; 95 %-CI = -0.220;-0.104) were less frequent stroke etiologies. However, no significant associations between SVD burden and stroke aetiology remained after additionally controlling for age (all p>0.125). Lesion-symptom-mapping and Bayesian statistics showed that SVD burden was not associated with a specific stroke lesion anatomy or size. CONCLUSIONS In patients with a high burden of SVD, non-SVD stroke is more likely to be caused by cardioembolic aetiology. The common risk factor of advanced age may link both pathologies and explain some of the existing associations between SVD and stroke. The SVD burden is not related to a specific stroke lesion location.
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Affiliation(s)
- Christoph Sperber
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Laura Gallucci
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Roza M Umarova
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
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Li T, Ye M, Yang G, Diao S, Zhou Y, Qin Y, Ding D, Zhu M, Fang Q. Regional white matter hyperintensity volume predicts persistent cognitive impairment in acute lacunar infarct patients. Front Neurol 2023; 14:1265743. [PMID: 37881309 PMCID: PMC10595143 DOI: 10.3389/fneur.2023.1265743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023] Open
Abstract
Background White matter hyperintensity (WMH) is often described in acute lacunar stroke (ALS) patients. However, the specific relationship between regional WMH volume and persistent cognitive impairment remains unclear. Methods We enrolled patients with ALS who were hospitalized at the First Affiliated Hospital of Soochow University between January 2020 and November 2022. All patients were assessed for global cognitive function using the Montreal Cognitive Assessment (MoCA) scale at 14 ± 2 days and 6 months after the onset of ALS. Manifestations of chronic cerebral small vessel disease (CSVD) were assessed via MRI scan. The distributions of regional WMH were segmented, and their relationship with cognitive impairment was evaluated. Results A total of 129 patients were enrolled. Baseline frontal WMH volume (OR = 1.18, P = 0.04) was an independent risk factor for long-term cognitive impairment after ALS. Furthermore, the presence of WMH at the genu of the corpus callosum (GCC) at baseline (OR = 3.1, P = 0.033) was strongly associated with persistent cognitive decline. Multivariable logistic regression analysis showed that depression (OR = 6.252, P = 0.029), NIHSS score (OR = 1.24, P = 0.011), and albumin at admission (OR = 0.841, P = 0.032) were also important determinants of long-term cognitive impairment after ALS. Conclusions Our study found that WMH, especially frontal WMH volume and the presence of WMH at the GCC at baseline, independently contributed to long-term cognitive decline in ALS patients. This study provides new evidence of the clinical relationship between regional WMH volume and cognitive impairment in ALS patients.
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Affiliation(s)
- Tan Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Mengfan Ye
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guopeng Yang
- Suzhou Jiasheng Medical Instrument Co., Ltd., Suzhou, Jiangsu, China
| | - Shanshan Diao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yun Zhou
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yiren Qin
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Dongxue Ding
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Mo Zhu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Sperber C, Hakim A, Gallucci L, Seiffge D, Rezny-Kasprzak B, Jäger E, Meinel T, Wiest R, Fischer U, Arnold M, Umarova R. A typology of cerebral small vessel disease based on imaging markers. J Neurol 2023; 270:4985-4994. [PMID: 37368130 PMCID: PMC10511610 DOI: 10.1007/s00415-023-11831-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Lacunes, microbleeds, enlarged perivascular spaces (EPVS), and white matter hyperintensities (WMH) are brain imaging features of cerebral small vessel disease (SVD). Based on these imaging markers, we aimed to identify subtypes of SVD and to evaluate the validity of these markers as part of clinical ratings and as biomarkers for stroke outcome. METHODS In a cross-sectional study, we examined 1207 first-ever anterior circulation ischemic stroke patients (mean age 69.1 ± 15.4 years; mean NIHSS 5.3 ± 6.8). On acute stroke MRI, we assessed the numbers of lacunes and microbleeds and rated EPVS and deep and periventricular WMH. We used unsupervised learning to cluster patients based on these variables. RESULTS We identified five clusters, of which the last three appeared to represent distinct late stages of SVD. The two largest clusters had no to only mild or moderate WMH and EPVS, respectively, and favorable stroke outcome. The third cluster was characterized by the largest number of lacunes and a likewise favorable outcome. The fourth cluster had the highest age, most pronounced WMH, and poor outcome. Showing the worst outcome, the fifth cluster presented pronounced microbleeds and the most severe SVD burden. CONCLUSION The study confirmed the existence of different SVD types with different relationships to stroke outcome. EPVS and WMH were identified as imaging features of presumably early progression. The number of microbleeds and WMH severity appear to be promising biomarkers for distinguishing clinical subgroups. Further understanding of SVD progression might require consideration of refined SVD features, e.g., for EPVS and type of lacunes.
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Affiliation(s)
- Christoph Sperber
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Laura Gallucci
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Beata Rezny-Kasprzak
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Eugen Jäger
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Meinel
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Roland Wiest
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Roza Umarova
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
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Tziaka E, Christidi F, Tsiptsios D, Sousanidou A, Karatzetzou S, Tsiakiri A, Doskas TK, Tsamakis K, Retzepis N, Konstantinidis C, Kokkotis C, Serdari A, Aggelousis N, Vadikolias K. Leukoaraiosis as a Predictor of Depression and Cognitive Impairment among Stroke Survivors: A Systematic Review. Neurol Int 2023; 15:238-272. [PMID: 36810471 PMCID: PMC9944578 DOI: 10.3390/neurolint15010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Stroke survivors are at increased risk of developing depression and cognitive decline. Thus, it is crucial for both clinicians and stroke survivors to be provided with timely and accurate prognostication of post-stroke depression (PSD) and post-stroke dementia (PSDem). Several biomarkers regarding stroke patients' propensity to develop PSD and PSDem have been implemented so far, leukoaraiosis (LA) being among them. The purpose of the present study was to review all available work published within the last decade dealing with pre-existing LA as a predictor of depression (PSD) and cognitive dysfunction (cognitive impairment or PSDem) in stroke patients. A literature search of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 25 June 2022 that dealt with the clinical utility of preexisting LA as a prognostic indicator of PSD and PSDem/cognitive impairment. Only full-text articles published in the English language were included. Thirty-four articles were traced and are included in the present review. LA burden, serving as a surrogate marker of "brain frailty" among stroke patients, appears to be able to offer significant information about the possibility of developing PSD or cognitive dysfunction. Determining the extent of pre-existing white matter abnormalities can properly guide decision making in acute stroke settings, as a greater degree of such lesioning is usually coupled with neuropsychiatric aftermaths, such as PSD and PSDem.
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Affiliation(s)
- Eftychia Tziaka
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Correspondence: ; Tel.: +30-6944320016
| | - Anastasia Sousanidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK
| | - Nikolaos Retzepis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Christos Konstantinidis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
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Ramaswamy S, Khasiyev F, Gutierrez J. Brain Enlarged Perivascular Spaces as Imaging Biomarkers of Cerebrovascular Disease: A Clinical Narrative Review. J Am Heart Assoc 2022; 11:e026601. [PMID: 36533613 PMCID: PMC9798817 DOI: 10.1161/jaha.122.026601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Perivascular spaces or Virchow-Robin spaces form pathways along the subarachnoid spaces that facilitate the effective clearance of brain metabolic by-products through intracellular exchange and drainage of cerebrospinal fluid. Best seen on magnetic resonance imaging of the brain, enlarged perivascular spaces (EPVSs) are increasingly recognized as potential imaging biomarkers of neurological conditions. EPVSs are an established subtype of cerebral small-vessel disease; however, their associations with other cerebrovascular disorders are yet to be fully understood. In particular, there has been great interest in the association between the various parameters of EPVSs, such as number, size, and topography, and vascular neurological conditions. Studies have identified cross-sectional and longitudinal relationships between EPVS parameters and vascular events, such as ischemic stroke (both clinical and silent), intracerebral hemorrhage, vascular risk factors, such as age and hypertension, and neurodegenerative processes, such as vascular dementia and Alzheimer disease. However, these studies are limited by heterogeneity of data and the lack of consistent results across studied populations. Existing meta-analyses also fail to provide uniformity of results. We performed a qualitative narrative review with an aim to provide an overview of the associations between EPVSs and cerebrovascular diseases, which may help recognize gaps in our knowledge, inform the design of future studies, and advance the role of EPVSs as imaging biomarkers.
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Affiliation(s)
- Srinath Ramaswamy
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNY
| | - Farid Khasiyev
- Department of NeurologySt. Louis University School of MedicineSt. LouisMO
| | - Jose Gutierrez
- Department of NeurologyColumbia University Irving Medical CenterNew YorkNY
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Einstad MS, Schellhorn T, Thingstad P, Lydersen S, Aamodt EB, Beyer MK, Saltvedt I, Askim T. Neuroimaging markers of dual impairment in cognition and physical performance following stroke: The Nor-COAST study. Front Aging Neurosci 2022; 14:1037936. [PMID: 36561134 PMCID: PMC9765078 DOI: 10.3389/fnagi.2022.1037936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background Cognitive decline and decline in physical performance are common after stroke. Concurrent impairments in the two domains are reported to give increased risk of dementia and functional decline. The concept of dual impairment of physical performance and cognition after stroke is poorly investigated. Clinically accessible imaging markers of stroke and pre-existing brain pathology might help identify patients at risk. Objective The primary aim of this study was to investigate to which extent pre-stroke cerebral pathology was associated with dual impairment in cognition and physical performance at time of stroke. Secondary aims were to examine whether white matter hyperintensities, medial temporal lobe atrophy, and stroke lesion volume and location were associated with dual impairment. Methods Participants from the Norwegian Cognitive Impairment After Stroke (Nor-COAST) study with available MRI data at baseline were included in this cross-sectional study. Logistic regression analyses were conducted, with impairment status (no impairment, impaired cognition, impaired physical performance, and dual impairment) as the dependent variable and MRI markers as covariates. Pre-existing brain pathologies were classified into neurodegenerative, cerebrovascular, or mixed pathology. In addition, white matter hyperintensities and medial temporal lobe atrophy were included as independent covariates. Stroke volume and location were also ascertained from study-specific MRI scans. Results Participants' (n = 348) mean (SD) age was 72.3 (11.3) years; 148 (42.5%) were women. Participants with dual impairment (n = 99) were significantly older, had experienced a more severe stroke, and had a higher comorbidity burden and poorer pre-stroke function. Stroke lesion volume (odds ratio 1.03, 95%, confidence interval 1.00 to 1.05, p = 0.035), but not stroke location or pre-existing brain pathology, was associated with dual impairment, after adjusting for age and sex. Conclusion In this large cohort of stroke survivors having suffered mainly mild to moderate stroke, stroke lesion volume-but not pre-existing brain pathology-was associated with dual impairment early after stroke, confirming the role of stroke severity in functional decline.
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Affiliation(s)
- Marte Stine Einstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway,*Correspondence: Marte Stine Einstad,
| | - Till Schellhorn
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Eva Birgitte Aamodt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Mona Kristiansen Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway,Department of Geriatric Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway,Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Joo L, Shim WH, Suh CH, Lim SJ, Heo H, Kim WS, Hong E, Lee D, Sung J, Lim JS, Lee JH, Kim SJ. Diagnostic performance of deep learning-based automatic white matter hyperintensity segmentation for classification of the Fazekas scale and differentiation of subcortical vascular dementia. PLoS One 2022; 17:e0274562. [PMID: 36107961 PMCID: PMC9477348 DOI: 10.1371/journal.pone.0274562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To validate the diagnostic performance of commercially available, deep learning-based automatic white matter hyperintensity (WMH) segmentation algorithm for classifying the grades of the Fazekas scale and differentiating subcortical vascular dementia. Methods This retrospective, observational, single-institution study investigated the diagnostic performance of a deep learning-based automatic WMH volume segmentation to classify the grades of the Fazekas scale and differentiate subcortical vascular dementia. The VUNO Med-DeepBrain was used for the WMH segmentation system. The system for segmentation of WMH was designed with convolutional neural networks, in which the input image was comprised of a pre-processed axial FLAIR image, and the output was a segmented WMH mask and its volume. Patients presented with memory complaint between March 2017 and June 2018 were included and were split into training (March 2017–March 2018, n = 596) and internal validation test set (April 2018–June 2018, n = 204). Results Optimal cut-off values to categorize WMH volume as normal vs. mild/moderate/severe, normal/mild vs. moderate/severe, and normal/mild/moderate vs. severe were 3.4 mL, 9.6 mL, and 17.1 mL, respectively, and the AUC were 0.921, 0.956 and 0.960, respectively. When differentiating normal/mild vs. moderate/severe using WMH volume in the test set, sensitivity, specificity, and accuracy were 96.4%, 89.9%, and 91.7%, respectively. For distinguishing subcortical vascular dementia from others using WMH volume, sensitivity, specificity, and accuracy were 83.3%, 84.3%, and 84.3%, respectively. Conclusion Deep learning-based automatic WMH segmentation may be an accurate and promising method for classifying the grades of the Fazekas scale and differentiating subcortical vascular dementia.
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Affiliation(s)
- Leehi Joo
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Su Jin Lim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwon Heo
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Woo Seok Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ben Assayag E, Tene O, Korczyn AD, Solomon Z, Bornstein NM, Shenhar-Tsarfaty S, Seyman E, Niry D, Molad J, Hallevi H. Posttraumatic Stress Symptoms After Stroke: The Effects of Anatomy and Coping Style. Stroke 2022; 53:1924-1933. [PMID: 35264011 DOI: 10.1161/strokeaha.121.036635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical emergencies, such as stroke. Data suggest that up to 25% of stroke survivors will develop PTSD symptomatology, but little is known about predisposing factors. We sought to examine whether neuroimaging measures and coping styles are related to PTSD symptoms after stroke. METHODS Participants were survivors of first-ever, mild-moderate ischemic stroke, or transient ischemic attack from the TABASCO study (Tel Aviv Brain Acute Stroke Cohort). All participants underwent a 3T magnetic resonance imaging at baseline and were examined 6, 12, and 24 months thereafter, using neurological, neuropsychological, and functional evaluations. At baseline, coping styles were evaluated by a self-reported questionnaire. PTSD symptoms were assessed using the PTSD checklist. Data were available for 436 patients. RESULTS Forty-eight participants (11%) developed probable PTSD (PTSD checklist ≥44) during the first year after the stroke/transient ischemic attack. Stroke was more likely to cause PTSD than transient ischemic attack. Stroke severity, larger white matter lesion volume, and worse hippocampal connectivity were associated with PTSD severity, while infarct volume or location was not. In a multivariate analysis, high-anxious and defensive coping styles were associated with a 6.66-fold higher risk of developing poststroke PTSD ([95% CI, 2.08-21.34]; P<0.01) compared with low-anxious and repressive coping styles, after adjusting for age, education, stroke severity, brain atrophy, and depression. CONCLUSIONS In our cohort, PTSD was a common sequela among stroke survivors. We suggest that risk factors for PTSD development include stroke severity, white matter damage, and premorbid coping styles. Early identification of at-risk patients is key to effective treatment.
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Affiliation(s)
- Einor Ben Assayag
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Oren Tene
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Amos D Korczyn
- Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, Israel. (Z.S.)
| | - Natan M Bornstein
- Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.)
| | - Shani Shenhar-Tsarfaty
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Estelle Seyman
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.)
| | - Dana Niry
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Jeremy Molad
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.)
| | - Hen Hallevi
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
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10
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Lee SJ, Hwang YH, Hong JM, Choi JW, Park JH, Park B, Kang DH, Kim YW, Kim YS, Hong JH, Yoo J, Kim CH, Sohn SI, Lee JS. Influence of cerebral microbleeds on mechanical thrombectomy outcomes. Sci Rep 2022; 12:3637. [PMID: 35256626 PMCID: PMC8901625 DOI: 10.1038/s41598-022-07432-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022] Open
Abstract
In ischemic stroke patients undergoing endovascular treatment (EVT), we aimed to test the hypothesis that cerebral microbleeds (CMBs) are associated with clinical outcomes, while estimating the mediating effects of hemorrhagic transformation (HT), small-vessel disease burden (white matter hyperintensities, WMH), and procedural success. From a multicenter EVT registry, patients who underwent pretreatment MR imaging were analyzed. They were trichotomized according to presence of CMBs (none vs. 1–4 vs. ≥ 5). The association between CMB burden and 3-month mRS was evaluated using multivariable ordinal logistic regression, and mediation analyses were conducted to estimate percent mediation. Of 577 patients, CMBs were present in 91 (15.8%); 67 (11.6%) had 1–4 CMBs, and 24 (4.2%) had ≥ 5. Increases in CMBs were associated with hemorrhagic complications (β = 0.27 [0.06–0.047], p = 0.010) in multivariable analysis. The CMB effect on outcome was partially mediated by post-procedural HT degree (percent mediation, 14% [0–42]), WMH (23% [7–57]) and lower rates of successful reperfusion (6% [0–25]). In conclusion, the influence of CMBs on clinical outcomes is mediated by small-vessel disease burden, post-procedural HT, and lower reperfusion rates, listed in order of percent mediation size.
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11
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Quinn TJ, Richard E, Teuschl Y, Gattringer T, Hafdi M, O'Brien JT, Merriman N, Gillebert C, Huygelier H, Verdelho A, Schmidt R, Ghaziani E, Forchammer H, Pendlebury ST, Bruffaerts R, Mijajlovic M, Drozdowska BA, Ball E, Markus HS. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur J Neurol 2021; 28:3883-3920. [PMID: 34476868 DOI: 10.1111/ene.15068] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The optimal management of post-stroke cognitive impairment (PSCI) remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making regarding prevention, diagnosis, treatment and prognosis. METHODS Guidelines were developed according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations. RESULTS There was limited randomized controlled trial (RCT) evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Lifestyle interventions and treating vascular risk factors have many health benefits, but a cognitive effect is not proven. We found no evidence regarding routine cognitive screening following stroke, but recognize the importance of targeted cognitive assessment. We describe the accuracy of various cognitive screening tests, but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognition. The association between PSCI and acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on brain magnetic resonance imaging may help predict cognitive outcomes. CONCLUSIONS These guidelines highlight fundamental areas where robust evidence is lacking. Further definitive RCTs are needed, and we suggest priority areas for future research.
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Affiliation(s)
- Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yvonne Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Thomas Gattringer
- Department of Neurology and Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Melanie Hafdi
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Niamh Merriman
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Celine Gillebert
- Department Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium.,TRACE, Centre for Translational Psychological Research (TRACE), KU Leuven - Hospital East-Limbourgh, Genk, Belgium
| | - Hanne Huygelier
- Department Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium.,TRACE, Centre for Translational Psychological Research (TRACE), KU Leuven - Hospital East-Limbourgh, Genk, Belgium
| | - Ana Verdelho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Lisbon, Portugal
| | - Reinhold Schmidt
- Department of Neurology and Medical University of Graz, Graz, Austria
| | - Emma Ghaziani
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Sarah T Pendlebury
- Departments of Medicine and Geratology and NIHR Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Rose Bruffaerts
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Milija Mijajlovic
- Neurosonology Unit, Neurology Clinic, University Clinical Center of Serbia and Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Bogna A Drozdowska
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Emily Ball
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Hugh S Markus
- Stroke Research group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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12
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Quinn TJ, Richard E, Teuschl Y, Gattringer T, Hafdi M, O’Brien JT, Merriman N, Gillebert C, Huyglier H, Verdelho A, Schmidt R, Ghaziani E, Forchammer H, Pendlebury ST, Bruffaerts R, Mijajlovic M, Drozdowska BA, Ball E, Markus HS. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur Stroke J 2021; 6:I-XXXVIII. [PMID: 34746430 PMCID: PMC8564156 DOI: 10.1177/23969873211042192] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023] Open
Abstract
The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment and prognosis. These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post-stroke cognitive impairment and most acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on acute MRI brain may help predict cognitive outcomes. These guidelines have highlighted fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research.
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Affiliation(s)
- Terence J Quinn
- Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, UK
| | - Edo Richard
- Department of Neurology, Donders
Institute for Brain, Behaviour and Cognition, Radboud University Medical
Centre, Nijmegen, The Netherlands
| | - Yvonne Teuschl
- Department for Clinical
Neurosciences and Preventive Medicine, Danube University Krems, der Donau, Austria
| | - Thomas Gattringer
- Department of Neurology and
Division of Neuroradiology, Vascular and Interventional Radiology, Department of
Radiology, Medical University of
Graz, Graz, Austria
| | - Melanie Hafdi
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge School of
Clinical Medicine, Cambridge, UK
| | - Niamh Merriman
- Deptartment of Health Psychology,
Division of Population Health Sciences, Royal College of Surgeons in
Ireland, Dublin, Ireland
| | - Celine Gillebert
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE, Centre for Translational
Psychological Research (TRACE), KU Leuven – Hospital
East-Limbourgh, Genk, Belgium
| | - Hanne Huyglier
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE, Centre for Translational
Psychological Research (TRACE), KU Leuven – Hospital
East-Limbourgh, Genk, Belgium
| | - Ana Verdelho
- Department of Neurosciences and
Mental Health, Hospital de Santa Maria, Lisbon, Portugal
| | - Reinhold Schmidt
- Department of Neurology, Medical University of
Graz, Graz, Austria
| | - Emma Ghaziani
- Department of Physical and
Occupational Therapy, Bispebjerg and Frederiksberg
Hospital, Copenhagen, Denmark
| | | | - Sarah T Pendlebury
- Departments of Medicine and
Geratology and NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS
Foundation Trust, Oxford, UK
| | - Rose Bruffaerts
- Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - Milija Mijajlovic
- Neurosonology Unit, Neurology
Clinic, University Clinical Center of Serbia
and Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Bogna A Drozdowska
- Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, UK
| | - Emily Ball
- Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Hugh S Markus
- Stroke Research Group, Department
of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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13
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Bir SC, Khan MW, Javalkar V, Toledo EG, Kelley RE. Emerging Concepts in Vascular Dementia: A Review. J Stroke Cerebrovasc Dis 2021; 30:105864. [PMID: 34062312 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105864] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Vascular dementia (VaD) is the second most common cause of dementia and a major health concern worldwide. A comprehensive review on VaD is warranted for better understanding and guidance for the practitioner. We provide an updated overview of the epidemiology, pathophysiological mechanisms, neuroimaging patterns as well as current diagnostic and therapeutic approaches. MATERIALS AND METHODS A narrative review of current literature in VaD was performed based on publications from the database of PubMed, Scopus and Google Scholar up to January, 2021. RESULTS VaD can be the result of ischemic or hemorrhagic tissue injury in a particular region of the brain which translates into clinically significant cognitive impairment. For example, a cerebral infarct in the speech area of the dominant hemisphere would translate into clinically significant impairment as would involvement of projection pathways such as the arcuate fasciculus. Specific involvement of the angular gyrus of the dominant hemisphere, with resultant Gerstman's syndrome, could have a pronounced effect on functional ability despite being termed a "minor stroke". Small vessel cerebrovascular disease can have a cumulate effect on cognitive function over time. It is unfortunately well recognized that "good" functional recovery in acute ischemic or haemorrhagic stroke, including subarachnoid haemorrhage, does not necessarily translate into good cognitive recovery. The victim may often be left unable to have gainful employment, drive a car safely or handle their affairs independently. CONCLUSIONS This review should serve as a compendium of updated information on VaD and provide guidance in terms of newer diagnostic and potential therapeutic approaches.
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Affiliation(s)
- Shyamal C Bir
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA
| | - Muhammad W Khan
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA
| | - Vijayakumar Javalkar
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA
| | | | - Roger E Kelley
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA.
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14
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Wang Y, Li C, Ding M, Lin L, Li P, Wang Y, Dong Q, Yang Y, Cui M. Carotid Atherosclerotic Calcification Characteristics Relate to Post-stroke Cognitive Impairment. Front Aging Neurosci 2021; 13:682908. [PMID: 34113247 PMCID: PMC8185032 DOI: 10.3389/fnagi.2021.682908] [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] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Together with cerebral small vessel disease (CSVD), large vessel atherosclerosis is considered to be an equally important risk factor in the progression of vascular cognitive impairment. This article aims to investigate whether carotid atherosclerotic calcification is associated with the increased risk of post-stroke cognitive impairment (PSCI). Methods: A total of 128 patients (mean age: 62.1 ± 12.2 years, 37 women) suffering from ischemic stroke underwent brain/neck computer tomography angiography examination. The presence and characteristic of carotid calcification (size, number and location) were analyzed on computer tomography angiography. White matter hyperintensity (WMH) was assessed using Fazekas scales. PSCI was diagnosed based on a battery of neuropsychological assessments implemented 6−12 months after stroke. Results: Among 128 patients, 26 developed post-stroke dementia and 96 had carotid calcification. Logistic regression found carotid calcification (odds ratio [OR] = 7.15, 95% confidence interval [CI]: 1.07–47.69) and carotid artery stenosis (OR = 6.42, 95% CI: 1.03–40.15) both significantly increased the risk for post-stroke dementia. Moreover, multiple, thick/mixed, and surface calcifications exhibited an increasing trend in PSCI (Ptrend = 0.004, 0.016, 0.045, respectively). The prediction model for post-stroke dementia including carotid calcification (area under curve = 0.67), WMH (area under curve = 0.67) and other covariates yielded an area under curve (AUC) of 0.90 (95% CI: 0.82–0.99). Conclusion: Our findings demonstrated that the quantity and location of carotid calcifications were independent indicators for PSCI. The significant role of large vessel atherosclerosis in PSCI should be concerned in future study.
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Affiliation(s)
- Yingzhe Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chanchan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengyuan Ding
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Luyi Lin
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Peixi Li
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yizhe Wang
- Department of Medicine, Nanchang University, Nanchang, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,The State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yanmei Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,The State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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15
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Valdés Hernández MDC, Ballerini L, Glatz A, Muñoz Maniega S, Gow AJ, Bastin ME, Starr JM, Deary IJ, Wardlaw JM. Perivascular spaces in the centrum semiovale at the beginning of the 8th decade of life: effect on cognition and associations with mineral deposition. Brain Imaging Behav 2021; 14:1865-1875. [PMID: 31250262 PMCID: PMC7572330 DOI: 10.1007/s11682-019-00128-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Brain iron deposits (IDs) are indicative of microvessel dysfunction which may predispose to small vessel disease (SVD) brain damage and worsen cognition later in life. Visible perivascular spaces in the centrum semiovale (CSO-PVS) are SVD features linked with microvessel dysfunction. We examined possible associations of CSO-PVS volume and count with brain IDs and cognitive abilities in 700 community-dwelling individuals from the Lothian Birth Cohort 1936 who underwent detailed cognitive testing and multimodal brain MRI at mean age 72.7 years. Brain IDs were assessed automatically followed by manual editing. PVS were automatically assessed in the centrum semiovale and deep corona radiata supraventricular. General factors of overall cognitive function (g), processing speed (g-speed) and memory (g-memory) were used in the analyses. Median (IQR) volumes of IDs and CSO-PVS expressed as a percentage of intracranial volume were 0.0021 (0.011) and 0.22 (0.13)% respectively. Median count of CSO-PVS was 410 (IQR = 201). Total volumes of CSO-PVS and ID, adjusted for head size, were correlated (Spearman ρ = 0.13, p < 0.001). CSO-PVS volume, despite being correlated with all three cognitive measures, was only associated with g-memory (B = -114.5, SE = 48.35, p = 0.018) in general linear models, adjusting for age, sex, vascular risk factors, childhood intelligence and white matter hyperintensity volume. The interaction of CSO-PVS count with diabetes (B = -0.0019, SE = 0.00093, p = 0.041) and volume with age (B = 1.57, SE = 0.67, p = 0.019) were also associated with g-memory. Linear regression models did not replicate these associations. Therefore, it does not seem that CSO-PVS burden is directly associated with general cognitive ability in older age.
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Affiliation(s)
- Maria Del C Valdés Hernández
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK. .,Dementia Research Institute, University of Edinburgh, 49 Little France Crescent, Chancellor's Building FU-427, Edinburgh, EH16 4SB, UK. .,Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK. .,Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh Campus, David Brewster Building (Room 2.63A), Edinburgh, EH14 4AS, UK.
| | - Lucia Ballerini
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK.,Dementia Research Institute, University of Edinburgh, 49 Little France Crescent, Chancellor's Building FU-427, Edinburgh, EH16 4SB, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Andreas Glatz
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK
| | - Susana Muñoz Maniega
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK.,Dementia Research Institute, University of Edinburgh, 49 Little France Crescent, Chancellor's Building FU-427, Edinburgh, EH16 4SB, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Alan J Gow
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK.,Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh Campus, David Brewster Building (Room 2.63A), Edinburgh, EH14 4AS, UK
| | - Mark E Bastin
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK.,Alzheimer Scotland Dementia Research Centre, Department of Psychology (Room G24), University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK.,Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Joanna M Wardlaw
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK.,Dementia Research Institute, University of Edinburgh, 49 Little France Crescent, Chancellor's Building FU-427, Edinburgh, EH16 4SB, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK.,Row Fogo Centre for Ageing and the Brain, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK
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16
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Einstad MS, Saltvedt I, Lydersen S, Ursin MH, Munthe-Kaas R, Ihle-Hansen H, Knapskog AB, Askim T, Beyer MK, Næss H, Seljeseth YM, Ellekjær H, Thingstad P. Associations between post-stroke motor and cognitive function: a cross-sectional study. BMC Geriatr 2021; 21:103. [PMID: 33546620 PMCID: PMC7863272 DOI: 10.1186/s12877-021-02055-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Motor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related. The aim of this study was to describe the prevalence of concurrent motor and cognitive impairments 3 months after stroke and to examine how motor performance was associated with memory, executive function and global cognition. METHODS The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study is a prospective multicentre cohort study including patients hospitalized with acute stroke between May 2015 and March 2017. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission. Level of disability was assessed by the Modified Rankin Scale (mRS). Motor and cognitive functions were assessed 3 months post-stroke using the Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (TMT-B), 10-Word List Recall (10WLR), Short Physical Performance Battery (SPPB), dual-task cost (DTC) and grip strength (Jamar®). Cut-offs were set according to current recommendations. Associations were examined using linear regression with cognitive tests as dependent variables and motor domains as covariates, adjusted for age, sex, education and stroke severity. RESULTS Of 567 participants included, 242 (43%) were women, mean (SD) age was 72.2 (11.7) years, 416 (75%) had an NIHSS score ≤ 4 and 475 (84%) had an mRS score of ≤2. Prevalence of concurrent motor and cognitive impairment ranged from 9.5% for DTC and 10WLR to 22.9% for grip strength and TMT-B. SPPB was associated with MoCA (regression coefficient B = 0.465, 95%CI [0.352, 0.578]), TMT-B (B = -9.494, 95%CI [- 11.726, - 7.925]) and 10WLR (B = 0.132, 95%CI [0.054, 0.211]). Grip strength was associated with MoCA (B = 0.075, 95%CI [0.039, 0.112]), TMT-B (B = -1.972, 95%CI [- 2.672, - 1.272]) and 10WLR (B = 0.041, 95%CI [0.016, 0.066]). Higher DTC was associated with more time needed to complete TMT-B (B = 0.475, 95%CI [0.075, 0.875]) but not with MoCA or 10WLR. CONCLUSION Three months after suffering mainly minor strokes, 30-40% of participants had motor or cognitive impairments, while 20% had concurrent impairments. Motor performance was associated with memory, executive function and global cognition. The identification of concurrent impairments could be relevant for preventing functional decline. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02650531 .
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Affiliation(s)
- Marte Stine Einstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatric Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Marie H Ursin
- Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yngve M Seljeseth
- Medical Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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17
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Zhi N, Zhang L, Wang Y, Bai S, Geng J, Yu L, Cao W, Zhuang L, Zhou Y, Guan Y. Modified cerebral small vessel disease score is associated with vascular cognitive impairment after lacunar stroke. Aging (Albany NY) 2021; 13:9510-9521. [PMID: 33535189 PMCID: PMC8064168 DOI: 10.18632/aging.202438] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/09/2020] [Indexed: 01/06/2023]
Abstract
We conducted a cross-sectional study to characterize the relationship between total and modified small vessel disease (SVD) score with vascular cognitive impairment (VCI). Patients (n = 157) between the ages of 50 and 85 years old who had suffered their first lacunar infarction were analyzed prospectively. Brain magnetic resonance imaging was performed to identify SVD manifestations, which were used to calculate total or modified SVD scores. Neuropsychological assessments measured cognitive function. Spearman correlation analysis demonstrated that the total and modified SVD scores were associated with overall cognition as well as with function in the executive and visuospatial domains. The associations remained significant in linear regression after adjusting for age, sex, education and vascular risk factors. Binary logistic regression and chi-squared trend tests revealed that VCI risk increased significantly with SVD burden based on the modified SVD score. Subsequent chi-squared testing demonstrated that the VCI rate was significantly higher in patients with a modified SVD score of 5-6 than in patients without any SVD burden. Our results suggest that both the total and modified SVD scores show a negative association with cognitive function, but the modified SVD score may be better at identifying patients at high VCI risk.
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Affiliation(s)
- Nan Zhi
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Laboratory of Genetics, The Salk Institute for Biological Studies, La Jolla, CA 92037, USA
| | - Yao Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuwei Bai
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jieli Geng
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ling Yu
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenwei Cao
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhuang
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yangtai Guan
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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18
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Chen X, Wang L, Jiang J, Gao Y, Zhang R, Zhao X, Shen T, Dai Q, Li J. Association of neuroimaging markers of cerebral small vessel disease with short-term outcomes in patients with minor cerebrovascular events. BMC Neurol 2021; 21:21. [PMID: 33441129 PMCID: PMC7805057 DOI: 10.1186/s12883-021-02043-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background Increasing evidences have showed that neuroimaging markers of SVD can predict the short-term outcome of acute ischemic stroke (AIS). It is unclear that whether neuroimaging markers of SVD are also associated with short-term outcomes of minor cerebrovascular events. In the present study, we investigate neuroimaging markers of SVD in order to explore their roles in prediction of short-term outcome in patients with minor cerebrovascular events. Methods Consecutive first-ever stroke patients (n = 546) from the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. A total of 388 patients were enrolled according to minor cerebrovascular events definition (National Institutes of Health Stroke Scale Score ≤ 3) and exclusion criteria. MRI scans were performed within 7 days of stroke onset, and then neuroimaging markers of SVD including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS), SVD burden scores were assessed. We completed baseline characteristics and evaluated the relationships of short-term outcomes to SVD neuroimaging markers and SVD scores. The 90-day modified Rankin Scale (mRS) was thought as primary outcome and was dichotomized as good functional outcome (mRS 0–1) and poor outcome (mRS 2–6). Secondary outcomes were stroke progression and stroke recurrence. Results Higher age, National Institutes of Health Stroke Scale (NIHSS) upon admission, lipoprotein-associated phospholipase A2 (LP-PLA2) and lacunes, Fazekas score were correlated with poor functional outcome (P < 0.05), But after adjusting for confounding variables, among the neuroimaging markers of cerebral small vessel disease, only Fazekas score (OR, 1.343; 95% confidence interval, 1.020–1.770; P = 0.036) was found to be associated with poor outcome at 90 days. Higher Fazekas and SVD scores were not associated with stroke progression or stroke recurrence. Conclusion WMH can predict the poor functional outcome of minor cerebrovascular events. Adding other neuroimaging markers of SVD and total SVD burden score, however, does not improve the prediction, which indicated WMH can as neuroimaging markers for guiding the treatment of minor cerebrovascular events.
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Affiliation(s)
- Xuemei Chen
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China.
| | - Lin Wang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Junying Jiang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Yuanyuan Gao
- Department of General Practice, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Rui Zhang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Xiaoyuan Zhao
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Tingwen Shen
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Qi Dai
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China.
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Kumon Y, Watanabe H, Tagawa M, Inoue A, Ohnishi T, Kunieda T. Relationship between Deep White Matter Hyperintensities on Magnetic Resonance Imaging and Postoperative Cognitive Function Following Clipping of Unruptured Intracranial Aneurysm. Neurol Med Chir (Tokyo) 2020; 61:152-161. [PMID: 33390419 PMCID: PMC7905299 DOI: 10.2176/nmc.oa.2020-0290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
To evaluate the effects on cognitive function of deep white matter hyperintensities (DWMHs) on magnetic resonance imaging (MRI) in patients treated surgically for unruptured intracranial aneurysms (UIAs). The subjects were 106 patients in whom a Wechsler adult intelligence scale-revised (WAIS-R) examination was performed 1 week before and 1 month after clipping surgery for asymptomatic UIAs. DWMH severity was evaluated on preoperative MR images by Fazekas scale, as follows: none (absence), mild (punctate foci), moderate (beginning confluence of foci), or severe (large confluent areas). A decrease of 7 or more points in intelligence quotient (IQ) postoperatively was considered deterioration. Fazekas score was none in 41 (none group), mild in 42 (mild group), moderate in 21, and severe in 2 patients (moderate/severe group). Patient characteristics, surgical factors, IQ change, and abnormal findings on postoperative MRI were compared among the groups. Although there was no statistically significant deterioration in IQ postoperatively in any group, the percentage of deteriorated patients was significantly higher in the moderate/severe group (34.8%) than in the other groups (4.9% in the none group, 7.1% in the mild group; p <0.01, p <0.05, respectively). Brain injury was observed more frequently on postoperative MR images in the moderate/severe group (17.4%) compared with the none group (2.4%; p = 0.052). The presence of moderate/severe DWMHs was an independent prognostic factor for postoperative cognitive dysfunction. In conclusion, the presence of moderate/severe DWMHs was a prognostic factor for postoperative cognitive dysfunction after surgery for UIAs.
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Affiliation(s)
- Yoshiaki Kumon
- Department of Neurosurgery, Washokai Sadamoto Hospital, Matsuyama, Ehime, Japan
| | - Hideaki Watanabe
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Masahiko Tagawa
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takanori Ohnishi
- Department of Neurosurgery, Washokai Sadamoto Hospital, Matsuyama, Ehime, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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20
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Fruhwirth V, Enzinger C, Fandler-Höfler S, Kneihsl M, Eppinger S, Ropele S, Schmidt R, Gattringer T, Pinter D. Baseline white matter hyperintensities affect the course of cognitive function after small vessel disease-related stroke: a prospective observational study. Eur J Neurol 2020; 28:401-410. [PMID: 33065757 PMCID: PMC7839458 DOI: 10.1111/ene.14593] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023]
Abstract
Background and purpose Cognitive impairment is a common sequel of recent small subcortical infarction (RSSI) and might be negatively affected by preexisting cerebral small vessel disease (SVD). We investigated whether the course of cognitive function in patients with RSSI is influenced by the severity of white matter hyperintensities (WMH), an important imaging feature of SVD. Methods Patients with magnetic resonance imaging (MRI)‐proven single RSSI were tested neuropsychologically concerning global cognition, processing speed, attention, and set‐shifting. Deep and periventricular WMH severity was assessed using the Fazekas scale, and total WMH lesion volume was calculated from T1‐weighted MRI images. We compared baseline function and course of cognition 15 months after the acute event in patients with absent, mild, and moderate‐to‐severe WMH. Results The study cohort comprised 82 RSSI patients (mean age: 61 ± 10 years, 23% female). At baseline, 40% had cognitive impairment (1.5 standard deviations below standardized mean), and deficits persisted in one‐third of the sample after 15 months. After age correction, there were no significant differences in set‐shifting between WMH groups at baseline. However, although patients without WMH (deep: p < 0.001, periventricular: p = 0.067) or only mild WMH (deep: p = 0.098, periventricular: p = 0.001) improved in set‐shifting after 15 months, there was no improvement in patients with moderate‐to‐severe WMH (deep: p = 0.980, periventricular: p = 0.816). Baseline total WMH volume (p = 0.002) was the only significant predictor for attention 15 months poststroke. Conclusions This longitudinal study demonstrates that preexisting moderate‐to‐severe WMH negatively affect the restoration of cognitive function after RSSI, suggesting limited functional reserve in patients with preexisting SVD.
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Affiliation(s)
- V Fruhwirth
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - S Fandler-Höfler
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - M Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Eppinger
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - R Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - D Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
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21
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Coutureau J, Asselineau J, Perez P, Kuchcinski G, Sagnier S, Renou P, Munsch F, Lopes R, Henon H, Bordet R, Dousset V, Sibon I, Tourdias T. Cerebral Small Vessel Disease MRI Features Do Not Improve the Prediction of Stroke Outcome. Neurology 2020; 96:e527-e537. [PMID: 33184231 DOI: 10.1212/wnl.0000000000011208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/11/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether the total small vessel disease (SVD) score adds information to the prediction of stroke outcome compared to validated predictors, we tested different predictive models of outcome in patients with stroke. METHODS White matter hyperintensity, lacunes, perivascular spaces, microbleeds, and atrophy were quantified in 2 prospective datasets of 428 and 197 patients with first-ever stroke, using MRI collected 24 to 72 hours after stroke onset. Functional, cognitive, and psychological status were assessed at the 3- to 6-month follow-up. The predictive accuracy (in terms of calibration and discrimination) of age, baseline NIH Stroke Scale score (NIHSS), and infarct volume was quantified (model 1) on dataset 1, the total SVD score was added (model 2), and the improvement in predictive accuracy was evaluated. These 2 models were also developed in dataset 2 for replication. Finally, in model 3, the MRI features of cerebral SVD were included rather than the total SVD score. RESULTS Model 1 showed excellent performance for discriminating poor vs good functional outcomes (area under the curve [AUC] 0.915), and fair performance for identifying cognitively impaired and depressed patients (AUCs 0.750 and 0.688, respectively). A higher SVD score was associated with a poorer outcome (odds ratio 1.30 [1.07-1.58], p = 0.0090 at best for functional outcome). However, adding the total SVD score (model 2) or individual MRI features (model 3) did not improve the prediction over model 1. Results for dataset 2 were similar. CONCLUSIONS Cerebral SVD was independently associated with functional, cognitive, and psychological outcomes, but had no clinically relevant added value to predict the individual outcomes of patients when compared to the usual predictors, such as age and baseline NIHSS.
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Affiliation(s)
- Juliette Coutureau
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Julien Asselineau
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Paul Perez
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Gregory Kuchcinski
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Sharmila Sagnier
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Pauline Renou
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Fanny Munsch
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Renaud Lopes
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Hilde Henon
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Regis Bordet
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Vincent Dousset
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Igor Sibon
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France
| | - Thomas Tourdias
- From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille; Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H., R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S., I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre Magendie, Bordeaux, France.
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22
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Etherton MR, Fotiadis P, Giese AK, Iglesias JE, Wu O, Rost NS. White Matter Hyperintensity Burden Is Associated With Hippocampal Subfield Volume in Stroke. Front Neurol 2020; 11:588883. [PMID: 33193055 PMCID: PMC7649326 DOI: 10.3389/fneur.2020.588883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 12/05/2022] Open
Abstract
White matter hyperintensities of presumed vascular origin (WMH) are a prevalent form of cerebral small-vessel disease and an important risk factor for post-stroke cognitive dysfunction. Despite this prevalence, it is not well understood how WMH contributes to post-stroke cognitive dysfunction. Preliminary findings suggest that increasing WMH volume is associated with total hippocampal volume in chronic stroke patients. The hippocampus, however, is a complex structure with distinct subfields that have varying roles in the function of the hippocampal circuitry and unique anatomical projections to different brain regions. For these reasons, an investigation into the relationship between WMH and hippocampal subfield volume may further delineate how WMH predispose to post-stroke cognitive dysfunction. In a prospective study of acute ischemic stroke patients with moderate/severe WMH burden, we assessed the relationship between quantitative WMH burden and hippocampal subfield volumes. Patients underwent a 3T MRI brain within 2–5 days of stroke onset. Total WMH volume was calculated in a semi-automated manner. Mean cortical thickness and hippocampal volumes were measured in the contralesional hemisphere. Total and subfield hippocampal volumes were measured using an automated, high-resolution, ex vivo computational atlas. Linear regression analyses were performed for predictors of total and subfield hippocampal volumes. Forty patients with acute ischemic stroke and moderate/severe white matter hyperintensity burden were included in this analysis. Median WMH volume was 9.0 cm3. Adjusting for intracranial volume and stroke laterality, age (β = −3.7, P < 0.001), hypertension (β = −44.7, P = 0.04), WMH volume (β = −0.89, P = 0.049), and mean cortical thickness (β = 286.2, P = 0.006) were associated with total hippocampal volume. In multivariable analysis, age (β = −3.3, P < 0.001) and cortical thickness (β = 205.2, P = 0.028) remained independently associated with total hippocampal volume. In linear regression for predictors of hippocampal subfield volume, increasing WMH volume was associated with decreased hippocampal-amygdala transition area volume (β = −0.04, P = 0.001). These finding suggest that in ischemic stroke patients, increased WMH burden is associated with selective hippocampal subfield degeneration in the hippocampal-amygdala transition area.
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Affiliation(s)
- Mark R Etherton
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Panagiotis Fotiadis
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anne-Katrin Giese
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Juan E Iglesias
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
| | - Ona Wu
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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23
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Gertje EC, van Westen D, Panizo C, Mattsson-Carlgren N, Hansson O. Association of Enlarged Perivascular Spaces and Measures of Small Vessel and Alzheimer Disease. Neurology 2020; 96:e193-e202. [PMID: 33046608 DOI: 10.1212/wnl.0000000000011046] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/28/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship between enlarged perivascular spaces (EPVS) and measures of Alzheimer disease (AD), small vessel disease (SVD), cognition, vascular risk factors, and neuroinflammation, we tested associations between EPVS and different relevant neuroimaging, biochemical, and cognitive variables in 778 study participants. METHODS Four hundred ninety-nine cognitively unimpaired (CU) individuals, 240 patients with mild cognitive impairment, and 39 patients with AD from the Swedish Biomarkers for Identifying Neurodegenerative Disorders Early and Reliably (BioFINDER) study were included. EPVS with diameter >1 mm in centrum semiovale (CSO), basal ganglia (BG), and hippocampus (HP); hippocampal volume; white matter lesions (WML); and other SVD markers were determined from MRI. CSF levels of β-amyloid42 (Aβ42), phosphorylated tau, total tau, and neuroinflammatory markers; amyloid accumulation determined with [18F]-flutemetamol PET; and vascular risk factors and results from cognitive tests were determined and collected. RESULTS EPVS in CSO, BG, and HP were associated with WML volume and Fazekas score in individuals without dementia. No associations were found between EPVS and CSF Aβ42, total tau and phosphorylated tau, neuroinflammatory markers, vascular risk factors, and cognitive tests. EPVS in HP were associated with hippocampal atrophy. In a matched group of individuals with AD and CU, EPVS in HP were associated with AD diagnosis. CONCLUSIONS EPVS are related to SVD, also in early disease stages, but the lack of correlation with cognition suggests that their importance is limited. Our data do not support a role for EPVS in early AD pathogenesis.
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Affiliation(s)
- Eske Christiane Gertje
- From the Clinical Memory Research Unit (E.C.G., N.M.-C., O.H.), Department of Clinical Sciences Malmö, Lund University; Department of Internal Medicine (E.C.G.), Skåne University Hospital; Diagnostic Radiology (D.v.W., C.P.), Department of Clinical Sciences Lund, Lund University; Imaging and Function (D.v.W., C.P.), Skåne University Health Care; Department of Clinical Sciences Lund (N.M.-C.), Neurology, Lund University, Skåne University Hospital; Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University; andMemory Clinic (O.H.), Skåne University Health Care, Malmö, Sweden
| | - Danielle van Westen
- From the Clinical Memory Research Unit (E.C.G., N.M.-C., O.H.), Department of Clinical Sciences Malmö, Lund University; Department of Internal Medicine (E.C.G.), Skåne University Hospital; Diagnostic Radiology (D.v.W., C.P.), Department of Clinical Sciences Lund, Lund University; Imaging and Function (D.v.W., C.P.), Skåne University Health Care; Department of Clinical Sciences Lund (N.M.-C.), Neurology, Lund University, Skåne University Hospital; Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University; andMemory Clinic (O.H.), Skåne University Health Care, Malmö, Sweden.
| | - Clara Panizo
- From the Clinical Memory Research Unit (E.C.G., N.M.-C., O.H.), Department of Clinical Sciences Malmö, Lund University; Department of Internal Medicine (E.C.G.), Skåne University Hospital; Diagnostic Radiology (D.v.W., C.P.), Department of Clinical Sciences Lund, Lund University; Imaging and Function (D.v.W., C.P.), Skåne University Health Care; Department of Clinical Sciences Lund (N.M.-C.), Neurology, Lund University, Skåne University Hospital; Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University; andMemory Clinic (O.H.), Skåne University Health Care, Malmö, Sweden
| | - Niklas Mattsson-Carlgren
- From the Clinical Memory Research Unit (E.C.G., N.M.-C., O.H.), Department of Clinical Sciences Malmö, Lund University; Department of Internal Medicine (E.C.G.), Skåne University Hospital; Diagnostic Radiology (D.v.W., C.P.), Department of Clinical Sciences Lund, Lund University; Imaging and Function (D.v.W., C.P.), Skåne University Health Care; Department of Clinical Sciences Lund (N.M.-C.), Neurology, Lund University, Skåne University Hospital; Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University; andMemory Clinic (O.H.), Skåne University Health Care, Malmö, Sweden
| | - Oskar Hansson
- From the Clinical Memory Research Unit (E.C.G., N.M.-C., O.H.), Department of Clinical Sciences Malmö, Lund University; Department of Internal Medicine (E.C.G.), Skåne University Hospital; Diagnostic Radiology (D.v.W., C.P.), Department of Clinical Sciences Lund, Lund University; Imaging and Function (D.v.W., C.P.), Skåne University Health Care; Department of Clinical Sciences Lund (N.M.-C.), Neurology, Lund University, Skåne University Hospital; Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University; andMemory Clinic (O.H.), Skåne University Health Care, Malmö, Sweden
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24
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Molad J, Hallevi H, Korczyn AD, Kliper E, Auriel E, Bornstein NM, Ben Assayag E. Vascular and Neurodegenerative Markers for the Prediction of Post-Stroke Cognitive Impairment: Results from the TABASCO Study. J Alzheimers Dis 2020; 70:889-898. [PMID: 31282420 DOI: 10.3233/jad-190339] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Stroke is a major cause of cognitive impairment and dementia. However, the underlying mechanisms beyond post-stroke cognitive impairment (PSCI) are not fully explained to date. OBJECTIVE We studied the contribution of vascular pathology measures to PSCI, separate from and in conjunction with pathologic markers associated with Alzheimer's disease (AD). METHODS Data from 397 cognitively intact ischemic stroke patients were available. All patients underwent 3T MRI and evaluated for white matter hyperintensity volume (WMHV) and integrity, ischemic lesions, small vessel disease (SVD) markers and grey matter (GM), hippocampal and cerebrospinal fluid (CSF) volumes. Comprehensive cognitive tests were performed on admission and after two years. We used multiple regression to evaluate the contributions of vascular pathology measures (Framingham risk score, WMHV, and existence of SVD) and AD-associated markers (apolipoprotein E4 status and hippocampal volume). RESULTS During two years follow-up, 80 participants (20.2%) developed PSCI. Low GM and cortex volume and high WMHV and CSF volume, but not the new lesion volume, predicted the development of PSCI in a dose-dependent relationship (p = 0.001). Vascular related imaging markers and risk factors predicted PSCI better than AD related markers (p < 0.001). CONCLUSIONS Brain structural measures, including total GM volume, WMHV, and CSF volume were independently associated with PSCI and may serve as early biomarkers for risk prediction. In our sample, vascular pathology measures contributed significantly better to PSCI prediction than markers associated with AD. The newly detected ischemic lesion has not emerged as biomarker for PSCI risk, thus maybe a part of the ongoing vascular pathology.
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Affiliation(s)
- Jeremy Molad
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hen Hallevi
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos D Korczyn
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Kliper
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eitan Auriel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rabin Medical Center, Petach Tikva, Israel
| | - Natan M Bornstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Brain Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Einor Ben Assayag
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Kraushar D, Molad J, Hallevi H, Bornstein NM, Ben-Assayag E, Auriel E. Cerebral microinfarcts disruption of remote cortical thickness. J Neurol Sci 2020; 420:117170. [PMID: 33032831 DOI: 10.1016/j.jns.2020.117170] [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: 05/12/2020] [Revised: 08/13/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cerebral microinfarcts (CMI) are common lesions, carrying an important contribution to small-vessel-related cognitive impairment. CMIs were previously found to cause local microstructural damage and disruption of white matter integrity. This study examines CMIs influence on cortical thickness in remote brain areas. METHODS Six small silent diffuse weighted imaging (DWI) lesions corresponding to subacute CMI were identified among five patients who underwent baseline and follow-up MRI scans from the Tel-Aviv Acute Brain Stroke Cohort (TABASCO). Regions of interest (ROIs) corresponding to the site of the DWI lesions and of the non-lesioned contralateral hemisphere (control ROI) were co-registered. DTI tractography was additionally performed to reconstruct the white matter tracts containing the ROIs. The normalized cortical thickness was calculated for the DWI lesional tract as well as for the contralateral non-lesional tract, and the lesion-to-control cortical thickness ratio (CTR) was calculated. RESULTS Post-lesional scans, performed 25.1 ± 1.2 months after CMI detection, demonstrated reduced mean CTR within the ROI from 1.8 to 1.1 (p = 0.032). There was no difference between the CTR of the right hemisphere relative to those on the left hemisphere, or between the CTR change of the cortical and non-cortical CMI. DISCUSSION This study demonstrated the prolonged influence of CMI on cortical thickness in remote ROI. The total number of CMIs is difficult to determine, however it has been shown that detecting even a single CMI suggests the existence of hundreds to thousands lesions. Therefore, the cumulative impact of these widely distributed lesions on cerebral cortex may have a significant contribution to the development of vascular cognitive impairment.
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Affiliation(s)
- D Kraushar
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - J Molad
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - H Hallevi
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - N M Bornstein
- Department of Neurology, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - E Ben-Assayag
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - E Auriel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Neurology, Rabin Medical Center, Petah-Tikva, Israel.
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26
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Simpkins AN, Janowski M, Oz HS, Roberts J, Bix G, Doré S, Stowe AM. Biomarker Application for Precision Medicine in Stroke. Transl Stroke Res 2020; 11:615-627. [PMID: 31848851 PMCID: PMC7299765 DOI: 10.1007/s12975-019-00762-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022]
Abstract
Stroke remains one of the leading causes of long-term disability and mortality despite recent advances in acute thrombolytic therapies. In fact, the global lifetime risk of stroke in adults over the age of 25 is approximately 25%, with 24.9 million cases of ischemic stroke and 18.7 million cases of hemorrhagic stroke reported in 2015. One of the main challenges in developing effective new acute therapeutics and enhanced long-term interventions for stroke recovery is the heterogeneity of stroke, including etiology, comorbidities, and lifestyle factors that uniquely affect each individual stroke survivor. In this comprehensive review, we propose that future biomarker studies can be designed to support precision medicine therapeutic interventions after stroke. The current challenges in defining ideal biomarkers for stroke are highlighted, including consideration of disease course, age, lifestyle factors, and subtypes of stroke. This overview of current clinical trials includes biomarker collection, and concludes with an example of biomarker design for aneurysmal subarachnoid hemorrhage. With the advent of "-omics" studies, neuroimaging, big data, and precision medicine, well-designed stroke biomarker trials will greatly advance the treatment of a disease that affects millions globally every year.
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Affiliation(s)
- Alexis N Simpkins
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Miroslaw Janowski
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Helieh S Oz
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Jill Roberts
- Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
- Center for Advanced Translational Stroke Science, Lexington, KY, USA
| | - Gregory Bix
- Clinical Neuroscience Research Center, Tulane University, New Orleans, LA, USA
- Department of Neurosurgery, Neurology, Tulane University, New Orleans, LA, USA
| | - Sylvain Doré
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
- Department of Neurology, Psychiatry, Pharmaceutics, Neuroscience, University of Florida, Gainesville, FL, USA
| | - Ann M Stowe
- Center for Advanced Translational Stroke Science, Lexington, KY, USA.
- Department of Neurology, University of Kentucky, Lexington, KY, USA.
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27
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Cao L, Guo Y, Zhu Z. Effects of hyperhomocysteinemia on ischemic cerebral small vessel disease and analysis of inflammatory mechanisms. Int J Neurosci 2020; 131:362-369. [PMID: 32233703 DOI: 10.1080/00207454.2020.1744597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Hyperhomocysteinemia is closely related to, but is not a confirmed risk factor of, cerebral small vessel disease (CSVD). This study aimed to determine whether hyperhomo-cysteinemia is correlated significantly with CSVD.Materials and methods: This cross-sectional study compared the homocysteine (Hcy) levels of patients with and without CSVD. High-sensitivity C-reactive protein (hs-CRP) levels were compared according to white matter lesion (WML) severity, which was classified using the Fazekas system. Risk factors for ischemic CSVD were analyzed through multivariate unconditional logistic regression analysis.Results: Hcy levels were significantly higher in patients with lacunar infarction (LI) than in controls (p=.0438), in patients with Fazekas 2-3 than in patients with Fazekas 0-1 WMLs (p=.0192), in patients with Fazekas 4-6 than in patients with Fazekas 2-3 WMLs (p=.0207), and in patients with LI than in patients without LI (p=.0043). hs-CRP levels were significantly higher in patients with LI than in patients without LI (p=.0068) and in patients with Fazekas 4-6 than in patients with Fazekas 0-1 WMLs (p=.0031). Three multivariate unconditional logistic regression analyses showed that hyperhomocysteinemia is a risk factor for LI (p=.006; odds ratio [OR], 27.668), severe WML (p=.028; OR, 1.984), and high hs-CRP level (p=.016; OR, 3.956).Conclusions: The assessment of Hcy levels is important for ischemic CSVD. Hyperhomocysteinemia is a risk factor for LI and severe WML. Further, hyperhomocysteinemia is associated with high hs-CRP levels, and this may involve an inflammatory mechanism; however, further studies are needed in this regard.
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Affiliation(s)
- Liming Cao
- Department of Neurology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, Shenzhen, China
| | - Zhishan Zhu
- Department of Neurology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, China
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28
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Yang HC, Zhang M, Wu R, Zheng HQ, Zhang LY, Luo J, Li LL, Hu XQ. C-C chemokine receptor type 2-overexpressing exosomes alleviated experimental post-stroke cognitive impairment by enhancing microglia/macrophage M2 polarization. World J Stem Cells 2020; 12:152-167. [PMID: 32184939 PMCID: PMC7062036 DOI: 10.4252/wjsc.v12.i2.152] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/27/2019] [Accepted: 01/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Human-derived mesenchymal stromal cells have been shown to improve cognitive function following experimental stroke. The activity of exosomes has been verified to be comparable to the therapeutic effects of mesenchymal stromal cells. However, the effects of exosomes derived from human umbilical cord mesenchymal stem cells (HUC-MSCs) (ExoCtrl) on post-stroke cognitive impairment (PSCI) have rarely been reported. Moreover, whether exosomes derived from C-C chemokine receptor type 2 (CCR2)-overexpressing HUC-MSCs (ExoCCR2) can enhance the therapeutic effects on PSCI and the possible underlying mechanisms have not been studied.
AIM To investigate the effects of ExoCtrl on PSCI and whether ExoCCR2 can enhance therapeutic effects on PSCI.
METHODS Transmission electron microscopy, qNano® particles analyzer, and Western blotting were employed to determine the morphology and CCR2 expression of ExoCtrl or ExoCCR2. ELISA was used to study the binding capacity of exosomes to CC chemokine ligand 2 (CCL2) in vivo. After the intravenous injection of ExoCtrl or ExoCCR2 into experimental rats, the effect of ExoCtrl and ExoCCR2 on PSCI was assessed by Morris water maze. Remyelination and oligodendrogenesis were analyzed by Western blotting and immunofluorescence microscopy. QRT-PCR and immunofluorescence microscopy were conducted to compare the microglia/macrophage polarization. The infiltration and activation of hematogenous macrophages were analyzed by Western blotting and transwell migration analysis.
RESULTS CCR2-overexpressing HUC-MSCs loaded the CCR2 receptor into their exosomes. The morphology and diameter distribution between ExoCtrl and ExoCCR2 showed no significant difference. ExoCCR2 bound significantly to CCL2 but ExoCtrl showed little CCL2 binding. Although both ExoCCR2 and ExoCtrl showed beneficial effects on PSCI, oligodendrogenesis, remyelination, and microglia/macrophage polarization, ExoCCR2 exhibited a significantly superior beneficial effect. We also found that ExoCCR2 could suppress the CCL2-induced macrophage migration and activation in vivo and in vitro, compared with ExoCtrl treated group.
CONCLUSION CCR2 over-expression enhanced the therapeutic effects of exosomes on the experimental PSCI by promoting M2 microglia/macrophage polarization, enhancing oligodendrogenesis and remyelination. These therapeutic effects are likely through suppressing the CCL2-induced hematogenous macrophage migration and activation.
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Affiliation(s)
- Huai-Chun Yang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Min Zhang
- Department of Andrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Rui Wu
- Department of Rehabilitation Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Hai-Qing Zheng
- Department of Rehabilitation Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Li-Ying Zhang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Jing Luo
- Department of Rehabilitation Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Li-Li Li
- Department of Rehabilitation Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Xi-Quan Hu
- Department of Rehabilitation Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
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The neural and neurocomputational bases of recovery from post-stroke aphasia. Nat Rev Neurol 2019; 16:43-55. [DOI: 10.1038/s41582-019-0282-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/15/2022]
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Debette S, Schilling S, Duperron MG, Larsson SC, Markus HS. Clinical Significance of Magnetic Resonance Imaging Markers of Vascular Brain Injury: A Systematic Review and Meta-analysis. JAMA Neurol 2019; 76:81-94. [PMID: 30422209 DOI: 10.1001/jamaneurol.2018.3122] [Citation(s) in RCA: 361] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Covert vascular brain injury (VBI) is highly prevalent in community-dwelling older persons, but its clinical and therapeutic implications are debated. Objective To better understand the clinical significance of VBI to optimize prevention strategies for the most common age-related neurological diseases, stroke and dementia. Data Source We searched for articles in PubMed between 1966 and December 22, 2017, studying the association of 4 magnetic resonance imaging (MRI) markers of covert VBI (white matter hyperintensities [WMHs] of presumed vascular origin, MRI-defined covert brain infarcts [BIs], cerebral microbleeds [CMBs], and perivascular spaces [PVSs]) with incident stroke, dementia, or death. Study Selection Data were taken from prospective, longitudinal cohort studies including 50 or more adults. Data Extraction and Synthesis We performed inverse variance-weighted meta-analyses with random effects and z score-based meta-analyses for WMH burden. The significance threshold was P < .003 (17 independent tests). We complied with the Meta-analyses of Observational Studies in Epidemiology guidelines. Main Outcomes and Measures Stroke (hemorrhagic and ischemic), dementia (all and Alzheimer disease), and death. Results Of 2846 articles identified, 94 studies were eligible, with up to 14 529 participants for WMH, 16 012 participants for BI, 15 693 participants for CMB, and 4587 participants for PVS. Extensive WMH burden was associated with higher risk of incident stroke (hazard ratio [HR], 2.45; 95% CI, 1.93-3.12; P < .001), ischemic stroke (HR, 2.39; 95% CI, 1.65-3.47; P < .001), intracerebral hemorrhage (HR, 3.17; 95% CI, 1.54-6.52; P = .002), dementia (HR, 1.84; 95% CI, 1.40-2.43; P < .001), Alzheimer disease (HR, 1.50; 95% CI, 1.22-1.84; P < .001), and death (HR, 2.00; 95% CI, 1.69-2.36; P < .001). Presence of MRI-defined BIs was associated with higher risk of incident stroke (HR, 2.38; 95% CI, 1.87-3.04; P < .001), ischemic stroke (HR, 2.18; 95% CI, 1.67-2.85; P < .001), intracerebral hemorrhage (HR, 3.81; 95% CI, 1.75-8.27; P < .001), and death (HR, 1.64; 95% CI, 1.40-1.91; P < .001). Presence of CMBs was associated with increased risk of stroke (HR, 1.98; 95% CI, 1.55-2.53; P < .001), ischemic stroke (HR, 1.92; 95% CI, 1.40-2.63; P < .001), intracerebral hemorrhage (HR, 3.82; 95% CI, 2.15-6.80; P < .001), and death (HR, 1.53; 95% CI, 1.31-1.80; P < .001). Data on PVS were limited and insufficient to conduct meta-analyses but suggested an association of high PVS burden with increased risk of stroke, dementia, and death; this requires confirmation. Conclusions and Relevance We report evidence that MRI markers of VBI have major clinical significance. This research prompts careful evaluation of the benefit-risk ratio for available prevention strategies in individuals with covert VBI.
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Affiliation(s)
- Stéphanie Debette
- University of Bordeaux, Inserm 1219, Bordeaux Population Health Research Center, Bordeaux, France.,Department of Neurology, Memory Clinic, Bordeaux University Hospital, Bordeaux, France
| | - Sabrina Schilling
- University of Bordeaux, Inserm 1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Marie-Gabrielle Duperron
- University of Bordeaux, Inserm 1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Susanna C Larsson
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.,Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
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31
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Hawe RL, Findlater SE, Kenzie JM, Hill MD, Scott SH, Dukelow SP. Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery. J Am Heart Assoc 2019; 7:e009360. [PMID: 30371192 PMCID: PMC6222954 DOI: 10.1161/jaha.118.009360] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Understanding how the size of acute lesions and white matter hyperintensities (WMH) impact stroke recovery can improve our ability to predict outcomes and tailor treatments. The aim of this exploratory study was to investigate the role of acute lesion volume and WMH volume on longitudinal recovery of specific sensory, motor, and cognitive impairments after stroke using robotic and clinical measures. Methods and Results Eighty‐two individuals were assessed at 1, 6, 12, and 26 weeks poststroke with robotic tasks and commonly used clinical measures. The volumes of acute lesions and WMH were measured on fluid‐attenuated inversion recovery images. Linear mixed models were used to investigate the role of acute lesions and WMH on parameters derived from the robotic tasks and clinical measures. Regression analysis determined the added value of acute lesion and WMH volumes along with measures of initial performance to predict outcomes at 6 months. Acute lesion volume has widespread effects on sensory, motor, and overall functional recovery poststroke. The impact of WMH was specific to cognitive impairments. Apart from the robotic position sense task, neither lesion volume nor WMH measure had significant ability to predict outcomes at 6 months over using initial impairment as measured by robotic assessments alone. Conclusions While acute lesion volume and WMH may impact different impairments poststroke, their clinical utility in predicting outcomes at 6 months poststroke is limited.
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Affiliation(s)
- Rachel L Hawe
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Sonja E Findlater
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Jeffrey M Kenzie
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Michael D Hill
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Stephen H Scott
- 2 Department of Biomedical and Molecular Sciences Queen's University Kingston Ontario Canada
| | - Sean P Dukelow
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
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Liang Y, Chen YK, Liu YL, Mok VCT, Ungvari GS, Chu WCW, Seo SW, Tang WK. Cerebral Small Vessel Disease Burden Is Associated With Accelerated Poststroke Cognitive Decline: A 1-Year Follow-Up Study. J Geriatr Psychiatry Neurol 2019; 32:336-343. [PMID: 31480986 DOI: 10.1177/0891988719862630] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study investigated the association between small vessel disease (SVD) burden, a combination of multiple SVD markers and cognitive dysfunction after stroke. METHODS The study sample comprised 451 patients with first-ever acute ischemic stroke. Cognitive functions were assessed with the Mini-Mental State Examination (MMSE) at 3, 9, and 15 months after the index stroke. Cognitive impairment was defined as an MMSE score of ≤26. A total SVD score, indicating SVD burden, was constructed by summing the scores of the 4 SVD markers (white matter hyperintensities [WMHs], lacunes, cerebral microbleeds, and perivascular spaces) ascertained by magnetic resonance imaging (range: 0-4). The association between SVD burden and cognitive dysfunction was assessed with linear mixed models or generalized estimating equation models, as appropriate. RESULTS The majority of patients had mild-to-moderate stroke and at least one identifiable SVD marker. Cognitive impairment was found in about one-third of patients. After adjusting for confounding factors, the SVD burden was associated with MMSE scores (β = -0.37, P = .003) and cognitive impairment (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.02-1.42). SVD burden was specifically associated with the performance of MMSE subscores including orientation to place and time, calculation, and word recall. Of the SVD markers, WMHs was the most robust predictor of decrease in MMSE scores (β = -0.25, P = .01) and cognitive impairment (OR = 1.14, 95% CI = 1.01-1.29). CONCLUSION Cerebral SVD burden is associated with decreased MMSE scores, suggesting cognitive dysfunction during the first year after mild-to-moderate acute ischemic stroke.
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Affiliation(s)
- Yan Liang
- 1 Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China.,2 Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yang-Kun Chen
- 3 Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yong-Lin Liu
- 3 Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Vincent C T Mok
- 4 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Gabor S Ungvari
- 5 University of Notre Dame Australia/Graylands Hospital, Perth, Australia
| | - Winnie C W Chu
- 6 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Sang Won Seo
- 7 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Wai-Kwong Tang
- 2 Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, SAR, China
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33
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Uniken Venema SM, Marini S, Lena UK, Morotti A, Jessel M, Moomaw CJ, Kourkoulis C, Testai FD, Kittner SJ, Brouwers HB, James ML, Woo D, Anderson CD, Rosand J. Impact of Cerebral Small Vessel Disease on Functional Recovery After Intracerebral Hemorrhage. Stroke 2019; 50:2722-2728. [PMID: 31446887 DOI: 10.1161/strokeaha.119.025061] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Purpose- In this study, we aim to investigate the association of computed tomography-based markers of cerebral small vessel disease with functional outcome and recovery after intracerebral hemorrhage. Methods- Computed tomographic scans of patients in the ERICH study (Ethnic and Racial Variations of Intracerebral Hemorrhage) were evaluated for the extent of leukoaraiosis and cerebral atrophy using visual rating scales. Poor functional outcome was defined as a modified Rankin Scale (mRS) of ≥3. Multivariable logistic and linear regression models were used to explore the associations of cerebral small vessel disease imaging markers with poor functional outcome at discharge and, as a measure of recovery, change in mRS from discharge to 90 days poststroke. Results- After excluding in-hospital deaths, data from 2344 patients, 583 (24.9%) with good functional outcome (mRS of 0-2) at discharge and 1761 (75.1%) with poor functional outcome (mRS of 3-5) at discharge, were included. Increasing extent of leukoaraiosis (P for trend, 0.01) and only severe (grade 4) global atrophy (odds ratio, 2.02; 95% CI, 1.22-3.39, P=0.007) were independently associated with poor functional outcome at discharge. Mean (SD) mRS change from discharge to 90-day follow-up was 0.57 (1.18). Increasing extent of leukoaraiosis (P for trend, 0.002) and severe global atrophy (β [SE], -0.23 [0.115]; P=0.045) were independently associated with less improvement in mRS from discharge to 90 days poststroke. Conclusions- In intracerebral hemorrhage survivors, the extent of cerebral small vessel disease at the time of intracerebral hemorrhage is associated with poor functional outcome at hospital discharge and impaired functional recovery from discharge to 90 days poststroke.
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Affiliation(s)
- Simone M Uniken Venema
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston
| | - Sandro Marini
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology (S.M., C.D.A., J.R.).,J.P. Kistler Stroke Research Center (S.M., M.J., C.D.A., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Umme K Lena
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston
| | - Andrea Morotti
- Stroke Unit, Instituto Neurologico Nazionale a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy (A.M.)
| | - Michael Jessel
- J.P. Kistler Stroke Research Center (S.M., M.J., C.D.A., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Charles J Moomaw
- Department Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (C.J.M., D.W.)
| | - Christina Kourkoulis
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago (F.D.T.)
| | - Steven J Kittner
- Department of Neurology, Baltimore Veterans Administration Medical Center, University of Maryland School of Medicine (S.J.K.)
| | - H Bart Brouwers
- Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (H.B.B.)
| | - Michael L James
- Departments of Anesthesiology (M.L.J.), Brain Injury Translational Research Center, Duke University, Durham, NC.,Neurology (M.L.J.), Brain Injury Translational Research Center, Duke University, Durham, NC
| | - Daniel Woo
- Department Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (C.J.M., D.W.)
| | - Christopher D Anderson
- Henry and Allison McCance Center for Brain Health (C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology (S.M., C.D.A., J.R.).,J.P. Kistler Stroke Research Center (S.M., M.J., C.D.A., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology (S.M., C.D.A., J.R.).,J.P. Kistler Stroke Research Center (S.M., M.J., C.D.A., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
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Gao F, Jing Y, Zang P, Hu X, Gu C, Wu R, Chai B, Zhang Y. Vascular Cognitive Impairment Caused by Cerebral Small Vessel Disease Is Associated with the TLR4 in the Hippocampus. J Alzheimers Dis 2019; 70:563-572. [PMID: 31256136 DOI: 10.3233/jad-190240] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Fulin Gao
- Department of Neurology, Gansu Provincial Hospital, Lanzhou City, Gansu Province, PR China
- School of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou City, Gansu Province, PR China
| | - Yuhong Jing
- Institute of Anatomy and Histology and Embryology, Neuroscience, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, Gansu Province, PR China
| | - Peixi Zang
- Department of Neurology, Gansu Provincial Hospital, Lanzhou City, Gansu Province, PR China
| | - Xiaojuan Hu
- Department of Neurology, Gansu Provincial Hospital, Lanzhou City, Gansu Province, PR China
| | - Cheng Gu
- Department of Neurology, Gansu Provincial Hospital, Lanzhou City, Gansu Province, PR China
| | - Ruipeng Wu
- Department of Neurology, Gansu Provincial Hospital, Lanzhou City, Gansu Province, PR China
| | - Bingyan Chai
- School of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou City, Gansu Province, PR China
| | - Yi Zhang
- Department of Neurology, Gansu Provincial Hospital, Lanzhou City, Gansu Province, PR China
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35
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Dey AK, Stamenova V, Bacopulos A, Jeyakumar N, Turner GR, Black SE, Levine B. Cognitive heterogeneity among community-dwelling older adults with cerebral small vessel disease. Neurobiol Aging 2019; 77:183-193. [DOI: 10.1016/j.neurobiolaging.2018.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 12/16/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
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Valdés Hernández MDC, Case T, Chappell FM, Glatz A, Makin S, Doubal F, Wardlaw JM. Association between Striatal Brain Iron Deposition, Microbleeds and Cognition 1 Year After a Minor Ischaemic Stroke. Int J Mol Sci 2019; 20:ijms20061293. [PMID: 30875807 PMCID: PMC6470500 DOI: 10.3390/ijms20061293] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 01/02/2023] Open
Abstract
Brain iron deposits (IDs) are inversely associated with cognitive function in community-dwelling older people, but their association with cognition after ischemic stroke, and whether that differs from microbleeds, is unknown. We quantified basal ganglia IDs (BGID) and microbleeds (BMBs) semi-automatically on brain magnetic resonance images from patients with minor stroke (NIHSS < 7), at presentation and 12 months after stroke. We administered the National Adult Reading Test (NART, estimates premorbid or peak adult cognition) and the Revised Addenbrooke's Cognitive Examination (ACE-R; current cognition) at 1 and 12 months after stroke. We adjusted analyses for baseline cognition, age, gender, white matter hyperintensity (WMH) volume and vascular risk factors. In 200 patients, mean age 65 years, striatal IDs and BMBs volumes did not change over the 12 months. Baseline BGID volumes correlated positively with NART scores at both times (ρ = 0.19, p < 0.01). Baseline and follow-up BGID volumes correlated positively with age (ρ = 0.248, p < 0.001 and ρ = 0.271, p < 0.001 respectively), but only baseline (and not follow-up) BMB volume correlated with age (ρ = 0.129, p < 0.05). Both smoking and baseline WMH burden predicted verbal fluency and visuospatial abilities scores (B = -1.13, p < 0.02 and B = -0.22, p = 0.001 respectively) at 12 months after stroke. BGIDs and BMBs are associated differently with cognition post-stroke; studies of imaging and post-stroke cognition should adjust for premorbid cognition. The positive correlation of BGID with NART may reflect the lower premorbid cognition in patients with stroke at younger vs older ages.
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Affiliation(s)
- Maria Del C Valdés Hernández
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK.
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK.
- Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK.
| | - Tessa Case
- Row Fogo Centre for Ageing and the Brain, University of Edinburgh, Edinburgh EH16 4SB, UK.
| | - Francesca M Chappell
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK.
- Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK.
| | - Andreas Glatz
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK.
| | - Stephen Makin
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK.
| | - Fergus Doubal
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK.
| | - Joanna M Wardlaw
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK.
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK.
- Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK.
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Casolla B, Caparros F, Cordonnier C, Bombois S, Hénon H, Bordet R, Orzi F, Leys D. Biological and imaging predictors of cognitive impairment after stroke: a systematic review. J Neurol 2018; 266:2593-2604. [PMID: 30350168 DOI: 10.1007/s00415-018-9089-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cognitive impairment is frequent after stroke, and several studies have suggested that biological and imaging characteristics present before stroke are associated with the development of post-stroke cognitive impairment. OBJECTIVE The aim of our study was to systematically review biological and imaging predictors of cognitive impairment after stroke. METHOD Studies were identified from bibliographic databases and reference lists, and were included if conducted in patients with acute stroke, with at least 30 patients, and a follow-up of at least 3 months. We included articles on potential biomarkers of cognitive impairment that pre-existed to stroke. RESULTS We identified 22,169 articles, including 20,349 with abstract. After analysis, 66 studies conducted in 42 cohorts met selection criteria. They included 30-9522 patients [median 170; interquartile range (IQR) 104-251] with a median follow-up of 12 months (IQR 3-36). All studies met quality criteria for description of the study population and standardization of biomarkers. Twenty-nine studies met all quality criteria. There was no convincing evidence that any biological marker may predict cognitive impairment. The most consistent predictors of cognitive impairment after stroke were global atrophy and medial temporal lobe atrophy. CONCLUSION Pre-existing cerebral atrophy is the most consistent predictor of cognitive impairment that can be identified in patients with an acute stroke.
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Affiliation(s)
- Barbara Casolla
- Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Roger Salengro Hospital, University Lille, Inserm U1171, 59000, Lille, France
| | - François Caparros
- Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Roger Salengro Hospital, University Lille, Inserm U1171, 59000, Lille, France
| | - Charlotte Cordonnier
- Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Roger Salengro Hospital, University Lille, Inserm U1171, 59000, Lille, France
| | - Stéphanie Bombois
- Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Roger Salengro Hospital, University Lille, Inserm U1171, 59000, Lille, France
| | - Hilde Hénon
- Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Roger Salengro Hospital, University Lille, Inserm U1171, 59000, Lille, France
| | - Régis Bordet
- Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Roger Salengro Hospital, University Lille, Inserm U1171, 59000, Lille, France
| | - Francesco Orzi
- Neurology Unit, NESMOS Department, Sapienza University of Rome, Rome, Italy
| | - Didier Leys
- Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Roger Salengro Hospital, University Lille, Inserm U1171, 59000, Lille, France.
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Shi Y, Li S, Li W, Zhang C, Guo L, Pan Y, Zhou X, Wang X, Niu S, Yu X, Tang H, Chen B, Zhang Z. MRI Lesion Load of Cerebral Small Vessel Disease and Cognitive Impairment in Patients With CADASIL. Front Neurol 2018; 9:862. [PMID: 30459701 PMCID: PMC6232772 DOI: 10.3389/fneur.2018.00862] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/25/2018] [Indexed: 11/13/2022] Open
Abstract
Background and objective: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the best known and the most common monogenic small vessel disease (SVD). Cognitive impairment is an inevitable feature of CADASIL. Total SVD score and global cortical atrophy (GCA) scale were found to be good predictors of poor cognitive performance in community-dwelling adults. We aimed to estimate the association between the total SVD score, GCA scale and the cognitive performance in patients with CADASIL. Methods: We enrolled 20 genetically confirmed CADASIL patients and 20 controls matched by age, gender, and years of education. All participants underwent cognitive assessments to rate the global cognition and individual domain of executive function, information processing speed, memory, language, and visuospatial function. The total SVD score and GCA scale were rated. Results: The CADASIL group performed worse than the controls on all cognition measures. Neither global cognition nor any separate domain of cognition was significantly different among patients grouped by total SVD score. Negative correlations between the GCA score and cognitive performance were observed. Approximately 40% of the variance was explained by the total GCA score in the domains of executive function, information processing speed, and language. The superficial atrophy score was associated with poor performance in most of the domains of cognition. Adding the superficial atrophy score decreased the prediction power of the deep atrophy score on cognitive impairment alone. Conclusions: The GCA score, not the total SVD score, was significantly associated with poor cognitive performance in patients with CADASIL. Adding the superficial atrophy score attenuated the prediction power of the deep atrophy score on cognitive impairment alone.
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Affiliation(s)
- YuZhi Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - ShaoWu Li
- Department of Functional Neuroimaging, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - LiYing Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - YunZhu Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - XueMei Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - XinGao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Songtao Niu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - XueYing Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - HeFei Tang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bin Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - ZaiQiang Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Chen X, Wang J, Shan Y, Cai W, Liu S, Hu M, Liao S, Huang X, Zhang B, Wang Y, Lu Z. Cerebral small vessel disease: neuroimaging markers and clinical implication. J Neurol 2018; 266:2347-2362. [PMID: 30291424 DOI: 10.1007/s00415-018-9077-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/28/2022]
Abstract
Cerebral small vessel disease (CSVD) is a broad category of cerebrovascular diseases which primarily affect the perforating arterioles, capillaries and venules with multiple distinct etiologies. In spite of distinctive pathogenesis, CSVD shares similar neuroimaging markers, including recent small subcortical infarct, lacune of presumed vascular origin, white matter hyperintensity of presumed vascular origin, perivascular space and cerebral microbleeds. The radiological features of neuroimaging markers are indicative for etiological analysis. Furthermore, in sporadic arteriosclerotic pathogenesis associated CSVD, the total CSVD burden is a significant predictor for stroke events, global cognitive impairment, psychiatric disorders and later life quality. This review aims to summarize the radiological characteristics as well as the clinical implication of CSVD markers and neuroimaging interpretation for CSVD symptomatology.
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Affiliation(s)
- Xiaodong Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Jihui Wang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, No.600 Tian He Road, Guangzhou, 510630, Guangdong, China
| | - Yilong Shan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Wei Cai
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Sanxin Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Mengyan Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Siyuan Liao
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Xuehong Huang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China.
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Paradise MB, Shepherd CE, Wen W, Sachdev PS. Neuroimaging and neuropathology indices of cerebrovascular disease burden. Neurology 2018; 91:310-320. [DOI: 10.1212/wnl.0000000000005997] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/17/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo systematically review the literature on the use of both neuroimaging and neuropathologic indices of cerebrovascular disease (CVD) burden, as estimation of this burden could have multiple benefits in the diagnosis and prognosis of cognitive impairment and dementia.MethodsMEDLINE and EMBASE databases were searched (inception to June 2017) to obtain and then systematically review all pertinent neuroimaging and neuropathology studies, where an index of CVD was developed or tested.ResultsTwenty-five neuroimaging articles were obtained, which included 4 unique indices. These utilized a limited range of CVD markers from mainly structural MRI, most commonly white matter hyperintensities (WMH), cerebral microbleeds, and dilated perivascular spaces. Weighting of the constituent markers was often coarse. There were 7 unique neuropathology indices, which were heterogeneous in their regions sampled and lesions examined.ConclusionThere is increasing interest in indices of total CVD burden that incorporate multiple lesions, as traditional individual markers of CVD such as WMH only provide limited information. Neuropathologic indices are needed to validate neuroimaging findings. The studies clearly demonstrated proof of concept that information from multiple imaging measures of CVD provide more information, including a stronger association with cognitive impairment and dementia, than that provided by a single measure. There has been limited exploration of the psychometric properties of published indices and no comparison between indices. Further development of indices is recommended, including the use of data from diffusion tensor and perfusion imaging.
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Clinical and radiological determinants of transient symptoms associated with infarction (TSI). J Neurol Sci 2018; 390:195-199. [DOI: 10.1016/j.jns.2018.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/29/2018] [Accepted: 04/22/2018] [Indexed: 11/21/2022]
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Jiang J, Liu T, Zhu W, Koncz R, Liu H, Lee T, Sachdev PS, Wen W. UBO Detector – A cluster-based, fully automated pipeline for extracting white matter hyperintensities. Neuroimage 2018; 174:539-549. [DOI: 10.1016/j.neuroimage.2018.03.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/27/2022] Open
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Osborn KE, Liu D, Samuels LR, Moore EE, Cambronero FE, Acosta LMY, Bell SP, Babicz MA, Gordon EA, Pechman KR, Davis LT, Gifford KA, Hohman TJ, Blennow K, Zetterberg H, Jefferson AL. Cerebrospinal fluid β-amyloid 42 and neurofilament light relate to white matter hyperintensities. Neurobiol Aging 2018; 68:18-25. [PMID: 29702372 DOI: 10.1016/j.neurobiolaging.2018.03.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/12/2022]
Abstract
White matter hyperintensities (WMHs) are associated with poorer brain health, but their pathophysiological substrates remain elusive. To better understand the mechanistic underpinnings of WMHs among older adults, this study examined in vivo cerebrospinal fluid biomarkers of β-amyloid42 deposition (Aβ42), hyperphosphorylated tau pathology, neurodegeneration (total tau), and axonal injury (neurofilament light [NFL]) in relation to log-transformed WMHs volume. Participants free of clinical stroke and dementia were drawn from the Vanderbilt Memory & Aging Project (n = 148, 72 ± 6 years). Linear regression models adjusted for age, sex, race/ethnicity, education, intracranial volume, modified Framingham Stroke Risk Profile (excluding points assigned for age), cognitive diagnosis, and APOE-ε4 carrier status. Aβ42 (β = -0.001, p = 0.007) and NFL (β = 0.0003, p = 0.01) concentrations related to WMHs but neither hyperphosphorylated tau nor total tau associations with WMHs reached statistical significance (p-values > 0.21). In a combined model, NFL accounted for 3.2% of unique variance in WMHs and Aβ42 accounted for an additional 4.3% beyond NFL, providing novel evidence of the co-occurrence of at least 2 distinct pathways for WMHs among older adults, including amyloid deposition and axonal injury.
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Affiliation(s)
- Katie E Osborn
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dandan Liu
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren R Samuels
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth E Moore
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Francis E Cambronero
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lealani Mae Y Acosta
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan P Bell
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Divisions of Cardiovascular and Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michelle A Babicz
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth A Gordon
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly R Pechman
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Taylor Davis
- Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine A Gifford
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy J Hohman
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Angela L Jefferson
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Zhu H, Li Z, Lv J, Zhao R. Effects of cerebral small vessel disease on the outcome of patients with ischemic stroke caused by large artery atherosclerosis. Neurol Res 2018. [PMID: 29543130 DOI: 10.1080/01616412.2018.1446283] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Hui Zhu
- Medical College, Qingdao University, Qingdao, China
| | - Zhixing Li
- Medical College, Qingdao University, Qingdao, China
| | - Jinglei Lv
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Renliang Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
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