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Min K, Yun JM, Hwang SE, Nam KW, Jeong HY, Kwon HM, Park JH. Association of Coronary Stenosis With Cerebral Small Vessel Diseases in Neurologically Asymptomatic Adults. J Stroke 2024; 26:104-107. [PMID: 38246722 PMCID: PMC10850444 DOI: 10.5853/jos.2023.01732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 01/23/2024] Open
Affiliation(s)
- Kyungha Min
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seo Eun Hwang
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Yeong Jeong
- Department of Neurology, Emergency Medical Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Xue Y, Tang J, Zhang M, He Y, Fu J, Ding F. Durative sleep fragmentation with or without hypertension suppress rapid eye movement sleep and generate cerebrovascular dysfunction. Neurobiol Dis 2023:106222. [PMID: 37419254 DOI: 10.1016/j.nbd.2023.106222] [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: 01/02/2023] [Revised: 06/07/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023] Open
Abstract
Either hypertension or chronic insomnia is the risk factor of developing vascular dementia. Durative hypertension can induce vascular remodeling and is used for modeling small vessel disease in rodents. It remains undetermined if the combination of hypertension and sleep disturbance exacerbates vascular dysfunction or pathologies. Previously, we found chronic sleep fragmentation (SF) dampened cognition in young mice without disease predispositions. In the current study, we superimposed SF with hypertension modeling in young mice. Angiotensin II (AngII)-releasing osmotic mini pumps were subcutaneously implanted to generate persistent hypertension, while sham surgeries were performed as controls. Sleep fragmentation with repetitive arousals (10 s every 2 min) during light-on 12 h for consecutive 30 days, while mice undergoing normal sleep (NS) processes were set as controls. Sleep architectures, whisker-stimulated cerebral blood flow (CBF) changes, vascular responsiveness as well as vascular pathologies were compared among normal sleep plus sham (NS + sham), SF plus sham (SF + sham), normal sleep plus AngII (NS + AngII), and SF plus AngII (SF + AngII) groups. SF and hypertension both alter sleep structures, particularly suppressing REM sleep. SF no matter if combined with hypertension strongly suppressed whisker-stimulated CBF increase, suggesting the tight association with cognitive decline. Hypertension modeling sensitizes vascular responsiveness toward a vasoactive agent, Acetylcholine (ACh, 5 mg/ml, 10 μl) delivered via cisterna magna infusion, while SF exhibits a similar but much milder effect. None of the modeling above was sufficient to induce arterial or arteriole vascular remodeling, but SF or SF plus hypertension increased vascular network density constructed by all categories of cerebral vessels. The current study would potentially help understand the pathogenesis of vascular dementia, and the interconnection between sleep and vascular health.
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Affiliation(s)
- Yang Xue
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200032, China
| | - Jie Tang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200032, China
| | - Miaoyi Zhang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200032, China
| | - Yifan He
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jianhui Fu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200032, China.
| | - Fengfei Ding
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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Physiology of the cerebrovascular adaptation to pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2021. [PMID: 32736760 DOI: 10.1016/b978-0-444-64239-4.00004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The adaptation of the cerebral circulation to pregnancy is unique compared with other organs and circulatory systems, because the brain requires relatively constant blood flow and water and solute composition to maintain homeostasis. Thus, a major adaptation of the maternal cerebrovasculature to pregnancy is to maintain normalcy in the face of expanded plasma volume, increased cardiac output, and high levels of permeability factors. In this chapter, the effect of pregnancy on critical functions of the cerebral circulation is discussed, including changes occurring at the endothelium and blood-brain barrier (BBB), which protect the maternal brain from changes in BBB permeability. Further, pregnancy-induced changes in the structure and function of cerebral arteries, arterioles, and veins will be discussed as they relate to cerebral vascular resistance, hemodynamics, and cerebral blood flow autoregulation.
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Loewenstein D, Rabbat M. Neurological complications of systemic hypertension. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:253-259. [PMID: 33632444 DOI: 10.1016/b978-0-12-819814-8.00018-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Systemic hypertension is the most common, most easily diagnosed, and one of the most reversible risk factors for neurologic pathology. Acute severe hypertension above a mean arterial pressure of approximately 150mmHg exceeds the brain's autoregulatory capacity and results in increased cerebral blood flow leading to hypertensive encephalopathy. Chronic hypertension predisposes to cerebral vasculature atherosclerosis, medial hypertrophy, luminal narrowing, endothelial dysfunction, impaired arterial relaxation, and decreased ability to augment cerebral blood flow at low blood pressures. The pathologic effects of hypertension increase stroke risk by three- to fivefold. With three-fourths of strokes incident events, primary prevention is essential. Multiple studies have demonstrated the benefit of blood pressure lowering in reducing incident and recurrent strokes. Even more, hypertension is a risk factor for cognitive impairment and dementia through multifactorial mechanisms including vascular compromise, cerebral small vessel disease, white matter disease (leukoaraiosis), cerebral microbleeds, cerebral atrophy, amyloid plaque deposition, and neurofibrillary tangles. In patients without hypotension, treatment with antihypertensives slows progression and assuages the degree of cognitive decline. While the choice of antihypertensive did not make a significant difference in most cognitive outcome studies, some large meta-analyses have pointed to angiotensin receptor blockers as the favored agent. Because of the well-documented morbidity and mortality associated with unchecked hypertension, treating and preventing hypertension are universally critical pillars in healthcare.
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Affiliation(s)
- Devin Loewenstein
- (1)Department of Medicine, Division of Cardiology, Rush University Medical Center, Chicago, IL, United States
| | - Mark Rabbat
- Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States.
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Liu N, Xue Y, Tang J, Zhang M, Ren X, Fu J. The dynamic change of phenotypic markers of smooth muscle cells in an animal model of cerebral small vessel disease. Microvasc Res 2021; 133:104061. [PMID: 32827495 DOI: 10.1016/j.mvr.2020.104061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/22/2020] [Accepted: 08/15/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The pathological character of cerebral small vessel disease (CSVD) is the dysfunction of cerebral small arteries caused by risk factors. A switch from the contractile phenotype to the synthetic phenotype of vascular smooth muscle cells (SMCs) can decrease the contractility of arteries. The alteration of the vascular wall extracellular matrix (ECM) is found to regulate the process. We speculated that SMCs phenotype changes may also occur in CSVD induced by hypertension and the alteration of ECM especially fibronectin and laminin may regulate the process. METHOD Male spontaneously hypertensive rats (SHR) were used as a CSVD animal model. SMCs phenotypic markers and the ECM expression of the cerebral small arteries of SHR at different ages were evaluated by immunofluorescence. The phenotype changes of primary brain microvascular SMCs cultured on laminin-coating dish or fibronectin-coating dish were evaluated by western blot. RESULT A switch from the contractile phenotype to synthetic phenotype in SHR at 10 and 22 weeks of age was observed. Meanwhile, increased expression of fibronectin and a temporary decline of laminin was found in small arteries of SHR at 22 weeks. In vitro experiments also convinced that SMCs cultured on a fibronectin-coating dish failed to maintain contractile phenotype. While at 50 weeks, significant drops of both synthetic and contractile phenotypic markers were witnessed in SHR, with high expressions of four kinds of ECM. CONCLUSION SMCs in cerebral small arteries exhibited a switch from the contractile phenotype to synthetic phenotype during the chronic process of hypertension and aging. Moreover, the change of fibronectin and laminin may regulate the process.
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MESH Headings
- Age Factors
- Animals
- Biomarkers/metabolism
- Cells, Cultured
- Cerebral Arteries/metabolism
- Cerebral Arteries/pathology
- Cerebral Arteries/physiopathology
- Cerebral Small Vessel Diseases/etiology
- Cerebral Small Vessel Diseases/metabolism
- Cerebral Small Vessel Diseases/pathology
- Cerebral Small Vessel Diseases/physiopathology
- Disease Models, Animal
- Extracellular Matrix/metabolism
- Extracellular Matrix/pathology
- Fibronectins/metabolism
- Hypertension/complications
- Hypertension/metabolism
- Hypertension/physiopathology
- Laminin/metabolism
- Male
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Phenotype
- Rats, Inbred SHR
- Rats, Inbred WKY
- Vascular Remodeling
- Vasoconstriction
- Rats
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Affiliation(s)
- Na Liu
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Yang Xue
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Jie Tang
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Miaoyi Zhang
- Department of Neurology, North Huashan hospital, Fudan University, No.108 Lu Xiang Road, Shanghai 201900, China
| | - Xue Ren
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Jianhui Fu
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai 200040, China; Department of Neurology, North Huashan hospital, Fudan University, No.108 Lu Xiang Road, Shanghai 201900, China.
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Duan Y, Shan W, Liu L, Wang Q, Wu Z, Liu P, Ji J, Liu Y, He K, Wang Y. Primary Categorizing and Masking Cerebral Small Vessel Disease Based on "Deep Learning System". Front Neuroinform 2020; 14:17. [PMID: 32523523 PMCID: PMC7261942 DOI: 10.3389/fninf.2020.00017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To supply the attending doctor’s diagnosis of the persisting of cerebral small vessel disease and speed up their work effectively, we developed a “deep learning system (DLS)” for cerebral small vessel disease predication. The reliability and the disease area segmentation accuracy, of the proposed DLS, was also investigated. Methods A deep learning model based on the convolutional neural network was designed and trained on 1,010 DWI b1000 images from 1010 patients diagnosed with segmentation of subcortical infarction, 359 T2∗ images from 359 patients diagnosed with segmentation of cerebral microbleed, as well as 824 T1-weighted and T2-FLAIR images from 824 patients diagnosed with segmentation of lacune and WMH. Dicw accuracy, recall, and f1-score were calculated to evaluate the proposed deep learning model. Finally, we also compared the DLS prediction capability with that of 6 doctors with 3 to 18 years’ clinical experience (8 ± 6 years). Results The results support that an appropriately trained DLS can achieve a high-level dice accuracy, 0.598 in the training section over all these four classifications on 30 patients (0.576 for young neuroradiologists), validation accuracy is 0.496 in lacune, 0.666 in WMH, 0.728 in subcortical infarction, and 0.503 in cerebral microbleeds. It is comparable to attending doctor with a few years of experience, regardless of whether the emphasis is placed on the segmentation or detection of lesions with less time-spending compared with manual analysis, about 4.4 s/case, which is dramatically less than doctors about 634 s/case. Conclusion The results of our comparison lend support to the case that an appropriately trained DLS can be trusted to the same extent as one would trust an attending doctor with a few years of experience, regardless of whether the emphasis is placed on the segmentation or detection of lesions.
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Affiliation(s)
- Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Wei Shan
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Liying Liu
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Qun Wang
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Zhenzhou Wu
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Pan Liu
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Jiahao Ji
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Clinical Medicine of Neurological Diseases, Beijing, China
| | - Kunlun He
- Laboratory of Translational Medicine, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese PLA General Hospital, Beijing, China
| | - Yongjun Wang
- National Center for Clinical Medicine of Neurological Diseases, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Borshchev YY, Uspensky YP, Galagudza MM. Pathogenetic pathways of cognitive dysfunction and dementia in metabolic syndrome. Life Sci 2019; 237:116932. [PMID: 31606384 DOI: 10.1016/j.lfs.2019.116932] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 12/13/2022]
Abstract
The prevalence of dementia worldwide is growing at an alarming rate. A number of studies and meta-analyses have provided evidence for increased risk of dementia in patients with metabolic syndrome (MS) as compared to persons without MS. However, there are some reports demonstrating a lack of association between MS and increased dementia risk. In this review, taking into account the potential role of individual MS components in the pathogenesis of MS-related cognitive dysfunction, we considered the underlying mechanisms in arterial hypertension, diabetes mellitus, dyslipidemia, and obesity. The pathogenesis of dementia in MS is multifactorial, involving both vascular injury and non-ischemic neuronal death due to neurodegeneration. Neurodegenerative and ischemic lesions do not simply coexist in the brain due to independent evolution, but rather exacerbate each other, leading to more severe consequences for cognition than would either pathology alone. In addition to universal mechanisms of cognitive dysfunction shared by all MS components, other pathogenetic pathways leading to cognitive deficits and dementia, which are specific for each component, also play a role. Examples of such component-specific pathogenetic pathways include central insulin resistance and hypoglycemia in diabetes, neuroinflammation and adipokine imbalance in obesity, as well as arteriolosclerosis and lipohyalinosis in arterial hypertension. A more detailed understanding of cognitive disorders based on the recognition of underlying molecular mechanisms will aid in the development of new methods for prevention and treatment of devastating cognitive problems in MS.
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Affiliation(s)
- Yury Yu Borshchev
- Institute of Experimental Medicine, Almazov National Medical Research Center, Saint Petersburg, Russian Federation
| | - Yury P Uspensky
- Department of Faculty Therapy, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation
| | - Michael M Galagudza
- Laboratory of Digital and Display Holography, ITMO University, Russian Federation, Saint Petersburg, Russian Federation.
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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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Altermatt A, Gaetano L, Magon S, Bauer L, Feurer R, Gnahn H, Hartmann J, Seifert CL, Poppert H, Wuerfel J, Radue EW, Kappos L, Sprenger T. Clinical associations of T2-weighted lesion load and lesion location in small vessel disease: Insights from a large prospective cohort study. Neuroimage 2019; 189:727-733. [DOI: 10.1016/j.neuroimage.2019.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 11/28/2022] Open
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Zwartbol MH, van der Kolk AG, Ghaznawi R, van der Graaf Y, Hendrikse J, Geerlings MI. Intracranial Vessel Wall Lesions on 7T MRI (Magnetic Resonance Imaging). Stroke 2019; 50:88-94. [DOI: 10.1161/strokeaha.118.022509] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maarten H.T. Zwartbol
- From the Department of Radiology (M.H.T.Z., A.G.v.d.K., R.G., J.H.), University Medical Center Utrecht and Utrecht University, the Netherlands
| | - Anja G. van der Kolk
- From the Department of Radiology (M.H.T.Z., A.G.v.d.K., R.G., J.H.), University Medical Center Utrecht and Utrecht University, the Netherlands
| | - Rashid Ghaznawi
- From the Department of Radiology (M.H.T.Z., A.G.v.d.K., R.G., J.H.), University Medical Center Utrecht and Utrecht University, the Netherlands
- Julius Center for Health Sciences and Primary Care (R.G., Y.v.d.G., M.I.G.), University Medical Center Utrecht and Utrecht University, the Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care (R.G., Y.v.d.G., M.I.G.), University Medical Center Utrecht and Utrecht University, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology (M.H.T.Z., A.G.v.d.K., R.G., J.H.), University Medical Center Utrecht and Utrecht University, the Netherlands
| | - Mirjam I. Geerlings
- Julius Center for Health Sciences and Primary Care (R.G., Y.v.d.G., M.I.G.), University Medical Center Utrecht and Utrecht University, the Netherlands
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Harris S, Kurniawan M, Rasyid A, Mesiano T, Hidayat R. Cerebral small vessel disease in Indonesia: Lacunar infarction study from Indonesian Stroke Registry 2012-2014. SAGE Open Med 2018; 6:2050312118784312. [PMID: 29977554 PMCID: PMC6024285 DOI: 10.1177/2050312118784312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 05/24/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Stroke is the number one cause of morbidity and mortality in Indonesia. Lacunar infarction is one of cerebral small vessel disease spectrum. This study aimed to present stroke epidemiology in Indonesia and risk factors associated with cerebral small vessel disease. METHODS A multicenter prospective cross-sectional study of 18 hospitals in Indonesia was conducted using Stroke Case Report Form from 2012 to 2014. Stroke was diagnosed based on clinical findings confirmed with non-contrast computed tomography of the brain. Subjects were classified into two large groups: ischemic (lacunar and non-lacunar) and hemorrhagic (intracranial and subarachnoid hemorrhage). Other risk factors were assessed on admission. RESULTS We enrolled 5411 patients, of whom 3627 (67.03%) had ischemic stroke and 1784 (32.97%) had hemorrhagic stroke. Male patients were prevalent in both large groups, although found less in subarachnoid hemorrhage group. Among patients with hemorrhagic stroke, 1603 (89.54%) of them had intracerebral hemorrhage and 181 (10.46%) had subarachnoid hemorrhage. From 3627 ischemic stroke patients, 1635 (45.07%) of them had lacunar infarction. We found that age above 55 years old, male gender, hypertension, dyslipidemia, and diabetes were important risk factors associated with lacunar stroke (p < 0.05). CONCLUSION Ischemic stroke was the leading cause of stroke in Indonesia. In total, 45% of the total ischemic stroke patients had lacunar infarction. Important risk factors associated with lacunar infarction were hypertension, dyslipidemia, diabetes, age over 55, and male population.
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Affiliation(s)
- Salim Harris
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Mohammad Kurniawan
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Al Rasyid
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Taufik Mesiano
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rakhmad Hidayat
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Li G, Zhu C, Li J, Wang X, Zhang Q, Zheng H, Zhan C. Increased level of procalcitonin is associated with total MRI burden of cerebral small vessel disease in patients with ischemic stroke. Neurosci Lett 2017; 662:242-246. [PMID: 29061396 DOI: 10.1016/j.neulet.2017.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/27/2017] [Accepted: 10/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Procalcitonin (PCT) has been found to be associated with subclinical cerebrovascular damage. The relationship between PCT levels and cerebral small vessel disease (cSVD), especially cSVD burden, has not been fully understood. This study aimed to investigate the association between PCT levels and cSVD in patients with first-ever acute ischemic stroke or transient ischemic attack (TIA). METHODS Two hundred and seventy-eight consecutive patients were prospectively recruited during Jan 2016 to Jun 2017. Serum PCT concentrations measurement was performed after admission. The presence and burden of cSVD was determined by magnetic resonance imaging (MRI). Multivariable logistic regression was used to assess whether serum PCT levels were associated with cSVD. RESULTS The median PCT level was 0.042μg/L (interquartile range, 0.025-0.065μg/L). Univariable logistic regression analysis indicated that patients with PCT level in the top quartile, compared with the lowest quartile, were more likely to have silent lacunar infarctions [odds ratio (OR), 2.266; 95% confidence interval (CI) 1.131-4.538, P=0.021], white matter lesions (OR, 1.793; 95% CI 1.029-3.574, P=0.047), high-grade enlarged perivascular spaces (OR, 8.061; 95% CI 3.599-14.055, P=0.001) and increased total MRI cSVD burden (OR, 3.743; 95% CI 1.998-7.008, P=0.002). These results persisted even after adjusting for potential confounders. CONCLUSIONS This study demonstrated that elevated PCT levels might be associated with total MRI cSVD burden in patients with ischemic stroke or TIA.
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Affiliation(s)
- Guangzong Li
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Chen Zhu
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Jing Li
- Department of Clinical Laboratory, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Xiangming Wang
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Qingbin Zhang
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Hongjia Zheng
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Cheng Zhan
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China.
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13
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Understanding a role for hypoxia in lesion formation and location in the deep and periventricular white matter in small vessel disease and multiple sclerosis. Clin Sci (Lond) 2017; 131:2503-2524. [PMID: 29026001 DOI: 10.1042/cs20170981] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/01/2017] [Accepted: 08/15/2017] [Indexed: 12/28/2022]
Abstract
The deep and periventricular white matter is preferentially affected in several neurological disorders, including cerebral small vessel disease (SVD) and multiple sclerosis (MS), suggesting that common pathogenic mechanisms may be involved in this injury. Here we consider the potential pathogenic role of tissue hypoxia in lesion development, arising partly from the vascular anatomy of the affected white matter. Specifically, these regions are supplied by a sparse vasculature fed by long, narrow end arteries/arterioles that are vulnerable to oxygen desaturation if perfusion is reduced (as in SVD, MS and diabetes) or if the surrounding tissue is hypoxic (as in MS, at least). The oxygen crisis is exacerbated by a local preponderance of veins, as these can become highly desaturated 'sinks' for oxygen that deplete it from surrounding tissues. Additional haemodynamic deficiencies, including sluggish flow and impaired vasomotor reactivity and vessel compliance, further exacerbate oxygen insufficiency. The cells most vulnerable to hypoxic damage, including oligodendrocytes, die first, resulting in demyelination. Indeed, in preclinical models, demyelination is prevented if adequate oxygenation is maintained by raising inspired oxygen concentrations. In agreement with this interpretation, there is a predilection of lesions for the anterior and occipital horns of the lateral ventricles, namely regions located at arterial watersheds, or border zones, known to be especially susceptible to hypoperfusion and hypoxia. Finally, mitochondrial dysfunction due to genetic causes, as occurs in leucodystrophies or due to free radical damage, as occurs in MS, will compound any energy insufficiency resulting from hypoxia. Viewing lesion formation from the standpoint of tissue oxygenation not only reveals that lesion distribution is partly predictable, but may also inform new therapeutic strategies.
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He JR, Zhang Y, Lu WJ, Liang HB, Tu XQ, Ma FY, Yang GY, Zeng LL. Age-Related Frontal Periventricular White Matter Hyperintensities and miR-92a-3p Are Associated with Early-Onset Post-Stroke Depression. Front Aging Neurosci 2017; 9:328. [PMID: 29051732 PMCID: PMC5633610 DOI: 10.3389/fnagi.2017.00328] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/22/2017] [Indexed: 01/13/2023] Open
Abstract
Objective: To explore the correlationship among white matter hyperintensities (WMHs), miR-92a-3p and early-onset post-stroke depression (PSD). Methods: We recruited consecutively 238 patients with acute cerebral infarction and MRI examination in the Department of neurology, Ruijin hospital, Shanghai Jiaotong University School of Medicine. The diagnosis of early-onset PSD was made in accordance with DSM-IV criteria for depression in 2 weeks after stroke. Clinical information and assessments of stroke severity were recorded on admission. The analysis of plasma miR-92a-3p was performed using quantitative PCR at the same time. WMHs were evaluated by the Fazekas and Scheltens visual rating scales. The relationship among WMHs, miR-92a-3p and PSD were analyzed by SPSS 22.0 software. Results: Logistic regression demonstrated that periventricular WMHs (PVWMHs) in frontal caps was an independent risk factor with early-onset PSD (OR = 1.579, 95% CI: 1.040-2.397, p = 0.032). The age and numbers of lacunes were related to frontal PVWMHs. Plasma miR-92a-3p in the PSD group was higher compared with the non-depressed group. Receiver operating curve analysis revealed that miR-92a-3p could predict early-onset PSD with 90% sensitivity and 90% specificity. The higher miR-92a-3p trended toward association with greater frontal PVWMHs. Conclusion: Acute ischemic stroke patients with frontal PVWMHs or a high plasma miR-92a-3p at baseline were more likely to develop early-onset PSD. MiR-92a-3p might be involved in the white matter impairment and post-stroke depression.
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Affiliation(s)
- Ji-Rong He
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Jing Lu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huai-Bin Liang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan-Qiang Tu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei-Yue Ma
- Department of Neurology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Yuan Yang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Li Zeng
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Scott JA, Tosun D, Braskie MN, Maillard P, Thompson PM, Weiner M, DeCarli C, Carmichael OT. Independent value added by diffusion MRI for prediction of cognitive function in older adults. NEUROIMAGE-CLINICAL 2017; 14:166-173. [PMID: 28180075 PMCID: PMC5279696 DOI: 10.1016/j.nicl.2017.01.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/15/2017] [Accepted: 01/24/2017] [Indexed: 11/04/2022]
Abstract
The purpose of this study was to determine whether white matter microstructure measured by diffusion magnetic resonance imaging (dMRI) provides independent information about baseline level or change in executive function (EF) or memory (MEM) in older adults with and without cognitive impairment. Longitudinal data was acquired from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study from phases GO and 2 (2009–2015). ADNI participants included were diagnosed as cognitively normal (n = 46), early mild cognitive impairment (MCI) (n = 48), late MCI (n = 29), and dementia (n = 39) at baseline. We modeled the association between dMRI-based global white matter mean diffusivity (MD) and baseline level and change in EF and MEM composite scores, in models controlling for baseline bilateral hippocampal volume, regional cerebral FDG PET metabolism and global cerebral AV45 PET uptake. EF and MEM composite scores were measured at baseline, 6, 12, 24 and 36 months. In the baseline late MCI and dementia groups, greater global MD was associated with lesser baseline EF, but not EF change nor MEM baseline or change. As expected, lesser hippocampal volume and lesser FDG PET metabolism was associated with greater rates of EF and MEM decline. In ADNI-GO/2 participants, white matter integrity provided independent information about current executive function, but was not sensitive to future cognitive change. Since individuals experiencing executive function declines progress to dementia more rapidly than those with only memory impairment, better biomarkers of future executive function decline are needed. In the ADNI cohort, MRI and PET predictors of baseline and change in executive function were tested. Global mean diffusivity was associated with baseline, but not change in, executive function. Diffusion MRI provides independent information on current executive function in older adults.
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Affiliation(s)
| | - Duygu Tosun
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Michael Weiner
- University of California San Francisco, San Francisco, CA, USA
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16
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Fan CF, Romero JR. "Cerebral Small Vessel Disease in subclinical and clinical stages, role of inflammation for risk prediction and potential treatment targets, and management strategies". INTERNAL MEDICINE REVIEW (WASHINGTON, D.C. : ONLINE) 2016; 2:265. [PMID: 35372740 PMCID: PMC8972798 DOI: 10.18103/imr.v2i11.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Stroke and dementia are the most common neurological disorders worldwide. Cerebrovascular disease, particularly cerebral small vessel disease (CSVD) is implicated in both, and the two main types of CSVD (hypertensive vasculopathy and cerebral amyloid angiopathy) account for the majority of cerebrovascular contributions to stroke and dementia. Current knowledge of CSVD may influence treatment decisions and preventive efforts. Although the causes of CSVD are not entirely elucidated, ongoing research of the pathophysiology of CSVD, such as the role of inflammation, is helping identify potential treatment targets, evaluate prediction models and develop preventive strategies. Given the detectability of CSVD in preclinical stages using brain MRI, a long window of opportunity is presented to implement existent preventive measures. This review considers CSVD including its subclinical manifestations detected using brain MRI, clinical manifestations, use of markers of CSVD as predictors of clinical outcomes such as dementia and stroke, and presents potential management strategies when seeing patients with cerebral small vessel disease to reduce its disease burden and clinical consequences. Clinical trials have evaluated some aspects of CSVD treatment and are beginning to recognize CSVD as endpoint in subclinical stages. Future studies will clarify if this approach is able to delay onset of dementia and prevent stroke occurrence, meanwhile implementation of existent recommendations for the prevention and treatment of stroke and dementia may reduce disability and clinical outcomes related to CSVD.
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Affiliation(s)
- C Frances Fan
- Department of Neurology (FF, JRR) at Boston University School of Medicine, and the NHLBI's Framingham Heart Study (JRR) Framingham, Massachusetts
| | - José R Romero
- Department of Neurology (FF, JRR) at Boston University School of Medicine, and the NHLBI's Framingham Heart Study (JRR) Framingham, Massachusetts
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17
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Elkahloun AG, Hafko R, Saavedra JM. An integrative genome-wide transcriptome reveals that candesartan is neuroprotective and a candidate therapeutic for Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2016; 8:5. [PMID: 26822027 PMCID: PMC4731966 DOI: 10.1186/s13195-015-0167-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/08/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alzheimer's disease is the most frequent age-related dementia, and is currently without treatment. To identify possible targets for early therapeutic intervention we focused on glutamate excitotoxicity, a major early pathogenic factor, and the effects of candesartan, an angiotensin receptor blocker of neuroprotective efficacy in cell cultures and rodent models of Alzheimer's disease. The overall goal of the study was to determine whether gene analysis of drug effects in a primary neuronal culture correlate with alterations in gene expression in Alzheimer's disease, thus providing further preclinical evidence of beneficial therapeutic effects. METHODS Primary neuronal cultures were treated with candesartan at neuroprotective concentrations followed by excitotoxic glutamate amounts. We performed genome-wide expression profile analysis and data evaluation by ingenuity pathway analysis and gene set enrichment analysis, compared with alterations in gene expression from two independent published datasets identified by microarray analysis of postmortem hippocampus from Alzheimer's disease patients. Preferential expression in cerebrovascular endothelial cells or neurons was analyzed by comparison to published gene expression in these cells isolated from human cortex by laser capture microdissection. RESULTS Candesartan prevented glutamate upregulation or downregulation of several hundred genes in our cultures. Ingenuity pathway analysis and gene set enrichment analysis revealed that inflammation, cardiovascular disease and diabetes signal transduction pathways and amyloid β metabolism were major components of the neuronal response to glutamate excitotoxicity. Further analysis showed associations of glutamate-induced changes in the expression of several hundred genes, normalized by candesartan, with similar alterations observed in hippocampus from Alzheimer's disease patients. Gene analysis of neurons and cerebrovascular endothelial cells obtained by laser capture microdissection revealed that genes up- and downregulated by glutamate were preferentially expressed in endothelial cells and neurons, respectively. CONCLUSIONS Our data may be interpreted as evidence of direct candesartan neuroprotection beyond its effects on blood pressure, revealing common and novel disease mechanisms that may underlie the in vitro gene alterations reported here and glutamate-induced cell injury in Alzheimer's disease. Our observations provide novel evidence for candesartan neuroprotection through early molecular mechanisms of injury in Alzheimer's disease, supporting testing this compound in controlled clinical studies in the early stages of the illness.
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Affiliation(s)
- Abdel G Elkahloun
- Comparative genomics and Cancer Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Roman Hafko
- Section on Pharmacology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Juan M Saavedra
- Section on Pharmacology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA. .,Department of Pharmacology and Physiology, Georgetown University Medical Center, SE402 Med/Dent, 3900 Reservoir Road, Washington, DC, 20057, USA.
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18
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Sfera A, Osorio C, Inderias L, Cummings M. The Ticking of the Epigenetic Clock: Antipsychotic Drugs in Old Age. Front Endocrinol (Lausanne) 2016; 7:122. [PMID: 27630617 PMCID: PMC5005952 DOI: 10.3389/fendo.2016.00122] [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] [Received: 05/02/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Exposed to antipsychotic drugs (APDs), older individuals with dementing illness are at risk of cerebrovascular adverse effects (CVAE), including sudden death. Transient microvascular dysfunctions are known to occur in younger persons exposed to APDs; however, they seldom progress to CVAE, suggesting that APDs alone are insufficient for engendering this untoward effect. It is, therefore, believed that a preexistent microvascular damage is necessary for CVAE to take place, but the exact nature of this lesion remains unclear. CNS small vessel disease (SVD) is a well-known age-related risk factor for strokes, dementia, and sudden death, which may constitute the initial CVAE-predisposing pathology. Therefore, we propose the two strikes CVAE paradigm, in which SVD represents the first strike, while exposure to APDs, the second. In this model, both strikes must be present for CVAE to take place, and the neuroimaging load of white matter hyperintensities may be directly proportional with the CVAE risk. To investigate this hypothesis at the molecular level, we focused on a seemingly unrelated phenomenon: both APDs and SVD were found protective against a similar repertoire of cancers and their spread to the brain (1-4). Since microRNA-29 has shown efficacy against the same malignancies and has been associated with small vessels pathology, we narrowed our search down to this miR, hypothesizing that the APDs mechanism of action includes miR-29 upregulation, which in turn facilitates the development of SVD. AIM To assess whether miR-29 can be utilized as a peripheral blood biomarker for SVD and CVAE risk. METHOD We conducted a search of experimentally verified miR-29 target genes utilizing the public domain tools miRanda, RNA22 and Weizemann Institute of Science miRNA Analysis. We identified in total 67 experimentally verified target genes for miR-29 family, 18 of which correlate with microvascular integrity and may be relevant for CVAE. CONCLUSION Upregulated microRNA-29 silences the expression of 18 genes connected with capillary stability, engendering a major vulnerability for SVD (first strike) which in turn increases the risk for CVAE after exposure to APDs (second strike).
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Affiliation(s)
- Adonis Sfera
- Psychiatry, Patton State Hospital, Patton, CA, USA
- *Correspondence: Adonis Sfera,
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De Cocker LJ, Kloppenborg RP, van der Graaf Y, Luijten PR, Hendrikse J, Geerlings MI, Algra A, Grobbee D, Rutten G, Visseren F, Moll F, Kappelle L, Mali W, Doevendans P. Cerebellar Cortical Infarct Cavities. Stroke 2015; 46:3154-60. [DOI: 10.1161/strokeaha.115.010093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/18/2015] [Indexed: 02/02/2023]
Abstract
Background and Purpose—
Small cerebellar infarct cavities have been recently found on magnetic resonance imaging (MRI) to preferentially involve the cerebellar cortex, but epidemiological studies are lacking. We aimed to determine the prevalence and risk factor profiles of cerebellar cortical infarct cavities (≤1.5 cm) as well as their association with MRI markers of cerebrovascular disease and functioning.
Methods—
We analyzed the 1.5 Tesla MRI of 636 patients (mean age, 62±9 years; 81% men) from the Second Manifestations of Arterial Disease-Memory, Depression and Aging (SMART-Medea) study. Logistic regression analyses were performed to estimate the associations of age, sex, vascular risk factors, MRI markers of cerebrovascular disease, and functioning with cerebellar cortical cavities, adjusted for age and sex.
Results—
Cerebellar cortical infarct cavities occurred on MRI in 10% of patients and were significantly associated with age, intima-media thickness (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1–3.7), high levels of homocysteinemia (OR, 1.8; 95% CI, 1.0–3.3), cortical infarcts (OR, 2.9; 95% CI, 1.6–5.4), gray matter lacunes of presumed vascular origin (OR, 3.0; 95% CI, 1.6–5.8), brain stem infarcts (OR, 5.1; 95% CI, 1.9–13.6), and decreased brain parenchymal fraction (OR, 0.84; 95% CI, 0.74–0.94), but not with white matter hyperintensities (OR, 1.2; 95% CI, 0.8–1.8) or white matter lacunes of presumed vascular origin (OR, 1.1; 95% CI, 0.5–2.5). They were also associated with worse physical functioning (OR 0.96; 95% CI, 0.94 to 0.99) but not with mental functioning.
Conclusions—
Cerebellar cortical infarct cavities are far more common than previously assumed based on symptomatic case series and are associated with markers of atherothromboembolic cerebrovascular disease.
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Affiliation(s)
- Laurens J.L. De Cocker
- From the Department of Radiology(L.J.L.D.C., P.R.L., J.H.) and Julius Center for Health Sciences and Primary Care (R.P.K., Y.v.d.G., M.I.G.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Neurology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands (R.P.K.)
| | - Raoul P. Kloppenborg
- From the Department of Radiology(L.J.L.D.C., P.R.L., J.H.) and Julius Center for Health Sciences and Primary Care (R.P.K., Y.v.d.G., M.I.G.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Neurology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands (R.P.K.)
| | - Yolanda van der Graaf
- From the Department of Radiology(L.J.L.D.C., P.R.L., J.H.) and Julius Center for Health Sciences and Primary Care (R.P.K., Y.v.d.G., M.I.G.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Neurology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands (R.P.K.)
| | - Peter R. Luijten
- From the Department of Radiology(L.J.L.D.C., P.R.L., J.H.) and Julius Center for Health Sciences and Primary Care (R.P.K., Y.v.d.G., M.I.G.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Neurology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands (R.P.K.)
| | - Jeroen Hendrikse
- From the Department of Radiology(L.J.L.D.C., P.R.L., J.H.) and Julius Center for Health Sciences and Primary Care (R.P.K., Y.v.d.G., M.I.G.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Neurology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands (R.P.K.)
| | - Mirjam I. Geerlings
- From the Department of Radiology(L.J.L.D.C., P.R.L., J.H.) and Julius Center for Health Sciences and Primary Care (R.P.K., Y.v.d.G., M.I.G.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Neurology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands (R.P.K.)
| | - A. Algra
- Julius Center for Health Sciences and Primary Care
| | - D.E. Grobbee
- Julius Center for Health Sciences and Primary Care
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Cai Z, Wang C, He W, Tu H, Tang Z, Xiao M, Yan LJ. Cerebral small vessel disease and Alzheimer's disease. Clin Interv Aging 2015; 10:1695-704. [PMID: 26604717 PMCID: PMC4629951 DOI: 10.2147/cia.s90871] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is a group of pathological processes with multifarious etiology and pathogenesis that are involved into the small arteries, arterioles, venules, and capillaries of the brain. CSVD mainly contains lacunar infarct or lacunar stroke, leukoaraiosis, Binswanger's disease, and cerebral microbleeds. CSVD is an important cerebral microvascular pathogenesis as it is the cause of 20% of strokes worldwide and the most common cause of cognitive impairment and dementia, including vascular dementia and Alzheimer's disease (AD). It has been well identified that CSVD contributes to the occurrence of AD. It seems that the treatment and prevention for cerebrovascular diseases with statins have such a role in the same function for AD. So far, there is no strong evidence-based medicine to support the idea, although increasing basic studies supported the fact that the treatment and prevention for cerebrovascular diseases will benefit AD. Furthermore, there is still lack of evidence in clinical application involved in specific drugs to benefit both AD and CSVD.
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Affiliation(s)
- Zhiyou Cai
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Chuanling Wang
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Wenbo He
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Hanjun Tu
- Department of Basic Research Center, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Zhengang Tang
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Ming Xiao
- Department of Anatomy, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Liang-Jun Yan
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
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21
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Characteristics of dynamic cerebral autoregulation in cerebral small vessel disease: Diffuse and sustained. Sci Rep 2015; 5:15269. [PMID: 26469343 PMCID: PMC4606796 DOI: 10.1038/srep15269] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/14/2015] [Indexed: 11/23/2022] Open
Abstract
Cerebral small vessel disease is a major cause of stroke and vascular dementia; however, the pathogenesis is largely unclear. In this study, we investigated the characteristics of the impairment of dynamic cerebral autoregulation (dCA) in lacunar infarction patients. Seventy-one lacunar infarction patients were enrolled in the study, including 46 unilateral middle cerebral artery (MCA) territory stroke patients and 25 unilateral posterior cerebral artery (PCA) territory stroke patients. Each group of patients was randomly divided into two subgroups. Group 1 underwent dCA assessments in the bilateral MCAs, and Group 2 underwent dCA assessments in the bilateral PCAs. All patients were followed up for 6 months. Transfer function analysis was applied to derive the autoregulatory parameters of gain and phase difference. In the unilateral MCA territory stroke patients, impairments of dCA were observed in both the MCAs and PCAs, and the same results were observed in the unilateral PCA territory stroke patients. These impairments remained unchanged during the 6-month follow-up. In lacunar infarction, which is most prevalent type of cerebral small vessel disease, though patients with unilateral MCA territory/PCA territory stroke, the impairments of dCA were global and sustained. This finding suggests that the physiological changes associated with lacunar infarction were diffuse.
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22
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Huang X, Kang X, Xue J, Kang C, Lv H, Li Z. Evaluation of carotid artery elasticity changes in patients with cerebral small vessel disease. Int J Clin Exp Med 2015; 8:18825-18830. [PMID: 26770502 PMCID: PMC4694402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/10/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The purpose of this study is to evaluate the intima-media thickness (IMT) and arterial elasticity of the common carotid artery (CCA) in patients with cerebral small vessel disease (SVD) by applying radiofrequency (RF) ultrasound technology. METHODS Fifty SVD subjects (SVD group) and fifty-three matched controls (Control group) were enrolled in the study. Structural and functional changes in the common carotid arterial wall were investigated by quality intima-media thickness (QIMT) and quanlity arterial stiffness (QAS) with a Mylab Twice ultrasound instrument. The vessel related variables between these two groups were analyzed. RESULTS There was a significant higher value of CCA-IMT in SVD group than that in control group (P<0.01). Pulse wave velocity (PWV), stiffness coefficient (α) and stiffness index (β) were remarkably greater (P<0.01) while compliance coefficient (CC) decreased significantly (P<0.01) in the SVD group than control group. Furthermore, significant difference was found on IMT between left and right CCA in SVD (P<0.01) and control group (P<0.01) while no significant difference was found on CC, α, β and PWV between left and right CCA in SVD (P>0.05) and control group (P>0.05). CONCLUSIONS Decreased arterial elasticity of the CCA in patients with SVD compared with normal subjects. Ultrasound RF technology can be used to non-invasively and quantitatively detect the change in the structure and function of the CCA in SVD subjects for evaluating preclinical atherosclerosis.
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Affiliation(s)
- Xiaochun Huang
- Department of Ultrasound, First Hospital of Shanxi Medical UniversityTaiyuan, Shanxi, China
| | - Xiaoyan Kang
- Department of Ultrasound, First Hospital of Shanxi Medical UniversityTaiyuan, Shanxi, China
| | - Jiping Xue
- Department of Ultrasound, Shanxi Academy of Medical Sciences & Shanxi DAYI HospitalTaiyuan, Shanxi, China
| | - Chunsong Kang
- Department of Ultrasound, Shanxi Academy of Medical Sciences & Shanxi DAYI HospitalTaiyuan, Shanxi, China
| | - Hong Lv
- Department of Ultrasound, Shanxi Academy of Medical Sciences & Shanxi DAYI HospitalTaiyuan, Shanxi, China
| | - Zhaojun Li
- Department of Ultrasound, Shanxi Academy of Medical Sciences & Shanxi DAYI HospitalTaiyuan, Shanxi, China
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Johnson AC, Cipolla MJ. The cerebral circulation during pregnancy: adapting to preserve normalcy. Physiology (Bethesda) 2015; 30:139-47. [PMID: 25729059 DOI: 10.1152/physiol.00048.2014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The adaptation of the brain and cerebral circulation to pregnancy are unique compared with other organs and circulatory systems, ultimately functioning to maintain brain homeostasis. In this review, the effect of pregnancy on critical functions of the cerebral circulation is discussed, including changes occurring at the endothelium and blood-brain barrier, and changes in the structure and function of cerebral arteries and arterioles, hemodynamics, and cerebral blood flow autoregulation.
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Affiliation(s)
- Abbie C Johnson
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont
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24
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Novelli EM, Elizabeth Sarles C, Jay Aizenstein H, Ibrahim TS, Butters MA, Connelly Ritter A, Erickson KI, Rosano C. Brain venular pattern by 7T MRI correlates with memory and haemoglobin in sickle cell anaemia. Psychiatry Res 2015; 233:18-22. [PMID: 26002434 PMCID: PMC7147953 DOI: 10.1016/j.pscychresns.2015.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/22/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022]
Abstract
Sickle cell anaemia (SCA) is a hereditary hemoglobinopathy characterised by extensive vascular dysfunction that stems from inflammation, thrombosis and occlusion of post-capillary venules. Cognitive impairment is a neurological complication of SCA whose pathogenesis is unknown. We hypothesised that cerebral venular abnormalities are linked to cognitive impairment in SCA. Thus, we employed 7T magnetic resonance imaging (MRI) to examine the association between venular density and cognitive function in homozygous SCA. We quantified the density of total, long, and short venules in pre-defined regions of interest between the frontal and occipital cornu on each hemisphere. Cognitive function was assessed using the Hopkins Verbal Learning Test - Revised (HVLT-R) test of learning and memory. Patients (n=11) were compared with race, age and gender-equated controls (n=7). Compared to controls, patients had an overall venular rarefaction, with significantly lower density of long venules and greater density of short venules which was inversely related to HVLT-R performance and haemoglobin. To our knowledge, this is the first 7T MRI study in SCA and first report of associations between cerebral venular patterns and cognitive performance and haemoglobin. Future studies should examine whether these novel neuroimaging markers predict cognitive impairment longitudinally and are mechanistically linked to severity of anaemia.
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Affiliation(s)
- Enrico M Novelli
- University of Pittsburgh Medical Center (UPMC) and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - C Elizabeth Sarles
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Tamer S Ibrahim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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Snyder HM, Corriveau RA, Craft S, Faber JE, Greenberg SM, Knopman D, Lamb BT, Montine TJ, Nedergaard M, Schaffer CB, Schneider JA, Wellington C, Wilcock DM, Zipfel GJ, Zlokovic B, Bain LJ, Bosetti F, Galis ZS, Koroshetz W, Carrillo MC. Vascular contributions to cognitive impairment and dementia including Alzheimer's disease. Alzheimers Dement 2015; 11:710-7. [PMID: 25510382 PMCID: PMC4731036 DOI: 10.1016/j.jalz.2014.10.008] [Citation(s) in RCA: 413] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/22/2014] [Accepted: 10/02/2014] [Indexed: 02/07/2023]
Abstract
Scientific evidence continues to demonstrate the linkage of vascular contributions to cognitive impairment and dementia such as Alzheimer's disease. In December, 2013, the Alzheimer's Association, with scientific input from the National Institute of Neurological Disorders and Stroke and the National Heart, Lung and Blood Institute from the National Institutes of Health, convened scientific experts to discuss the research gaps in our understanding of how vascular factors contribute to Alzheimer's disease and related dementia. This manuscript summarizes the meeting and the resultant discussion, including an outline of next steps needed to move this area of research forward.
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Affiliation(s)
- Heather M Snyder
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA.
| | - Roderick A Corriveau
- National Institute on Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Suzanne Craft
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - James E Faber
- Department of Cell Biology and Physiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Bruce T Lamb
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas J Montine
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Maiken Nedergaard
- Division of Glial Disease and Therapeutics, University of Rochester Medical Center, Rochester, NY, USA
| | - Chris B Schaffer
- Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Julie A Schneider
- Departments of Pathology and Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donna M Wilcock
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Gregory J Zipfel
- Departments of Neurological Surgery and Neurology, Washington University, St Louis, St Louis, MO, USA
| | - Berislav Zlokovic
- Department of Physiology, University of Southern California, Los Angeles, CA, USA
| | - Lisa J Bain
- Independent Science Writer, Elverson, PA, USA
| | - Francesca Bosetti
- National Institute on Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Zorina S Galis
- National Institute of Heart, Lung and Blood, National Institutes of Health, Bethesda, MD, USA
| | - Walter Koroshetz
- National Institute on Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Maria C Carrillo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
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Jellinger KA. Pathogenesis and treatment of vascular cognitive impairment. Neurodegener Dis Manag 2014; 4:471-90. [DOI: 10.2217/nmt.14.37] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
SUMMARY Vascular cognitive impairment (VCI) defines a continuum of disorders ranging from mild cognitive impairment to full-blown dementia, attributable to cerebrovascular causes. Major morphological types – multi-infarct encephalopathy, strategic infarct type, subcortical arteriosclerotic leukoencephalopathy, multilacunar state, postischemic encephalopathy – result from systemic, cardiac and local large or small vessel disease. Cognitive decline is commonly caused by widespread small cerebrovascular lesions (CVLs) affecting regions/networks essential for cognition, memory and behavior. CVLs often coexist with Alzheimer-type and other pathologies, which interact in promoting dementia, but in many nondemented elderly individuals, mixed brain pathologies are also present. Due to the high variability of CVLs, no validated clinical and neuropathological criteria for VCI are available. Cholinesterase inhibitors and memantine produce small cognitive improvement but without essential effect. Antihypertensive treatment, cardiovascular control and lifestyle modifications reducing vascular risk factors are essential. Given its growing health, social and economic burden, prevention and treatment of VCI are a major challenge of neuroscience.
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Zhang Y, Liu X, Zhang J, Li N. Short-term effects of extremely low frequency electromagnetic fields exposure on Alzheimer's disease in rats. Int J Radiat Biol 2014; 91:28-34. [DOI: 10.3109/09553002.2014.954058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Attems J, Jellinger KA. The overlap between vascular disease and Alzheimer's disease--lessons from pathology. BMC Med 2014; 12:206. [PMID: 25385447 PMCID: PMC4226890 DOI: 10.1186/s12916-014-0206-2] [Citation(s) in RCA: 478] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/07/2014] [Indexed: 12/15/2022] Open
Abstract
Recent epidemiological and clinico-pathological data indicate considerable overlap between cerebrovascular disease (CVD) and Alzheimer's disease (AD) and suggest additive or synergistic effects of both pathologies on cognitive decline. The most frequent vascular pathologies in the aging brain and in AD are cerebral amyloid angiopathy and small vessel disease. Up to 84% of aged subjects show morphological substrates of CVD in addition to AD pathology. AD brains with minor CVD, similar to pure vascular dementia, show subcortical vascular lesions in about two-thirds, while in mixed type dementia (AD plus vascular dementia), multiple larger infarcts are more frequent. Small infarcts in patients with full-blown AD have no impact on cognitive decline but are overwhelmed by the severity of Alzheimer pathology, while in early stages of AD, cerebrovascular lesions may influence and promote cognitive impairment, lowering the threshold for clinically overt dementia. Further studies are warranted to elucidate the many hitherto unanswered questions regarding the overlap between CVD and AD as well as the impact of both CVD and AD pathologies on the development and progression of dementia.
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Affiliation(s)
- Johannes Attems
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
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Bůžková P, Barzilay JI, Fink HA, Robbins JA, Cauley JA, Fitzpatrick AL. Ratio of urine albumin to creatinine attenuates the association of dementia with hip fracture risk. J Clin Endocrinol Metab 2014; 99:4116-23. [PMID: 25148233 PMCID: PMC4223436 DOI: 10.1210/jc.2014-2409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Microvascular disease is a leading cause of cognitive impairment. Approximately 50% of people with a hip fracture have cognitive impairment. OBJECTIVE We tested the hypothesis that microvascular diseases of the brain (lacunar infarcts and white matter disease [WMD]), kidney (albuminuria [≥ 30 mg/g creatinine] and albumin creatinine ratio [ACR]), and eye (retinal vascular disorders) attenuate the association of cognitive impairment with hip fracture risk. SETTING The Cardiovascular Health Cognition Study. PATIENTS Three thousand, one-hundred six participants (mean age, ∼ 79 y; 8.84 y median follow-up) with cognitive testing. Subsets received ACR testing (n=2389), brain magnetic resonance imaging scans (n = 2094), and retinal photography (n = 1098). MAIN OUTCOME MEASURE Incident hip fracture. RESULTS There were 488 participants (16%) with mild cognitive impairment (MCI) and 564 (18%) with dementia. There were 337 incident hip fractures, of which 19% occurred in participants with MCI and 26% in participants with dementia. Adjusted hazard ratios (HR) and 95% confidence interval for hip fracture in participants with MCI were 2.45 (1.67-3.61) and for dementia 2.35 (1.57-3.52). With doubling of ACR, the HR for fracture was attenuated in participants with dementia compared with participants with normal cognition [interaction HR 0.70 (0.55-0.91)]. No such effect was found in participants with MCI. Albuminuria, lacunar infarcts, WMD, and retinal vascular disease (RVD) did not modify the association of dementia or MCI with hip fracture risk. CONCLUSIONS ACR attenuates part of the risk of hip fracture in people with dementia, suggesting that these disorders share a common pathogenesis.
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Affiliation(s)
- Petra Bůžková
- Department of Biostatistics (P.B.), University of Washington, Seattle, Washington 98115; Division of Endocrinology, Kaiser Permanente of Georgia and the Division of Endocrinology (J.I.B.), Emory University School of Medicine, Atlanta, Georgia 30096; Geriatric Research Education & Clinical Center (H.A.F.), Veterans Affair Medical Center, Minneapolis, Minnesota 55417; Department of Medicine (J.A.R.), University of California, Davis, Sacramento, California; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh 15261, Pennsylvania; and Department of Epidemiology (A.L.F.), University of Washington, Seattle, Washington 98115
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Jellinger KA, Attems J. Challenges of multimorbidity of the aging brain: a critical update. J Neural Transm (Vienna) 2014; 122:505-21. [DOI: 10.1007/s00702-014-1288-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/24/2014] [Indexed: 12/11/2022]
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