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Tao W, Liu J, Ye C, Kwapong WR, Wang A, Wang Z, Chen S, Liu M. Relationships between cerebral small vessel diseases markers and cognitive performance in stroke-free patients with atrial fibrillation. Front Aging Neurosci 2023; 14:1045910. [PMID: 36688147 PMCID: PMC9846141 DOI: 10.3389/fnagi.2022.1045910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background Atrial fibrillation (AF) is related to an increased risk of cognitive dysfunction. Besides clinically overt stroke, AF can damage the brain via several pathophysiological mechanisms. We aimed to assess the potential mediating role of cerebral small vessel disease (SVD) and cognitive performance in individuals with AF. Methods Stroke-free individuals with AF from the cardiological outpatient clinic at West China Hospital of Sichuan University were recruited. Extensive neuropsychological testing tools were assessed including global function, domains of attention, executive functions, learning, and memory. 3 T magnetic resonance imaging (MRI) was used for SVD markers assessment of white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS). The correlation between SVD markers and cognitive measures was analyzed by multivariate linear regression models. Results We finally enrolled 158 participants, of whom 95 (60.1%) were males. In multivariate models, the presence of lacunes independently associated with Montreal Cognitive Assessment (Model 1: ß = 0.52, Model 2: ß = 0.55), Rey Auditory Verbal Learning Test-immediate and delayed recall (Model 1: ß = 0.49; ß = 0.69; Model 2: ß = 0.53; ß = 0.73) as well as Stroop-Acorrect (Model 1: ß = 0.12; Model 2: ß = 0.13), while total WMH severity independently associated with Strooptime-A (Model 1: ß = 0.24; Model 3: ß = 0.27), Strooptime-B (Model 1: ß = 0.17; Model 3: ß = 0.17), Strooptime-C (Model 1: ß = 0.22; Model 3: ß = 0.21) and Shape Trail Test-A (Model 1: ß = 0.17; Model 3: ß = 0.16). Conclusion In our cohort of stroke-free individuals with AF, lacunes, and WMHs were independently associated with cognitive decline while EPVS and CMBs did not show significance. Assessment of SVD MRI markers might be valuable for cognition risk stratification and facilitate optimal management of patients with AF.
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Affiliation(s)
- Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Anmo Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhetao Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China,Shi Chen, ✉
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Ming Liu, ✉
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White Matter Lesions Predominantly Located in Deep White Matter Represent Embolic Etiology Rather Than Small Vessel Disease. Dement Neurocogn Disord 2023; 22:28-42. [PMID: 36814699 PMCID: PMC9939570 DOI: 10.12779/dnd.2023.22.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/15/2023] [Accepted: 01/28/2023] [Indexed: 02/17/2023] Open
Abstract
Background and Purpose We investigated the correlation between the deep distribution of white matter hyperintensity (WMH) (dWMH: WMH in deep and corticomedullary areas, with minimal periventricular WMH) and a positive agitated saline contrast echocardiography result. Methods We retrospectively recruited participants with comprehensive dementia evaluations, an agitated saline study, and brain imaging. The participants were classified into two groups according to WMH-distributions: dWMH and dpWMH (mainly periventricular WMH with or without deep WMH.) We hypothesized that dWMH is more likely associated with embolism, whereas dpWMH is associated with small-vessel diseases. We compared the clinical characteristics, WMH-distributions, and positive rate of agitated saline studies between the two groups. Results Among 90 participants, 27 and 12 met the dWMH and dpWMH criteria, respectively. The dWMH-group was younger (62.2±7.5 vs. 78.9±7.3, p<0.001) and had a lower prevalence of hypertension (29.6% vs. 75%, p=0.008), diabetes mellitus (3.7% vs. 25%, p=0.043), and hyperlipidemia (33.3% vs. 83.3%, p=0.043) than the dpWMH-group. Regarding deep white matter lesions, the number of small lesions (<3 mm) was higher in the dWMH-group(10.9±9.7) than in the dpWMH-group (3.1±6.4) (p=0.008), and WMH was predominantly distributed in the border-zones and corticomedullary areas. Most importantly, the positive agitated saline study rate was higher in the dWMH-group than in the dpWMH-group (81.5% vs. 33.3%, p=0.003). Conclusions The dWMH-group with younger participants had fewer cardiovascular risk factors, showed more border-zone-distributions, and had a higher agitated saline test positivity rate than the dpWMH-group, indicating that corticomedullary or deep WMH-distribution with minimal periventricular WMH suggests embolic etiologies.
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Simone SM, Price CC, Floyd TF, Fanning M, Messé SR, Drabick DAG, Giovannetti T. Preoperative cognition predicts clinical stroke/TIA and mortality after surgical aortic valve replacement in older adults. J Clin Exp Neuropsychol 2022; 44:550-561. [PMID: 36371699 PMCID: PMC9923940 DOI: 10.1080/13803395.2022.2142526] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022]
Abstract
Stroke and death remain risks of surgical aortic valve replacement (SAVR). Preoperative cognitive screeners repeatedly show that reduced scores predict postoperative outcome, but less is known about comprehensive neuropsychological measures predicting risk. This study had two aims: 1) investigate whether preoperative cognitive measures predicted postoperative clinical stroke/transient ischemic attack (TIA) and mortality in older adults undergoing SAVR, and 2) identify the best predictors within a comprehensive cognitive protocol. A total of 165 participants aged 65 + with moderate-to-severe aortic stenosis completed a comprehensive cognitive test battery preoperatively. Postoperative stroke evaluations were conducted by trained stroke neurologists preoperatively and postoperatively, and mortality outcomes were obtained by report and records. Logistic regressions were conducted to evaluate preoperative cognitive predictors of clinical stroke/TIA within 1 week of surgery and mortality within 1 year of surgery. Multivariate models showed measures of delayed verbal memory recall (OR = 0.86; 95% CI 0.74-0.99) and visuospatial skills (OR = 0.95; 95% CI 0.90-1.01) predicted clinical stroke/TIA within 1 week of surgery, R2 = .41, p < .001, ƒ2 = .69. Measures of naming ability (OR = 0.88; 95% CI 0.80-0.96), verbal memory recall (OR = 1.23; 95% CI 0.99-1.51), visual memory recall (OR = 0.90; 95% CI 0.80-1.00), medical comorbidities (OR = 1.71; 95% CI 1.22-2.65), and sex (OR = 2.39; 95% CI 0.90-7.04) were significant predictors of death within 1 year of surgery, R2 = .68, p < .001, ƒ2 = 2.12. Preoperative cognitive measures reflecting temporal and parietal lobe functions predicted postoperative clinical stroke/TIA within 1 week of SAVR and mortality within 1 year of SAVR. As such, cognitive measures may offer objective and timely indicators of preoperative health, specifically vulnerabilities in cerebral hypoperfusion, which may inform intervention and/or intensive postoperative monitoring and follow-up after SAVR.
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Affiliation(s)
- Stephanie M. Simone
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida College of Medicine, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Thomas F. Floyd
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas
- Department of Cardiovascular Surgery, University of Texas Southwestern, Dallas, Texas
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Molly Fanning
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven R. Messé
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deborah A. G. Drabick
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Tania Giovannetti
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
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Jin L, Liu Y, Huang Q. Research progress in atrial fibrillation with cerebral small vessel disease. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:258-264. [PMID: 35545417 PMCID: PMC10930520 DOI: 10.11817/j.issn.1672-7347.2022.210540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Indexed: 06/15/2023]
Abstract
Non-valvular atrial fibrillation is a common arrhythmia and a major risk factor for cardioembolic stroke. Small cerebral vascular disease is a syndrome of clinical, cognitive, imaging, and pathological manifestations caused by intracranial small vascular lesions. The imaging findings on cranial magnetic resonance usually shows recent subcortical small infarction, vascularised lacunae, white matter hypersignal, perivascular space enlargement, cerebral microhemorrhage, and brain atrophy. It is a major cause of neurological loss and cognitive function decline in the elderly. Current studies suggest that atrial fibrillation may increase the imaging load of cerebral small vessel disease through a series of mechanisms such as microembolization, hypoperfusion, inflammation, endothelial dysfunction, and lymphoid system dysfunction. The imaging of cerebral small vessel disease with atrial fibrillation has a potential relationship with cognitive function decline and is related to the occurrence and prognosis of stroke, even more has a potential role in suggesting the etiology and secondary prevention strategies of ischemic stroke.
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Affiliation(s)
- Ling Jin
- Department of Neurology, First People's Hospital of Changde City, Changde Hunan 415003.
| | - Yunhai Liu
- Hunan Cerebrovascular Disease Clinical Medical Research Center, Changsha 410008
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Qing Huang
- Hunan Cerebrovascular Disease Clinical Medical Research Center, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008.
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China.
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Ghaznawi R, Geerlings MI, Jaarsma-Coes M, Hendrikse J, de Bresser J. Association of White Matter Hyperintensity Markers on MRI and Long-term Risk of Mortality and Ischemic Stroke: The SMART-MR Study. Neurology 2021; 96:e2172-e2183. [PMID: 33727406 PMCID: PMC8166430 DOI: 10.1212/wnl.0000000000011827] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 01/28/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether white matter hyperintensity (WMH) markers on MRI are associated with long-term risk of mortality and ischemic stroke. METHODS We included consecutive patients with manifest arterial disease enrolled in the Second Manifestations of Arterial Disease-Magnetic Resonance (SMART-MR) study. We obtained WMH markers (volume, type, and shape) from brain MRI scans performed at baseline using an automated algorithm. During follow-up, occurrence of death and ischemic stroke was recorded. Using Cox regression, we investigated associations of WMH markers with risk of mortality and ischemic stroke, adjusting for demographics, cardiovascular risk factors, and cerebrovascular disease. RESULTS We included 999 patients (59 ± 10 years; 79% male) with a median follow-up of 12.5 years (range 0.2-16.0 years). A greater periventricular or confluent WMH volume was independently associated with a greater risk of vascular death (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.13-1.47) for a 1-unit increase in natural log-transformed WMH volume and ischemic stroke (HR 1.53, 95% CI 1.26-1.86). A confluent WMH type was independently associated with a greater risk of vascular (HR 1.89, 95% CI 1.15-3.11) and nonvascular death (HR 1.65, 95% CI 1.01-2.73) and ischemic stroke (HR 2.83, 95% CI 1.36-5.87). A more irregular shape of periventricular or confluent WMH, as expressed by an increase in concavity index, was independently associated with a greater risk of vascular (HR 1.20, 95% CI 1.05-1.38 per SD increase) and nonvascular death (HR 1.21, 95% CI 1.03-1.42) and ischemic stroke (HR 1.28, 95% CI 1.05-1.55). CONCLUSIONS WMH volume, type, and shape are associated with long-term risk of mortality and ischemic stroke in patients with manifest arterial disease.
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Affiliation(s)
- Rashid Ghaznawi
- From the Department of Radiology (R.G., J.H.) and Julius Center for Health Sciences and Primary Care (R.G., M.I.G.), University Medical Center Utrecht and Utrecht University; and Department of Radiology (M.J.-C., J.d.B.), Leiden University Medical Center, the Netherlands
| | - Mirjam I Geerlings
- From the Department of Radiology (R.G., J.H.) and Julius Center for Health Sciences and Primary Care (R.G., M.I.G.), University Medical Center Utrecht and Utrecht University; and Department of Radiology (M.J.-C., J.d.B.), Leiden University Medical Center, the Netherlands.
| | - Myriam Jaarsma-Coes
- From the Department of Radiology (R.G., J.H.) and Julius Center for Health Sciences and Primary Care (R.G., M.I.G.), University Medical Center Utrecht and Utrecht University; and Department of Radiology (M.J.-C., J.d.B.), Leiden University Medical Center, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology (R.G., J.H.) and Julius Center for Health Sciences and Primary Care (R.G., M.I.G.), University Medical Center Utrecht and Utrecht University; and Department of Radiology (M.J.-C., J.d.B.), Leiden University Medical Center, the Netherlands
| | - Jeroen de Bresser
- From the Department of Radiology (R.G., J.H.) and Julius Center for Health Sciences and Primary Care (R.G., M.I.G.), University Medical Center Utrecht and Utrecht University; and Department of Radiology (M.J.-C., J.d.B.), Leiden University Medical Center, the Netherlands
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