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Liu P, Lin Z, Hazel K, Pottanat G, Xu C, Jiang D, Pillai JJ, Lucke E, Bauer CE, Gold BT, Greenberg SM, Helmer KG, Jann K, Jicha G, Kramer J, Maillard P, Mulavelil RM, Rodriguez P, Satizabal CL, Schwab K, Seshadri S, Singh H, Velarde Dediós ÁG, Wang DJJ, Kalyani RR, Moghekar A, Rosenberg PB, Yasar S, Albert M, Lu H. Cerebrovascular reactivity MRI as a biomarker for cerebral small vessel disease-related cognitive decline: Multi-site validation in the MarkVCID Consortium. Alzheimers Dement 2024. [PMID: 38951718 DOI: 10.1002/alz.13888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Vascular contributions to cognitive impairment and dementia (VCID) represent a major factor in cognitive decline in older adults. The present study examined the relationship between cerebrovascular reactivity (CVR) measured by magnetic resonance imaging (MRI) and cognitive function in a multi-site study, using a predefined hypothesis. METHODS We conducted the study in a total of three analysis sites and 263 subjects. Each site performed an identical CVR MRI procedure using 5% carbon dioxide inhalation. A global cognitive measure of Montreal Cognitive Assessment (MoCA) and an executive function measure of item response theory (IRT) score were used as outcomes. RESULTS CVR and MoCA were positively associated, and this relationship was reproduced at all analysis sites. CVR was found to be positively associated with executive function. DISCUSSION The predefined hypothesis on the association between CVR and a global cognitive score was validated in three independent analysis sites, providing support for CVR as a biomarker in VCID. HIGHLIGHTS This study measured a novel functional index of small arteries referred to as cerebrovascular reactivity (CVR). CVR was positively associated with global cognition in older adults. This finding was observed in three independent cohorts at three sites. Our statistical analysis plan was predefined before beginning data collection.
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Affiliation(s)
- Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zixuan Lin
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kaisha Hazel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - George Pottanat
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cuimei Xu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dengrong Jiang
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jay J Pillai
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Division of Neuroradiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Emma Lucke
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher E Bauer
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Brian T Gold
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Karl G Helmer
- Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Kay Jann
- Laboratory of Functional MRI Technology, Keck School of Medicine, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Gregory Jicha
- Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - Joel Kramer
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, Sacramento, California, USA
| | - Rachel M Mulavelil
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Pavel Rodriguez
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Herpreet Singh
- Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Ángel G Velarde Dediós
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Danny J J Wang
- Laboratory of Functional MRI Technology, Keck School of Medicine, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Rita R Kalyani
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, USA
- F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
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Mikulis DJ. Cerebrovascular Reserve Imaging: Problems and Solutions. Magn Reson Imaging Clin N Am 2024; 32:93-109. [PMID: 38007286 DOI: 10.1016/j.mric.2023.09.002] [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] [Indexed: 11/27/2023]
Abstract
The current standard of practice for assessing patients with cerebrovascular steno-occlusive disease is based on measuring resting blood flow metrics using MR imaging and CT perfusion imaging. However, the reliability of these methods decreases as the degree and number of stenoses increase. The reason for this is that measures of adequate baseline blood flow in highly collateralized circulations do not account for possible shortfalls in recruitable blood flow or increased metabolic demand. The following offers a clinically tested solution for this purpose using cerebrovascular reactivity methodology that applies a quantifiable vasodilatory stimulus improving reproducibility and repeatability essential for optimizing patient management.
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Affiliation(s)
- David J Mikulis
- The Krembil Brain Institute, Institute of Medcial Science, Department of Medical Imaging, The University of Toronto, The University Health Network, The Toronto Western Hospital, 399 Bathurst Street, Room 3MC-431, Toronto, ON M5T 2S8, Canada.
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3
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Panigrahy A, Schmithorst V, Ceschin R, Lee V, Beluk N, Wallace J, Wheaton O, Chenevert T, Qiu D, Lee JN, Nencka A, Gagoski B, Berman JI, Yuan W, Macgowan C, Coatsworth J, Fleysher L, Cannistraci C, Sleeper LA, Hoskoppal A, Silversides C, Radhakrishnan R, Markham L, Rhodes JF, Dugan LM, Brown N, Ermis P, Fuller S, Cotts TB, Rodriguez FH, Lindsay I, Beers S, Aizenstein H, Bellinger DC, Newburger JW, Umfleet LG, Cohen S, Zaidi A, Gurvitz M. Design and Harmonization Approach for the Multi-Institutional Neurocognitive Discovery Study (MINDS) of Adult Congenital Heart Disease (ACHD) Neuroimaging Ancillary Study: A Technical Note. J Cardiovasc Dev Dis 2023; 10:381. [PMID: 37754810 PMCID: PMC10532244 DOI: 10.3390/jcdd10090381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Dramatic advances in the management of congenital heart disease (CHD) have improved survival to adulthood from less than 10% in the 1960s to over 90% in the current era, such that adult CHD (ACHD) patients now outnumber their pediatric counterparts. ACHD patients demonstrate domain-specific neurocognitive deficits associated with reduced quality of life that include deficits in educational attainment and social interaction. Our hypothesis is that ACHD patients exhibit vascular brain injury and structural/physiological brain alterations that are predictive of specific neurocognitive deficits modified by behavioral and environmental enrichment proxies of cognitive reserve (e.g., level of education and lifestyle/social habits). This technical note describes an ancillary study to the National Heart, Lung, and Blood Institute (NHLBI)-funded Pediatric Heart Network (PHN) "Multi-Institutional Neurocognitive Discovery Study (MINDS) in Adult Congenital Heart Disease (ACHD)". Leveraging clinical, neuropsychological, and biospecimen data from the parent study, our study will provide structural-physiological correlates of neurocognitive outcomes, representing the first multi-center neuroimaging initiative to be performed in ACHD patients. Limitations of the study include recruitment challenges inherent to an ancillary study, implantable cardiac devices, and harmonization of neuroimaging biomarkers. Results from this research will help shape the care of ACHD patients and further our understanding of the interplay between brain injury and cognitive reserve.
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Affiliation(s)
- Ashok Panigrahy
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, 45th Str., Penn Ave., Pittsburgh, PA 15201, USA
| | - Vanessa Schmithorst
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Rafael Ceschin
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Vince Lee
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Nancy Beluk
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Julia Wallace
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Olivia Wheaton
- HealthCore Inc., 480 Pleasant Str., Watertown, MA 02472, USA;
| | - Thomas Chenevert
- Department of Radiology, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
- Congenital Heart Center, C. S. Mott Children’s Hospital, 1540 E Hospital Dr., Ann Arbor, MI 48109, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory School of Medicine, 1364 Clifton Rd., Atlanta, GA 30322, USA;
| | - James N Lee
- Department of Radiology, The University of Utah, 50 2030 E, Salt Lake City, UT 84112, USA;
| | - Andrew Nencka
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Borjan Gagoski
- Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jeffrey I. Berman
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
| | - Weihong Yuan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA;
- Department of Radiology, University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA
| | - Christopher Macgowan
- Department of Medical Biophysics, University of Toronto, 101 College Str. Suite 15-701, Toronto, ON M5G 1L7, Canada;
- The Hospital for Sick Children Division of Translational Medicine, 555 University Ave., Toronto, ON M5G 1X8, Canada
| | - James Coatsworth
- Department of Radiology, Medical University of South Carolina, 171 Ashley Ave., Room 372, Charleston, SC 29425, USA;
| | - Lazar Fleysher
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Christopher Cannistraci
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Arvind Hoskoppal
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Candice Silversides
- Department of Cardiology, University of Toronto, C. David Naylor Building, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada;
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 University Blvd., Indianapolis, IN 46202, USA;
| | - Larry Markham
- Department of Cardiology, University of Indiana School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA;
| | - John F. Rhodes
- Department of Cardiology, Medical University of South Carolina, 96 Jonathan Lucas Str. Ste. 601, MSC 617, Charleston, SC 29425, USA;
| | - Lauryn M. Dugan
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Nicole Brown
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Peter Ermis
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Stephanie Fuller
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Timothy Brett Cotts
- Departments of Internal Medicine and Pediatrics, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
| | - Fred Henry Rodriguez
- Department of Cardiology, Emory School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA;
| | - Ian Lindsay
- Department of Cardiology, The University of Utah, 95 S 2000 E, Salt Lake City, UT 84112, USA;
| | - Sue Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - David C. Bellinger
- Cardiac Neurodevelopmental Program, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Laura Glass Umfleet
- Department of Neuropsychology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Scott Cohen
- Heart and Vascular Center, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Ali Zaidi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
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Mahaparn I, Lepping RJ, Montgomery RN, Mukherjee R, Billinger SA, Brooks WM, Gupta A. The Association of Tacrolimus Formulation on Cerebral Blood Flow and Cognitive Function. Transplant Direct 2023; 9:e1511. [PMID: 37456588 PMCID: PMC10348734 DOI: 10.1097/txd.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 07/18/2023] Open
Abstract
Calcineurin inhibitors are inherent vasoconstrictors. Cerebral vasoconstriction can reduce cerebral blood flow (CBF), and negatively impact cerebrovascular response (CVR) to exercise, and cognitive function. The once-daily extended-release (LCP) tacrolimus has fewer side effects than the immediate-release (IR) tacrolimus. The role of calcineurin inhibitors on CBF and the impact of specific formulations of tacrolimus on CBF, CVR, and cognitive function are unknown. In this pilot study, we evaluated whether changing from IR tacrolimus to LCP tacrolimus modulates CBF, CVR, or cognitive function in kidney transplant (KT) recipients. Methods We randomized (2:1) 30 stable KT recipients on IR tacrolimus to intervention (switch to LCP tacrolimus) and control (continue IR tacrolimus) arms. We measured CBF, CVR, and cognitive function at baseline and at 12 wk. We used ANCOVA to evaluate changes in outcome variables, with baseline values and study arm as covariates. We used descriptive statistics with mean changes in outcome variables to compare the 2 groups. Results Participants were 51 ± 13 y old. There was no difference in plasma tacrolimus levels at baseline and at 12 wk in the 2 arms. The changes in CBF, resting middle cerebral artery velocity, CVR, and cognitive function were more favorable in the intervention arm than in the control group. Conclusions Changing IR tacrolimus to LCP tacrolimus may improve CBF, cerebrovascular dynamics, and cognitive function in KT recipients. Larger studies are needed to confirm these results.
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Affiliation(s)
- Irisa Mahaparn
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Rebecca J. Lepping
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS
| | - Robert N. Montgomery
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS
| | - Rishav Mukherjee
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS
| | - Sandra A. Billinger
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - William M. Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS
| | - Aditi Gupta
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS
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Vlisides PE, Mentz G, Leis AM, Colquhoun D, McBride J, Naik BI, Dunn LK, Aziz MF, Vagnerova K, Christensen C, Pace NL, Horn J, Cummings K, Cywinski J, Akkermans A, Kheterpal S, Moore LE, Mashour GA. Carbon Dioxide, Blood Pressure, and Perioperative Stroke: A Retrospective Case-Control Study. Anesthesiology 2022; 137:434-445. [PMID: 35960872 PMCID: PMC10324342 DOI: 10.1097/aln.0000000000004354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The relationship between intraoperative physiology and postoperative stroke is incompletely understood. Preliminary data suggest that either hypo- or hypercapnia coupled with reduced cerebrovascular inflow (e.g., due to hypotension) can lead to ischemia. This study tested the hypothesis that the combination of intraoperative hypotension and either hypo- or hypercarbia is associated with postoperative ischemic stroke. METHODS We conducted a retrospective, case-control study via the Multicenter Perioperative Outcomes Group. Noncardiac, nonintracranial, and nonmajor vascular surgical cases (18 yr or older) were extracted from five major academic centers between January 2004 and December 2015. Ischemic stroke cases were identified via manual chart review and matched to controls (1:4). Time and reduction below key mean arterial blood pressure thresholds (less than 55 mmHg, less than 60 mmHg, less than 65 mmHg) and outside of specific end-tidal carbon dioxide thresholds (30 mmHg or less, 35 mmHg or less, 45 mmHg or greater) were calculated based on total area under the curve. The association between stroke and total area under the curve values was then tested while adjusting for relevant confounders. RESULTS In total, 1,244,881 cases were analyzed. Among the cases that screened positive for stroke (n = 1,702), 126 were confirmed and successfully matched with 500 corresponding controls. Total area under the curve was significantly associated with stroke for all thresholds tested, with the strongest combination observed with mean arterial pressure less than 55 mmHg (adjusted odds ratio per 10 mmHg-min, 1.17 [95% CI, 1.10 to 1.23], P < 0.0001) and end-tidal carbon dioxide 45 mmHg or greater (adjusted odds ratio per 10 mmHg-min, 1.11 [95% CI, 1.10 to 1.11], P < 0.0001). There was no interaction effect observed between blood pressure and carbon dioxide. CONCLUSIONS Intraoperative hypotension and carbon dioxide dysregulation may each independently increase postoperative stroke risk. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Phillip E. Vlisides
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI USA 48109
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI USA 48109
| | - Graciela Mentz
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI USA 48109
| | - Aleda M. Leis
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA 48109
| | - Douglas Colquhoun
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI USA 48109
| | - Jonathon McBride
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI USA 48109
| | - Bhiken I. Naik
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA USA 22908
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA USA 22908
| | - Lauren K. Dunn
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA USA 22908
| | - Michael F. Aziz
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR USA 97239
| | - Kamila Vagnerova
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR USA 97239
| | - Clint Christensen
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT USA 84132
| | - Nathan L. Pace
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT USA 84132
| | - Jeffrey Horn
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT USA 84132
| | | | - Jacek Cywinski
- Anesthesiology Institute, Cleveland Clinic, OH USA 44195
| | - Annemarie Akkermans
- Department of Anesthesiology, University Medical Center Utrecht, Netherlands
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI USA 48109
| | - Laurel E. Moore
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI USA 48109
| | - George A. Mashour
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI USA 48109
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI USA 48109
- Neuroscience Graduate Program, University of Michigan Medical School, Ann Arbor, MI USA
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Sayin ES, Sobczyk O, Poublanc J, Mikulis DJ, Fisher JA, Kuo KHM, Duffin J. Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease. Front Physiol 2022; 13:847969. [PMID: 35422710 PMCID: PMC9002264 DOI: 10.3389/fphys.2022.847969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
In patients with sickle cell disease (SCD) the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno-occlusive vascular disease. Meeting demands for oxygen delivery requires compensatory features of brain perfusion. The cerebral vasculature’s regulatory function and reserves can be assessed by observing the flow response to a vasoactive stimulus. In a traditional approach we measured voxel-wise change in Blood Oxygen-Level Dependent (BOLD) MRI signal as a surrogate of cerebral blood flow (CBF) in response to a linear progressive ramping of end-tidal partial pressure of carbon dioxide (PETCO2). Cerebrovascular reactivity (CVR) was defined as ΔBOLD/ΔPETCO2. We used a computer model to fit a virtual sigmoid resistance curve to the progressive CBF response to the stimulus, enabling the calculation of resistance parameters: amplitude, midpoint, range response, resistance sensitivity and vasodilatory reserve. The quality of the resistance sigmoid fit was expressed as the r2 of the fit. We tested 35 patients with SCD, as well as 24 healthy subjects to provide an indication of the normal ranges of the resistance parameters. We found that gray matter CVR and resistance amplitude, range, reserve, and sensitivity are reduced in patients with SCD compared to healthy controls, while resistance midpoint was increased. This study is the first to document resistance measures in adult patients with SCD. It is also the first to score these vascular resistance measures in comparison to the normal range. We anticipate these data will complement the current understanding of the cerebral vascular pathophysiology of SCD, identify paths for therapeutic interventions, and provide biomarkers for monitoring the progress of the disease.
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Affiliation(s)
- Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Fisher
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Kevin H. M. Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- *Correspondence: James Duffin,
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7
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Beaudin AE, McCreary CR, Mazerolle EL, Gee M, Sharma B, Subotic A, Zwiers AM, Cox E, Nelles K, Charlton A, Frayne R, Ismail Z, Beaulieu C, Jickling G, Camicioli RM, Pike GB, Smith E. Cerebrovascular Reactivity Across the Entire Brain in Cerebral Amyloid Angiopathy. Neurology 2022; 98:e1716-e1728. [PMID: 35210294 PMCID: PMC9071369 DOI: 10.1212/wnl.0000000000200136] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Reduced cerebrovascular reactivity is proposed to be a feature of cerebral amyloid angiopathy (CAA) but has not been measured directly. Employing a global vasodilatory stimulus (hypercapnia), this study assessed the relationships between cerebrovascular reactivity and MRI markers of CAA and cognitive function. Methods In a cross-sectional study, individuals with probable CAA, mild cognitive impairment, or dementia due to Alzheimer disease and healthy controls underwent neuropsychological testing and an MRI that included a 5% carbon dioxide challenge. Cerebrovascular reactivity was compared across groups controlling for age, sex, and the presence of hypertension, and its associations with MRI markers of CAA in participants with CAA and with cognition across all participants were determined using multivariable linear regression adjusting for group, age, sex, education, and the presence of hypertension. Results Cerebrovascular reactivity data (mean ± SD) were available for 26 participants with CAA (9 female; 74.4 ± 7.7 years), 19 participants with mild cognitive impairment (5 female; 72.1 ± 8.5 years), 12 participants with dementia due to Alzheimer disease (4 female; 69.4 ± 6.6 years), and 39 healthy controls (30 female; 68.8 ± 5.4 years). Gray and whiter matter reactivity averaged across the entire brain was lower in participants with CAA and Alzheimer disease dementia compared to healthy controls, with a predominantly posterior distribution of lower reactivity in both groups. Higher white matter hyperintensity volume was associated with lower white matter reactivity (standardized coefficient [β], 95% CI −0.48, −0.90 to −0.01). Higher gray matter reactivity was associated with better global cognitive function (β 0.19, 0.03–0.36), memory (β 0.21, 0.07–0.36), executive function (β 0.20, 0.02–0.39), and processing speed (β 0.27, 0.10–0.45) and higher white matter reactivity was associated with higher memory (β 0.22, 0.08–0.36) and processing speed (β 0.23, 0.06–0.40). Conclusions Reduced cerebrovascular reactivity is a core feature of CAA and its assessment may provide an additional biomarker for disease severity and cognitive impairment.
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Affiliation(s)
- Andrew E Beaudin
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada .,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Cheryl R McCreary
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Erin L Mazerolle
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Myrlene Gee
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Breni Sharma
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Arsenije Subotic
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Angela M Zwiers
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Emily Cox
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Krista Nelles
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anna Charlton
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Richard Frayne
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, AB, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Glen Jickling
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Richard M Camicioli
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - G Bruce Pike
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Eric Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
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8
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Liu P, Jiang D, Albert M, Bauer CE, Caprihan A, Gold BT, Greenberg SM, Helmer KG, Jann K, Jicha G, Rodriguez P, Satizabal CL, Seshadri S, Singh H, Thompson JF, Wang DJJ, Lu H. Multi-vendor and multisite evaluation of cerebrovascular reactivity mapping using hypercapnia challenge. Neuroimage 2021; 245:118754. [PMID: 34826595 PMCID: PMC8783393 DOI: 10.1016/j.neuroimage.2021.118754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/05/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023] Open
Abstract
Cerebrovascular reactivity (CVR), which measures the ability of cerebral blood vessels to dilate or constrict in response to vasoactive stimuli such as CO2 inhalation, is an important index of the brain's vascular health. Quantification of CVR using BOLD MRI with hypercapnia challenge has shown great promises in research and clinical studies. However, in order for it to be used as a potential imaging biomarker in large-scale and multi-site studies, the reliability of CO2-CVR quantification across different MRI acquisition platforms and researchers/raters must be examined. The goal of this report from the MarkVCID small vessel disease biomarkers consortium is to evaluate the reliability of CO2-CVR quantification in three studies. First, the inter-rater reliability of CO2-CVR data processing was evaluated by having raters from 5 MarkVCID sites process the same 30 CVR datasets using a cloud-based CVR data processing pipeline. Second, the inter-scanner reproducibility of CO2-CVR quantification was assessed in 10 young subjects across two scanners of different vendors. Third, test-retest repeatability was evaluated in 20 elderly subjects from 4 sites with a scan interval of less than 2 weeks. In all studies, the CO2 CVR measurements were performed using the fixed inspiration method, where the subjects wore a nose clip and a mouthpiece and breathed room air and 5% CO2 air contained in a Douglas bag alternatively through their mouth. The results showed that the inter-rater CoV of CVR processing was 0.08 ± 0.08% for whole-brain CVR values and ranged from 0.16% to 0.88% in major brain regions, with ICC of absolute agreement above 0.9959 for all brain regions. Inter-scanner CoV was found to be 6.90 ± 5.08% for whole-brain CVR values, and ranged from 4.69% to 12.71% in major brain regions, which are comparable to intra-session CoVs obtained from the same scanners on the same day. ICC of consistency between the two scanners was 0.8498 for whole-brain CVR and ranged from 0.8052 to 0.9185 across major brain regions. In the test-retest evaluation, test-retest CoV across different days was found to be 18.29 ± 17.12% for whole-brain CVR values, and ranged from 16.58% to 19.52% in major brain regions, with ICC of absolute agreement ranged from 0.6480 to 0.7785. These results demonstrated good inter-rater, inter-scanner, and test-retest reliability in healthy volunteers, and suggested that CO2-CVR has suitable instrumental properties for use as an imaging biomarker of cerebrovascular function in multi-site and longitudinal observational studies and clinical trials.
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Affiliation(s)
- Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dengrong Jiang
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Brian T Gold
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Karl G Helmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Kay Jann
- Laboratory of Functional MRI Technology, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gregory Jicha
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Pavel Rodriguez
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Herpreet Singh
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey F Thompson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Danny J J Wang
- Laboratory of Functional MRI Technology, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore 21287, USA; F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, 21205, USA.
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9
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Perioperative Care of Patients at High Risk for Stroke During or After Non-cardiac, Non-neurological Surgery: 2020 Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care. J Neurosurg Anesthesiol 2021; 32:210-226. [PMID: 32433102 DOI: 10.1097/ana.0000000000000686] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Perioperative stroke is associated with considerable morbidity and mortality. Stroke recognition and diagnosis are challenging perioperatively, and surgical patients receive therapeutic interventions less frequently compared with stroke patients in the outpatient setting. These updated guidelines from the Society for Neuroscience in Anesthesiology and Critical Care provide evidence-based recommendations regarding perioperative care of patients at high risk for stroke. Recommended areas for future investigation are also proposed.
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10
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Sobczyk O, Fierstra J, Venkatraghavan L, Poublanc J, Duffin J, Fisher JA, Mikulis DJ. Measuring Cerebrovascular Reactivity: Sixteen Avoidable Pitfalls. Front Physiol 2021; 12:665049. [PMID: 34305634 PMCID: PMC8294324 DOI: 10.3389/fphys.2021.665049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/07/2021] [Indexed: 12/04/2022] Open
Abstract
An increase in arterial PCO2 is the most common stressor used to increase cerebral blood flow for assessing cerebral vascular reactivity (CVR). That CO2 is readily obtained, inexpensive, easy to administer, and safe to inhale belies the difficulties in extracting scientifically and clinically relevant information from the resulting flow responses. Over the past two decades, we have studied more than 2,000 individuals, most with cervical and cerebral vascular pathology using CO2 as the vasoactive agent and blood oxygen-level-dependent magnetic resonance imaging signal as the flow surrogate. The ability to deliver different forms of precise hypercapnic stimuli enabled systematic exploration of the blood flow-related signal changes. We learned the effect on CVR of particular aspects of the stimulus such as the arterial partial pressure of oxygen, the baseline PCO2, and the magnitude, rate, and pattern of its change. Similarly, we learned to interpret aspects of the flow response such as its magnitude, and the speed and direction of change. Finally, we were able to test whether the response falls into a normal range. Here, we present a review of our accumulated insight as 16 “lessons learned.” We hope many of these insights are sufficiently general to apply to a range of types of CO2-based vasoactive stimuli and perfusion metrics used for CVR.
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Affiliation(s)
- Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Zürich, Switzerland
| | - Lakshmikumar Venkatraghavan
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - James Duffin
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Joseph A Fisher
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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11
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Al-Khazraji BK, Buch S, Kadem M, Matushewski BJ, Norozi K, Menon RS, Shoemaker JK. Protocol-dependence of middle cerebral artery dilation to modest hypercapnia. Appl Physiol Nutr Metab 2021; 46:1038-1046. [PMID: 34139129 DOI: 10.1139/apnm-2021-0220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is a need for improved understanding of how different cerebrovascular reactivity (CVR) protocols affect vascular cross-sectional area (CSA) to reduce error in CVR calculations when measures of vascular CSA are not feasible. In human participants, we delivered ∼±4 mm Hg end-tidal partial pressure of CO2 (PETCO2) relative to baseline through controlled delivery, and measured changes in middle cerebral artery (MCA) CSA (7 Tesla magnetic resonance imaging (MRI)), blood velocity (transcranial Doppler and Phase contrast MRI), and calculated CVR based on a 3-minute steady-state (+4 mm Hg PETCO2) and a ramp (-3 to +4 mm Hg of PETCO2). We observed that (1) the MCA did not dilate during the ramp protocol (slope for CSA across time P > 0.05; R2 = 0.006), but did dilate by ∼7% during steady-state hypercapnia (P < 0.05); and (2) MCA blood velocity CVR was not different between ramp and steady-state hypercapnia protocols (ramp: 3.8 ± 1.7 vs. steady-state: 4.0 ± 1.6 cm/s/mm Hg), although calculated MCA blood flow CVR was ∼40% greater during steady-state hypercapnia than during ramp (P < 0.05) with the discrepancy due to MCA CSA changes during steady-state hypercapnia. We propose that a ramp model, across a delta of -3 to +4 mm Hg PETCO2, may provide an alternative approach to collecting CVR measures in young adults with transcranial Doppler when CSA measures are not feasible. Novelty: We optimized a magnetic resonance imaging sequence to measure dynamic middle cerebral artery (MCA) cross-sectional area (CSA). A ramp model of hypercapnia elicited similar MCA blood velocity reactivity as the steady-state model while maintaining MCA CSA.
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Affiliation(s)
- Baraa K Al-Khazraji
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Sagar Buch
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, London, ON, Canada
| | - Mason Kadem
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Brad J Matushewski
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Kambiz Norozi
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Pediatric Cardiology, Hannover Medical School, Hannover, Germany
| | - Ravi S Menon
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Centre for Functional and Metabolic Mapping, Robarts Research Institute
| | - J Kevin Shoemaker
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Kinesiology, Faculty of Health Sciences
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12
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Snyder BD, Simone SM, Giovannetti T, Floyd TF. Cerebral Hypoxia: Its Role in Age-Related Chronic and Acute Cognitive Dysfunction. Anesth Analg 2021; 132:1502-1513. [PMID: 33780389 PMCID: PMC8154662 DOI: 10.1213/ane.0000000000005525] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Postoperative cognitive dysfunction (POCD) has been reported with widely varying frequency but appears to be strongly associated with aging. Outside of the surgical arena, chronic and acute cerebral hypoxia may exist as a result of respiratory, cardiovascular, or anemic conditions. Hypoxia has been extensively implicated in cognitive impairment. Furthermore, disease states associated with hypoxia both accompany and progress with aging. Perioperative cerebral hypoxia is likely underdiagnosed, and its contribution to POCD is underappreciated. Herein, we discuss the various disease processes and forms in which hypoxia may contribute to POCD. Furthermore, we outline hypoxia-related mechanisms, such as hypoxia-inducible factor activation, cerebral ischemia, cerebrovascular reserve, excitotoxicity, and neuroinflammation, which may contribute to cognitive impairment and how these mechanisms interact with aging. Finally, we discuss opportunities to prevent and manage POCD related to hypoxia.
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Affiliation(s)
- Brina D. Snyder
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Thomas F. Floyd
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
- Department of Cardiothoracic Surgery, UT Southwestern Medical Center, Dallas, TX
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13
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Chen Z, Li M, Wu Z, Zhang M, Weng G, Li M, Liao R, Zhao P, Wu J, Zhu S, Wang Q, Li C, Wei X. Cerebral Circulation Time Is a Potential Predictor of Disabling Ischemic Cerebrovascular Events in Patients With Non-disabling Middle Cerebral Artery Stenosis. Front Neurol 2021; 12:653752. [PMID: 34025557 PMCID: PMC8137834 DOI: 10.3389/fneur.2021.653752] [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: 01/15/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with non-disabling middle cerebral artery (MCA) stenosis (ND-MCAS) are at risk for disabling ischemic cerebrovascular events (DICE) despite aggressive medical therapy. In this study, we aimed to verify whether cerebral circulation time (CCT) was a potential predictor of DICE in patients with ND-MCAS. From January 2015 to January 2020, 46 patients with ND-MCAS treated with aggressive medical therapy were enrolled for digital subtraction angiography (DSA) in this convenience sampling study. They were divided into the DICE (-) and DICE (+) groups based on the occurrence of DICE within 3 months after DSA. The CCT was defined as the time from the appearance of the MCA to the peak intensity of the Trolard vein during DSA. The rCCT (relative CCT) was defined as the ratio of the CCT of the stenotic side (sCCT) to the CCT of the healthy side (hCCT). The differences in sCCT, hCCT, and rCCT between the two groups were analyzed with Mann-Whitney U tests. Logistic regression analysis was performed to evaluate the association between the risk factors and DICE. Receiver operating characteristic (ROC) curves were constructed to assess the predictive value of rCCT in identifying DICE in ND-MCAS patients. The results showed that DICE appeared in 5 of the 46 patients within 3 months. rCCT were significantly increased in the DICE (+) group compared with the DICE (-) group [1.08 (1.05, 1.14) vs. 1.30 (1.22, 1.54), p < 0.001]. Logistic regression analysis found that prolonged rCCT was an independent positive prognostic factor for DICE (odds ratio = 1.273, p = 0.019) after adjustment for potential confounders (age, diabetes, antithrombotic use, and stenosis degree). ROC analysis showed that rCCT provided satisfactory accuracy in distinguishing the DICE (+) group from the DICE (-) group among ND-MCAS patients (area under the curve = 0.985, p < 0.001), with an optimal cutoff point of 1.20 (100% sensitivity, 97.6% specificity). In conclusion, prolonged rCCT is independently associated with the occurrence of DICE in ND-MCAS patients and may be used to identify individuals at risk of DICE.
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Affiliation(s)
- Zhenze Chen
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mingchun Li
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhihuan Wu
- Department of Neurology, 1st People Hospital of Zhaoqing, Zhaoqing, China
| | - Min Zhang
- Department of Neurology, Jiangmen Centrol Hospital, Jiangmen, China
| | - Guomei Weng
- Department of Neurology, 1st People Hospital of Zhaoqing, Zhaoqing, China
| | - Minzi Li
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rongxin Liao
- Department of Gerontology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Peng Zhao
- Department of Gerontology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Jianming Wu
- Department of Gerontology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Shuzhen Zhu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chunguang Li
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaobo Wei
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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14
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Ogoh S, Sato K, de Abreu S, Denise P, Normand H. Effect of jump exercise training on long-term head-down bed rest-induced cerebral blood flow responses in arteries and veins. Exp Physiol 2021; 106:1549-1558. [PMID: 33866619 DOI: 10.1113/ep089102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/29/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? What is the effect of an exercise countermeasure on microgravity-induced change in cerebral blood flow? What is the main finding and its importance? Jump exercise training as a countermeasure did not modify the heterogeneous cerebral blood flow response to head-down bed rest, suggesting that this method is effective in preventing cardiovascular system deconditioning but is not good for cerebral haemodynamics. ABSTRACT This study aimed to examine the effect of an exercise countermeasure on cerebral blood flow (CBF) response to long-term -6° head-down bed rest (HDBR) in all cerebral arteries and veins. Twenty male volunteers were exposed to HDBR for 60 days with (training group, n = 10) or without (control group, n = 10) jump exercise training as a countermeasure to spaceflight. The blood flow in the neck conduit arteries (internal carotid and vertebral artery; ICA and VA) and veins (internal jugular and vertebral veins; IJV and VV) was measured, using ultrasonography before (baseline) HDBR, on the 30th and 57th day of HDBR. Long-term HDBR causes a heterogeneous CBF response between the anterior and the posterior brain or between arteries and veins. Long-term HDBR decreased anterior cerebral arterial and venous blood flow, while posterior cerebral arterial and venous blood flows were well maintained. However, exercise jump training did not change each arterial and venous CBF responses to HDBR (control vs. training; ICA, P = 0.643; VA, P = 0.542; external carotid artery, P = 0.644; IJV, P = 0.980; VV, P = 0.999). These findings suggest that jump exercise training did not modify the heterogeneous CBF response to long-term HDBR.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | | | - Steven de Abreu
- Unicaen, Inserm Comete, GIP Cyceron, Normandie University, Caen, France
| | - Pierre Denise
- Unicaen, Inserm Comete, GIP Cyceron, Normandie University, Caen, France
| | - Hervé Normand
- Unicaen, Inserm Comete, GIP Cyceron, Normandie University, Caen, France
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15
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Figeys M, Zeeman M, Kim ES. Effects of Transcranial Direct Current Stimulation (tDCS) on Cognitive Performance and Cerebral Oxygen Hemodynamics: A Systematic Review. Front Hum Neurosci 2021; 15:623315. [PMID: 33897392 PMCID: PMC8058208 DOI: 10.3389/fnhum.2021.623315] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is increasing evidence to support the efficacy of transcranial direct current stimulation (tDCS) applications in cognitive augmentation and rehabilitation. Neuromodulation achieved with tDCS may further regulate regional cerebral perfusion affiliated through the neurovascular unit; however, components of cerebral perfusion decrease across aging. A novel neuroimaging approach, functional near-infrared spectroscopy (fNIRS), can aid in quantifying these regional perfusional changes. To date, the interaction of the effects of tDCS on cognitive performance across the lifespan and obtained fNIRS hemodynamic responses remain unknown. Objective: This review aims to examine the effects of tDCS on cognitive performance and fNIRS hemodynamic responses within the context of cognitive aging. Methods: Six databases were searched for studies. Quality appraisal and data extraction were conducted by two independent reviewers. Meta-analysis was carried out to determine overall and subgroup effect sizes. Results: Eight studies met inclusion criteria. The overall effect size demonstrates that tDCS can alter cognitive performance and fNIRS signals, with aging being a potential intermediary in tDCS efficacy. Conclusion: From the studies included, the effects of tDCS on cognitive performance and fNIRS metrics are most prominent in young healthy adults and appear to become less robust with increasing age. Given the small number of studies included in this review further investigation is recommended.
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Affiliation(s)
- Mathieu Figeys
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Michael Zeeman
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Esther Sung Kim
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
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16
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Sleight E, Stringer MS, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review. Front Physiol 2021; 12:643468. [PMID: 33716793 PMCID: PMC7947694 DOI: 10.3389/fphys.2021.643468] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
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Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom,*Correspondence: Michael S. Stringer
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
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Wang J, Yang C, Wang H, Li D, Li T, Sun Y, Zhao M, Ma J, Hua W, Yang Z. A New Rat Model of Chronic Cerebral Hypoperfusion Resulting in Early-Stage Vascular Cognitive Impairment. Front Aging Neurosci 2020; 12:86. [PMID: 32351379 PMCID: PMC7174718 DOI: 10.3389/fnagi.2020.00086] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/12/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Currently, most models of vascular cognitive impairment are established by occluding the carotid arteries uni- or bilaterally to reduce the cerebral blood flow mimicking chronic cerebral hypoxia. Due to the sudden blood flow interruption, a gradual narrowing of the carotid artery cannot be completely imitated. This paper aims to establish a bilateral carotid stenosis model with mild cognitive dysfunction and mild white matter changes to simulate patients with vascular predementia. Methods Aged Wistar rats (18 months old) underwent either bilateral common carotid artery stenosis (BCAS) or occlusion (BCAO) surgery or a sham operation (control group). The cerebral blood flow in the frontal cortex was measured using Doppler flowmetry. Thirty days after surgery, cognitive function impairments were determined with the Morris water maze; cerebral magnetic resonance imaging was performed to detect changes in fractional anisotropy to assess white matter injuries, and histological studies were performed. Results The aged rats in the BCAS group showed a more gradual cerebral blood flow reduction and a lower mortality rate (11%) compared to rats in the BCAO group. The water maze test revealed a more marginal impairment affecting spatial learning and memory in rats with BCAS than in rats with BCAO. Diffusion tensor imaging detected white matter injuries in the hippocampus and cerebral cortex of BCAS rats. Particularly, a small portion of nerve fibers of the lateral somatosensory cortex was significantly different between rats of the BCAO and BCAS groups. In the BCAS group, the microscopic structure of the hippocampal CA1 region changed slightly after 30 days and sustained a slight mitochondrial crista crack. Fluorescence staining indicated that the number of GFAP-positive cells was increased in rat brains of the BCAS group, and this phenomenon was even more pronounced in the BCAO group. The hnRNPA2/B1 and GABAAR-α1 expression levels were significantly decreased in the hippocampus of rats with BCAS compared to those of controls. Conclusion Severe bilateral carotid stenosis induced mild cognitive dysfunction and slight structural changes in the brains of aged rats. Thus, a chronic cerebral hypoperfusion model was successfully established.
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Affiliation(s)
- Jinxin Wang
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Chenyi Yang
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Haiyun Wang
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.,Medical College of Nankai University, Nankai University, Tianjin, China.,Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Dongxue Li
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Tang Li
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Yi Sun
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Mingshu Zhao
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Ji Ma
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Wei Hua
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Zhuo Yang
- Medical College of Nankai University, Nankai University, Tianjin, China
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18
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Gao H, Ma HJ, Li YJ, Yin C, Li Z. Prevalence and risk factors of postoperative delirium after spinal surgery: a meta-analysis. J Orthop Surg Res 2020; 15:138. [PMID: 32272939 PMCID: PMC7146882 DOI: 10.1186/s13018-020-01651-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Postoperative delirium (POD) was common after spinal surgery, but the main findings in previous studies remained conflicting. This current meta-analysis was aimed at exploring the prevalence and risk factors of POD after spinal surgery. METHODS PubMed and Embase were searched from inception to June 2019. Studies which reported the prevalence and risk factors of POD after spinal surgery were included. STATA version 12.0 was employed to analyze the pooled data. Statistical heterogeneity across included studies was identified using the I2 statistics. RESULTS A total of 28 studies with 588,732 patients were included in the meta-analysis. The pooled prevalence of POD after spinal surgery was 0.85% (95%CI, 0.83-0.88%) with substantial heterogeneity (I2 = 97.3%). The central nervous system disorder (OR 4.73; 95%CI, 4.30-5.19) was a strong predictor for POD, whereas age (OR 1.16; 95%CI, 1.05-2.47; I2 = 99.2%) and blood loss (OR 1.10; 95%CI, 1.01-1.20; I2 = 93.3%) were weaker predictors. The funnel plot and statistical tests suggested that there existed potential publication bias, but the trim and fill method indicated that the pooled prevalence basically kept stable after adding two "missing" studies. CONCLUSIONS The pooled POD after spinal surgery ranges from 0.83 to 0.88%. The central nervous system disorder, age, and blood loss were potential risk factors for POD.
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Affiliation(s)
- Hua Gao
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China.
| | - Hui-Juan Ma
- Operating Theater, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China
| | - Ying-Jia Li
- Operating Theater, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China
| | - Ci Yin
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China
| | - Zheng Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China
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Ogoh S, Sato K, Abreu S, Denise P, Normand H. Arterial and venous cerebral blood flow responses to long‐term head‐down bed rest in male volunteers. Exp Physiol 2019; 105:44-52. [DOI: 10.1113/ep088057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering Toyo University Kawagoe‐Shi Saitama Japan
| | - Kohei Sato
- Tokyo Gakugei University Koganei Tokyo Japan
| | - Steven Abreu
- Normandie Université, Unicaen; Inserm Comete GIP Cyceron Chu Caen France
| | - Pierre Denise
- Normandie Université, Unicaen; Inserm Comete GIP Cyceron Chu Caen France
| | - Hervé Normand
- Normandie Université, Unicaen; Inserm Comete GIP Cyceron Chu Caen France
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20
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Kume Y, Takahashi T, Itakura Y, Lee S, Makizako H, Ono T, Shimada H, Ota H. Characteristics of Mild Cognitive Impairment in Northern Japanese Community-Dwellers from the ORANGE Registry. J Clin Med 2019; 8:jcm8111937. [PMID: 31717664 PMCID: PMC6912714 DOI: 10.3390/jcm8111937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/03/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022] Open
Abstract
A gradually increasing prevalence of mild cognitive impairment (MCI) is recognized in the super-aging society that Japan faces, and early detection and intervention in community-dwellers with MCI are critical issues to prevent dementia. Although many previous studies have revealed MCI/non-MCI differences in older individuals, information on the prevalence and characteristics of MCI in rural older adults is limited. The aim of this study was to investigate differential characteristics between older adults with and without MCI. The investigation was conducted over one year from 2018 to 2019. Participants were recruited from Akita in northern Japan. Neuropsychological assessments were applied to classify MCI, including the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT) and the Touch panel-type Dementia Assessment Scale (TDAS) based on the Alzheimer's disease assessment scale. Our samples consisted of 103 older adults divided into 54 non-MCI and 49 MCI. The MCI group had lower scores of all cognitive items. Our results showed that individuals with MCI had significantly slower walking speed (WS) and worse geriatric depression scale (GDS) compared to non-MCI. In addition, WS was significantly associated with some cognitive items in non-MCI, but not in MCI. Finally, we showed that predictive variables of MCI were WS and GDS. Our study provides important information about MCI in rural community-dwellers. We suggest that older adults living in a super-aging society should receive lower limb training, and avoiding depression in older adults through interaction of community-dwellers may contribute to preventing the onset of MCI.
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Affiliation(s)
- Yu Kume
- Department of Occupational Therapy, Graduate School of Medicine, Akita University, Akita 010-8543, Japan;
| | - Tomoko Takahashi
- Integrated Community Support Center, Public Health and Welfare Department, City Hall of Yokote, Akita 013-0525, Japan;
| | - Yuki Itakura
- Advanced Research Center for Geriatric and Gerontology, Akita University, Akita 010-8543, Japan;
| | - Sangyoon Lee
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan; (S.L.); (H.S.)
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Tsuyosi Ono
- Omori Municipal Hospital, Akita 013-0525, Japan;
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan; (S.L.); (H.S.)
| | - Hidetaka Ota
- Advanced Research Center for Geriatric and Gerontology, Akita University, Akita 010-8543, Japan;
- Correspondence: ; Tel.: +81-18-801-7061; Fax: +81-18-801-7062
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21
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Al‐Khazraji BK, Badrov MB, Kadem M, Lingum NR, Birmingham TB, Shoemaker JK. Exploring Cerebrovascular Function in Osteoarthritis: "Heads-up". Physiol Rep 2019; 7:e14212. [PMID: 31660705 PMCID: PMC6817995 DOI: 10.14814/phy2.14212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 11/24/2022] Open
Abstract
Individuals with osteoarthritis (OA) are at greater risk of cardiovascular and cerebrovascular incidents; yet, cerebrovascular control remains uncharacterized. Our primary outcome was to acquire cerebrovascular control metrics in patients with OA and compare measures to healthy control adults (CTL) without OA or cardiovascular complications. Our primary covariate was a 10-year risk factor for cardiovascular and stroke incidents, and secondary covariates were other cardiovascular disease risk factors (i.e., body mass index, carotid intima media thickness, and brachial flow-mediated dilation). Our secondary outcomes were to assess anatomical and functional changes that may be related to cerebrovascular reactivity were also acquired such as white matter lesion volume and brief cognitive assessments. In 25 adults (n = 13 CTL, n = 12 OA), under hypercapnia, magnetic resonance imaging (3T) was used to acquire a "Global Cerebrovascular Reactivity" index across the larger intracranial cerebral arteries and white matter lesions, and transcranial Doppler was used for both middle cerebral artery hemodynamic responses to hypercapnia and to assess autoregulation via a sit-to-stand task. Compared to CTL, OA had lower "Global Cerebrovascular Reactivity" index responses to hypercapnia, autoregulatory responses, and greater white matter lesions (P < 0.05). These differences persisted after covarying for the outlined primary and secondary covariates. Patients with OA, in the absence of known cardiovascular disease, can exhibit pre-clinical and impaired (compared to CTL) peripheral and cerebrovascular control metrics.
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Affiliation(s)
- Baraa K. Al‐Khazraji
- School of Kinesiology, Faculty of Health SciencesWestern UniversityLondonOntarioCanada
- Bone and Joint InstituteWestern UniversityLondonOntarioCanada
| | - Mark B. Badrov
- School of Kinesiology, Faculty of Health SciencesWestern UniversityLondonOntarioCanada
| | - Mason Kadem
- Brain and Mind InstituteWestern UniversityLondonOntarioCanada
| | - Navena R. Lingum
- School of Kinesiology, Faculty of Health SciencesWestern UniversityLondonOntarioCanada
| | - Trevor B. Birmingham
- School of Physical TherapyFaculty of Health SciencesWestern OntarioLondon, OntarioCanada
- Bone and Joint InstituteWestern UniversityLondonOntarioCanada
| | - Joel Kevin Shoemaker
- School of Kinesiology, Faculty of Health SciencesWestern UniversityLondonOntarioCanada
- Bone and Joint InstituteWestern UniversityLondonOntarioCanada
- Department of Physiology and Pharmacology, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
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