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Karkoska KA, Gollamudi J, Sawyer RP, Woo D, Hyacinth HI. Quantifying dilated perivascular spaces in children with sickle cell disease. Pediatr Blood Cancer 2024; 71:e31150. [PMID: 38953143 PMCID: PMC11327878 DOI: 10.1002/pbc.31150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024]
Abstract
Sickle cell disease (SCD)-related neurological effects are particularly devastating. Dilated perivascular spaces (dPVS) are a well-described component of cerebral small vessel disease in older adults without SCD. However, the burden and association of dPVS with neurological complications in children with SCD have not been described. In this study, we used the international consensus criteria to quantify dPVS in the centrum semiovale and basal ganglia in T2-weighted magnetic resonance images (MRI) of children with SCD who were randomized as part of the Silent Cerebral Infarct Transfusion (SIT) trial. We examined the relationship between global and/or regional dPVS burden and presence or area of silent cerebral infarctions, hematological measures, demographic variables, and full-scale intelligence quotient (FSIQ) scores. The study included 156 SIT trial participants who had pre-randomization and study exit MRI. Their median age was 9.6 (5-15) years, 39% were female, and 94 (60%) participants had a high dPVS burden. Participants randomized to the blood transfusion arm and who had a high dPVS burden at baseline had a moderate decline in dPVS score over 36 months compared to no change in the observation group. On multivariable logistic regression, intelligence quotient was not associated with dPVS burden. Children with SCD included in the SIT trial have a high burden of dPVS compared to children without SCD. However, dPVS do not appear to have the same pathophysiology of silent cerebral infarcts. Further study is needed to determine both their etiology and clinical relevance.
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Affiliation(s)
- Kristine A Karkoska
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jahnavi Gollamudi
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Russell P Sawyer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hyacinth I Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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2
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Liu L, Tu L, Shen Q, Bao Y, Xu F, Zhang D, Xu Y. Meta-analysis of the relationship between the number and location of perivascular spaces in the brain and cognitive function. Neurol Sci 2024; 45:3743-3755. [PMID: 38459400 DOI: 10.1007/s10072-024-07438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Cerebral perivascular spaces are part of the cerebral microvascular structure and play a role in lymphatic drainage and the removal of waste products from the brain. Relationships of the number and location of such spaces with cognition are unclear. OBJECTIVE To meta-analyze available data on potential associations of severity and location of perivascular spaces with cognitive performance. METHODS We searched PubMed, EMBASE, Web of Science and the Cochrane Central Registry of Controlled Trials for relevant studies published between January 2000 and July 2023. Performance on different cognitive domains was compared to the severity of perivascular spaces in different brain regions using comprehensive meta-analysis. When studies report unadjusted and adjusted means, we use adjusted means for meta-analysis. The study protocol is registered in the PROSPERO database (CRD42023443460). RESULTS We meta-analyzed data from 26 cross-sectional studies and two longitudinal studies involving 7908 participants. In most studies perivascular spaces was using a visual rating scale. A higher number of basal ganglia perivascular spaces was linked to lower general intelligence and attention. Moreover, increased centrum semiovale perivascular spaces were associated with worse general intelligence, executive function, language, and memory. Conversely, higher hippocampus perivascular spaces were associated with enhanced memory and executive function. Subgroup analyses revealed variations in associations among different disease conditions. CONCLUSIONS A higher quantity of perivascular spaces in the brain is correlated with impaired cognitive function. The location of these perivascular spaces and the underlying disease conditions may influence the specific cognitive domains that are affected. SYSTEMATIC REVIEW REGISTRATION The study protocol has been registered in the PROSPERO database (CRD42023443460).
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Affiliation(s)
- Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liangdan Tu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiuyan Shen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Bao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dan Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Jung LB, Wiegand TLT, Tuz-Zahra F, Tripodis Y, Iliff JJ, Piantino J, Arciniega H, Kim CL, Pankatz L, Bouix S, Lin AP, Alosco ML, Daneshvar DH, Mez J, Sepehrband F, Rathi Y, Pasternak O, Coleman MJ, Adler CH, Bernick C, Balcer L, Cummings JL, Reiman EM, Stern RA, Shenton ME, Koerte IK. Repetitive Head Impacts and Perivascular Space Volume in Former American Football Players. JAMA Netw Open 2024; 7:e2428687. [PMID: 39186275 DOI: 10.1001/jamanetworkopen.2024.28687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Importance Exposure to repetitive head impacts (RHI) is associated with increased risk for neurodegeneration. Accumulation of toxic proteins due to impaired brain clearance is suspected to play a role. Objective To investigate whether perivascular space (PVS) volume is associated with lifetime exposure to RHI in individuals at risk for RHI-associated neurodegeneration. Design, Setting, and Participants This cross-sectional study was part of the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project, a 7-year multicenter study consisting of 4 US study sites. Data were collected from September 2016 to February 2020 and analyses were performed between May 2021 and October 2023. After controlling for magnetic resonance image (MRI) and processing quality, former American football players and unexposed asymptomatic control participants were included in analyses. Exposure Prior exposure to RHI while participating in American football was estimated using the 3 cumulative head impact indices (CHII-G, linear acceleration; CHII-R, rotational acceleration; and CHII, number of head impacts). Main Outcomes and Measures Individual PVS volume was calculated in the white matter of structural MRI. Cognitive impairment was based on neuropsychological assessment. Linear regression models were used to assess associations of PVS volume with neuropsychological assessments in former American football players. All analyses were adjusted for confounders associated with PVS volume. Results Analyses included 224 participants (median [IQR] age, 57 [51-65] years), with 170 male former football players (114 former professional athletes, 56 former collegiate athletes) and 54 male unexposed control participants. Former football players had larger PVS volume compared with the unexposed group (mean difference, 0.28 [95% CI, 0.00-0.56]; P = .05). Within the football group, PVS volume was associated with higher CHII-R (β = 2.71 × 10-8 [95% CI, 0.50 × 10-8 to 4.93 × 10-8]; P = .03) and CHII-G (β = 2.24 × 10-6 [95% CI, 0.35 × 10-6 to 4.13 × 10-6]; P = .03). Larger PVS volume was also associated with worse performance on cognitive functioning in former American football players (β = -0.74 [95% CI, -1.35 to -0.13]; P = .04). Conclusions and Relevance These findings suggest that impaired perivascular brain clearance, as indicated by larger PVS volume, may contribute to the association observed between RHI exposure and neurodegeneration.
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Affiliation(s)
- Leonard B Jung
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tim L T Wiegand
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Fatima Tuz-Zahra
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey J Iliff
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Neurology, University of Washington School of Medicine, Seattle
- VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Juan Piantino
- Department of Pediatrics, Division of Child Neurology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland
| | - Hector Arciniega
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, New York
| | - Cara L Kim
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lara Pankatz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Département de génie logiciel et TI, École de technologie supérieure, Université du Québec, Montreal, Canada
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Farshid Sepehrband
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona Scottsdale, Arizona
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada
| | - Laura Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany
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Meng JC, Shen MQ, Lu YL, Feng HX, Chen XY, Xu DQ, Wu GH, Cheng QZ, Wang LH, Gui Q. Correlation of glymphatic system abnormalities with Parkinson's disease progression: a clinical study based on non-invasive fMRI. J Neurol 2024; 271:457-471. [PMID: 37755462 DOI: 10.1007/s00415-023-12004-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The glymphatic system is reportedly involved in Parkinson's disease (PD). Based on previous studies, we aimed to confirm the correlation between the glymphatic system and PD progression by combining two imaging parameters, diffusion tensor image analysis along the perivascular space (DTI-ALPS), and enlarged perivascular spaces (EPVS). METHODS Fifty-one PD patients and fifty healthy control (HC) were included. Based on the Hoehn-Yahr scale, the PD group was divided into early-stage and medium-to late-stage. All PD patients were scored using the Unified PD Rating Scale (UPDRS). We assessed the DTI-ALPS indices in the bilateral hemispheres and EPVS numbers in bilateral centrum semiovale (CSO), basal ganglia (BG), and midbrain. RESULTS The DTI-ALPS indices were significantly lower bilaterally in PD patients than in the HC group, and EPVS numbers in any of the bilateral CSO, BG, and midbrain were significantly higher, especially for the medium- to late-stage group and the BG region. In PD patients, the DTI-ALPS index was significantly negatively correlated with age, while the BG-EPVS numbers were significantly positively correlated with age. Furthermore, the DTI-ALPS index was negatively correlated with UPDRS II and III scores, while the BG-EPVS numbers were positively correlated with UPDRS II and III scores. Similarly, the correlation was more pronounced in the medium- to late-stage group. CONCLUSION The DTI-ALPS index and EPVS numbers (especially in the BG region) are closely related to age and PD progression and can serve as non-invasive assessments for glymphatic dysfunction and its interventions in clinical studies.
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Affiliation(s)
- Jing-Cai Meng
- Department of Physiology and Neurobiology, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu, China
| | - Ming-Qiang Shen
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, 215002, Jiangsu, China
| | - Yan-Li Lu
- Department of Radiology, Suzhou Hospital Affiliated to Nanjing Medical University(Suzhou Municipal Hospital), Suzhou, 215002, Jiangsu, China
| | - Hong-Xuan Feng
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, 215002, Jiangsu, China
| | - Xin-Yi Chen
- Department of Physiology and Neurobiology, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu, China
| | - Da-Qiang Xu
- Department of Radiology, Suzhou Hospital Affiliated to Nanjing Medical University(Suzhou Municipal Hospital), Suzhou, 215002, Jiangsu, China
| | - Guan-Hui Wu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, 215002, Jiangsu, China
| | - Qing-Zhang Cheng
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, 215002, Jiangsu, China
| | - Lin-Hui Wang
- Department of Physiology and Neurobiology, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu, China
| | - Qian Gui
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, 215002, Jiangsu, China.
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Okar SV, Hu F, Shinohara RT, Beck ES, Reich DS, Ineichen BV. The etiology and evolution of magnetic resonance imaging-visible perivascular spaces: Systematic review and meta-analysis. Front Neurosci 2023; 17:1038011. [PMID: 37065926 PMCID: PMC10098201 DOI: 10.3389/fnins.2023.1038011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesPerivascular spaces have been involved in neuroinflammatory and neurodegenerative diseases. Upon a certain size, these spaces can become visible on magnetic resonance imaging (MRI), referred to as enlarged perivascular spaces (EPVS) or MRI-visible perivascular spaces (MVPVS). However, the lack of systematic evidence on etiology and temporal dynamics of MVPVS hampers their diagnostic utility as MRI biomarker. Thus, the goal of this systematic review was to summarize potential etiologies and evolution of MVPVS.MethodsIn a comprehensive literature search, out of 1,488 unique publications, 140 records assessing etiopathogenesis and dynamics of MVPVS were eligible for a qualitative summary. 6 records were included in a meta-analysis to assess the association between MVPVS and brain atrophy.ResultsFour overarching and partly overlapping etiologies of MVPVS have been proposed: (1) Impairment of interstitial fluid circulation, (2) Spiral elongation of arteries, (3) Brain atrophy and/or perivascular myelin loss, and (4) Immune cell accumulation in the perivascular space. The meta-analysis in patients with neuroinflammatory diseases did not support an association between MVPVS and brain volume measures [R: −0.15 (95%-CI −0.40–0.11)]. Based on few and mostly small studies in tumefactive MVPVS and in vascular and neuroinflammatory diseases, temporal evolution of MVPVS is slow.ConclusionCollectively, this study provides high-grade evidence for MVPVS etiopathogenesis and temporal dynamics. Although several potential etiologies for MVPVS emergence have been proposed, they are only partially supported by data. Advanced MRI methods should be employed to further dissect etiopathogenesis and evolution of MVPVS. This can benefit their implementation as an imaging biomarker.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346564, identifier CRD42022346564.
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Affiliation(s)
- Serhat V. Okar
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Fengling Hu
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Erin S. Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Benjamin V. Ineichen
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Reproducible Science, University of Zurich, Zurich, Switzerland
- *Correspondence: Benjamin V. Ineichen, , ; orcid.org/0000-0003-1362-4819
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Jeong SH, Cha J, Park M, Jung JH, Ye BS, Sohn YH, Chung SJ, Lee PH. Association of Enlarged Perivascular Spaces With Amyloid Burden and Cognitive Decline in Alzheimer Disease Continuum. Neurology 2022; 99:e1791-e1802. [PMID: 35985826 DOI: 10.1212/wnl.0000000000200989] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the effects of enlarged perivascular space (EPVS) on amyloid burden and cognitive function in Alzheimer disease (AD) continuum. METHODS We retrospectively reviewed 208 patients with AD across the cognitive continuum (preclinical, prodromal, and AD dementia) who showed amyloid deposition on 18F-florbetaben PET scans and 82 healthy controls. EPVSs were counted for each patient in the basal ganglia (BG), centrum semiovale (CSO), and hippocampus (HP) on axial T2-weighted images. Patients were then classified according to the number of EPVSs into the EPVS+ (>10 EPVSs) and EPVS- (0-10 EPVSs) groups for the BG and CSO, respectively. In terms of HP-EPVS, equal or more than 7 EPVSs on bilateral hemisphere were regarded as the presence of HP-EPVS. After adjusting for markers of small vessel disease (SVD), multiple linear regression analyses were performed to determine the intergroup differences in global and regional amyloid deposition and cognitive function at the time of diagnosis of AD continuum. A linear mixed model was used to assess the effects of EPVSs on the longitudinal changes in the Mini-Mental State Examination (MMSE) scores. RESULTS Amyloid burden at the time of diagnosis of AD continuum was not associated with the degree of BG-, CSO-, or HP-EPVS. BG-EPVS affected language and frontal/executive function via SVD markers, and HP-EPVS was associated with general cognition via SVD markers. However, CSO-EPVS was not associated with baseline cognition. A higher number of CSO-EPVS was significantly associated with a more rapid decline in MMSE scores (β = -0.58, standard error = 0.23, p = 0.011) independent of the amyloid burden. In terms of BG and HP, there was no difference between the EPVS+ and EPVS- groups in the rate of longitudinal decreases in MMSE scores. DISCUSSION Our findings suggest that BG-, CSO-, and HP-EPVS are not associated with baseline β-amyloid burden or cognitive function independently of SVD at the diagnosis of AD continuum. However, CSO-EPVS appears to be associated with the progression of cognitive decline in an amyloid-independent manner. Further studies are needed to investigate whether CSO-EPVS is a potential therapeutic target in patients with AD continuum.
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Affiliation(s)
- Seong Ho Jeong
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Mincheol Park
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea.
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Wang XX, Cao QC, Teng JF, Wang RF, Yang ZT, Wang MG, Cao ZH. MRI-visible enlarged perivascular spaces: imaging marker to predict cognitive impairment in older chronic insomnia patients. Eur Radiol 2022; 32:5446-5457. [PMID: 35286409 DOI: 10.1007/s00330-022-08649-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/27/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Perivascular spaces (PVS), components of the glymphatic system in the brain, have been known to be important conduits for clearing metabolic waste, and this process mainly increases during sleep. Sleep disruption might result in PVS dysfunction and cognitive impairment. In this study, we aim to explore whether MRI-visible enlarged perivascular spaces (EPVS) could be imaging markers to predict cognitive impairment in chronic insomnia patients. METHOD We obtained data from 156 patients with chronic insomnia and 79 age-matched healthy individuals. Using T2-weighted MRI images, visible EPVS in various brain regions were measured and analyzed. The associations between EPVS numbers and cerebrospinal fluid (CSF) β-amyloid 42 (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau) level in chronic insomnia patients were evaluated. RESULT Our results showed that MRI-visible EPVS in the frontal cortex, centrum semiovale, basal ganglia, and hippocampus of chronic insomnia patients with impaired cognition (ICG) significantly increased than that in normal cognition (NCG) patients. The increased MRI-visible EPVS in the frontal cortex, centrum semiovale, and basal ganglia were also associated with the increased CSF Aβ42, t-tau, and p-tau level in ICG patients. MRI-visible EPVS in the basal ganglia and centrum semiovale had high sensitivity and specificity in distinguishing ICG chronic insomnia patients from those with NCG. CONCLUSION Our study indicated that MRI-visible EPVS in the basal ganglia and centrum semiovale might be valuable imaging markers to predict cognitive impairment in chronic insomnia patients. It will be meaningful to discern those cognitive decline patients in preclinical stage and take some measures to prevent disease progression. KEY POINTS • Increased MRI-visible EPVS were associated with the increased CSF Aβ42, t-tau, and p-tau level in older chronic insomnia patients with impaired cognition.
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Affiliation(s)
- Xin-Xin Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| | - Qin-Chen Cao
- Department of Radiation Therapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jun-Fang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Rui-Fang Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Medical Key Laboratory of Molecular Imaging, Zhengzhou, 450052, Henan, China
| | - Zi-Tao Yang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Meng-Ge Wang
- Department of Respiratory and Sleep, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Zheng-Hao Cao
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
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Bown CW, Carare RO, Schrag MS, Jefferson AL. Physiology and Clinical Relevance of Enlarged Perivascular Spaces in the Aging Brain. Neurology 2022; 98:107-117. [PMID: 34810243 PMCID: PMC8792814 DOI: 10.1212/wnl.0000000000013077] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/29/2021] [Indexed: 01/21/2023] Open
Abstract
Perivascular spaces (PVS) are fluid-filled compartments that are part of the cerebral blood vessel wall and represent the conduit for fluid transport in and out of the brain. PVS are considered pathologic when sufficiently enlarged to be visible on MRI. Recent studies have demonstrated that enlarged PVS (ePVS) may have clinical consequences related to cognition. Emerging literature points to arterial stiffening and abnormal protein aggregation in vessel walls as 2 possible mechanisms that drive ePVS formation. We describe the clinical consequences, anatomy, fluid dynamics, physiology, risk factors, and in vivo quantification methods of ePVS. Given competing views of PVS physiology, we detail the 2 most prominent theoretical views and review ePVS associations with other common small vessel disease markers. Because ePVS are a marker of small vessel disease and ePVS burden is higher in Alzheimer disease, a comprehensive understanding about ePVS is essential in developing prevention and treatment strategies.
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Affiliation(s)
- Corey W Bown
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
| | - Roxana O Carare
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
| | - Matthew S Schrag
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
| | - Angela L Jefferson
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
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Yim Y, Moon WJ. An Enlarged Perivascular Space: Clinical Relevance and the Role of Imaging in Aging and Neurologic Disorders. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:538-558. [PMID: 36238506 PMCID: PMC9514531 DOI: 10.3348/jksr.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Younghee Yim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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