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Mamah D, Chen S, Shimony JS, Harms MP. Tract-based analyses of white matter in schizophrenia, bipolar disorder, aging, and dementia using high spatial and directional resolution diffusion imaging: a pilot study. Front Psychiatry 2024; 15:1240502. [PMID: 38362028 PMCID: PMC10867155 DOI: 10.3389/fpsyt.2024.1240502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Structural brain connectivity abnormalities have been associated with several psychiatric disorders. Schizophrenia (SCZ) is a chronic disabling disorder associated with accelerated aging and increased risk of dementia, though brain findings in the disorder have rarely been directly compared to those that occur with aging. Methods We used an automated approach to reconstruct key white matter tracts and assessed tract integrity in five participant groups. We acquired one-hour-long high-directional diffusion MRI data from young control (CON, n =28), bipolar disorder (BPD, n =21), and SCZ (n =22) participants aged 18-30, and healthy elderly (ELD, n =15) and dementia (DEM, n =9) participants. Volume, fractional (FA), radial diffusivity (RD) and axial diffusivity (AD) of seven key white matter tracts (anterior thalamic radiation, ATR; dorsal and ventral cingulum bundle, CBD and CBV; corticospinal tract, CST; and the three superior longitudinal fasciculi: SLF-1, SLF-2 and SLF-3) were analyzed with TRACULA. Group comparisons in tract metrics were performed using multivariate and univariate analyses. Clinical relationships of tract metrics with recent and chronic symptoms were assessed in SCZ and BPD participants. Results A MANOVA showed group differences in FA (λ=0.5; p=0.0002) and RD (λ=0.35; p<0.0001) across the seven tracts, but no significant differences in tract AD and volume. Post-hoc analyses indicated lower tract FA and higher RD in ELD and DEM groups compared to CON, BPD and SCZ groups. Lower FA and higher RD in SCZ compared to CON did not meet statistical significance. In SCZ participants, a significant negative correlation was found between chronic psychosis severity and FA in the SLF-1 (r= -0.45; p=0.035), SLF-2 (r= -0.49; p=0.02) and SLF-3 (r= -0.44; p=0.042). Discussion Our results indicate impaired white matter tract integrity in elderly populations consistent with myelin damage. Impaired tract integrity in SCZ is most prominent in patients with advanced illness.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - ShingShiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael P. Harms
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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Al-darsani Z, Jacobs DR, Bryan RN, Launer LJ, Steffen LM, Yaffe K, Shikany JM, Odegaard AO. Measures of MRI Brain Biomarkers in Middle Age According to Average Modified Mediterranean Diet Scores Throughout Young and Middle Adulthood. NUTRITION AND HEALTHY AGING 2023; 8:109-121. [PMID: 38013773 PMCID: PMC10475985 DOI: 10.3233/nha-220192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 06/08/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The Mediterranean diet (MedDiet) has been linked with better cognitive function and brain integrity. OBJECTIVE To examine the association of modified Mediterranean diet (mMedDiet) scores from early through middle adulthood in relation to volumetric and microstructural midlife MRI brain measures. Assess the association of mMedDiet and brain measures with four cognitive domains. If variables are correlated, determine if brain measures mediate the relationship between mMedDiet and cognition. METHODS 618 participants (mean age 25.4±3.5 at year 0) of the Coronary Artery Risk Development in Young Adults (CARDIA) study were included. Cumulative average mMedDiet scores were calculated by averaging scores from years 0, 7, and 20. MRI scans were obtained at years 25 and 30. General linear models were used to examine the association between mMedDiet and brain measures. RESULTS Higher cumulative average mMedDiet scores were associated with better microstructural white matter (WM) integrity measured by fractional anisotropy (FA) at years 25 and 30 (all ptrend <0.05). Higher mMedDiet scores at year 7 were associated with higher WM FA at year 25 (β= 0.003, ptrend = 0.03). Higher mMedDiet scores at year 20 associated with higher WM FA at years 25 (β= 0.0005, ptrend = 0.002) and 30 (β= 0.0003, ptrend = 0.02). mMedDiet scores were not associated with brain volumes. Higher mMedDiet scores and WM FA were both correlated with better executive function, processing speed, and global cognition (all ptrend <0.05). WM FA did not mediate the association between mMedDiet scores and cognition. CONCLUSIONS mMedDiet scores may be associated with microstructural WM integrity at midlife.
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Affiliation(s)
- Zeinah Al-darsani
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - R. Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew O. Odegaard
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA
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3
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Reilly OT, Brosnan SF, Benítez ME, Phillips KA, Hecht EE. Sex differences in white matter tracts of capuchin monkey brains. J Comp Neurol 2023; 531:1096-1107. [PMID: 37127839 PMCID: PMC10247455 DOI: 10.1002/cne.25480] [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: 10/12/2022] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 05/03/2023]
Abstract
Nonhuman primates exhibit sexual dimorphism in behavior, suggesting that there could be underlying differences in brain organization and function. Understanding this neuroanatomical variation is critical for enhancing our understanding of the evolution of sex differences in the human brain. Tufted capuchin monkeys (Sapajus [Cebus] apella) represent a phylogenetically diverse taxa of neotropical primates that converge on several behavioral characteristics with humans relevant to social organization, making them an important point of comparison for studying the evolution of sex differences in primates. While anatomical sex differences in gray matter have previously been found in capuchin monkeys, the current study investigates sex differences in white matter tracts. We carried out tract-based spatial statistical analysis on fractional anisotropy images of tufted capuchin monkeys (15 female, 5 male). We found that females showed significantly higher fractional anisotropy than males in regions of frontal-parietal white matter in the right cerebral hemisphere. Paralleling earlier findings in gray matter, male and female fractional anisotropy values in these regions were nonoverlapping. This complements prior work pointing toward capuchin sex differences in limbic circuitry and higher-order visual regions. We propose that these sex differences are related to the distinct socioecological niches occupied by male and female capuchins. Capuchin neuroanatomical sex differences appear to be more pronounced than in humans, which we suggest may relate to human adaptations for prolonged neurodevelopmental trajectories and increased plasticity.
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Affiliation(s)
- Olivia T Reilly
- Department of Psychology, Georgia State University, Atlanta, Georgia
- Language Research Center, Georgia State University, Atlanta, Georgia
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts
| | - Sarah F Brosnan
- Department of Psychology, Georgia State University, Atlanta, Georgia
- Language Research Center, Georgia State University, Atlanta, Georgia
- Center for Behavioral Neuroscience, Georgia State University, Atlanta, Georgia
- Neuroscience Institute, Georgia State University, Atlanta, Georgia
| | - Marcela E Benítez
- Language Research Center, Georgia State University, Atlanta, Georgia
- Department of Anthropology, Emory University, Atlanta, Georgia
| | - Kimberley A Phillips
- Department of Psychology, Trinity University, San Antonio, Texas
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas
| | - Erin E Hecht
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts
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Rajashekar N, Blumberg HP, Villa LM. Neuroimaging Studies of Brain Structure in Older Adults with Bipolar Disorder: A Review. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7:e220006. [PMID: 36092855 PMCID: PMC9453888 DOI: 10.20900/jpbs.20220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bipolar disorder (BD) is a common mood disorder that can have severe consequences during later life, including suffering and impairment due to mood and cognitive symptoms, elevated risk for dementia and an especially high risk for suicide. Greater understanding of the brain circuitry differences involved in older adults with BD (OABD) in later life and their relationship to aging processes is required to improve outcomes of OABD. The current literature on gray and white matter findings, from high resolution structural and diffusion-weighted magnetic resonance imaging (MRI) studies, has shown that BD in younger age groups is associated with gray matter reductions within cortical and subcortical brain regions that subserve emotion processing and regulation, as well as reduced structural integrity of white matter tracts connecting these brain regions. While fewer neuroimaging studies have focused on OABD, it does appear that many of the structural brain differences found in younger samples are present in OABD. There is also initial suggestion that there are additional brain differences, for at least a subset of OABD, that may result from more pronounced gray and white matter declines with age that may contribute to adverse outcomes. Preclinical and clinical data supporting neuro-plastic and -protective effects of mood-stabilizing medications, suggest that treatments may reverse and/or prevent the progression of brain changes thereby reducing symptoms. Future neuroimaging research implementing longitudinal designs, and large-scale, multi-site initiatives with detailed clinical and treatment data, holds promise for reducing suffering, cognitive dysfunction and suicide in OABD.
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Affiliation(s)
- Niroop Rajashekar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
- Child Study Center, Yale School of Medicine, New Haven, CT 06519, USA
| | - Luca M. Villa
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
- Department of Psychiatry, University of Oxford, Oxford, OX37JX, UK
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5
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DeLuca V, Voits T. Bilingual experience affects white matter integrity across the lifespan. Neuropsychologia 2022; 169:108191. [DOI: 10.1016/j.neuropsychologia.2022.108191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 01/28/2023]
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6
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Ettehadi N, Kashyap P, Zhang X, Wang Y, Semanek D, Desai K, Guo J, Posner J, Laine AF. Automated Multiclass Artifact Detection in Diffusion MRI Volumes via 3D Residual Squeeze-and-Excitation Convolutional Neural Networks. Front Hum Neurosci 2022; 16:877326. [PMID: 35431841 PMCID: PMC9005752 DOI: 10.3389/fnhum.2022.877326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022] Open
Abstract
Diffusion MRI (dMRI) is widely used to investigate neuronal and structural development of brain. dMRI data is often contaminated with various types of artifacts. Hence, artifact type identification in dMRI volumes is an essential pre-processing step prior to carrying out any further analysis. Manual artifact identification amongst a large pool of dMRI data is a highly labor-intensive task. Previous attempts at automating this process are often limited to a binary classification ("poor" vs. "good" quality) of the dMRI volumes or focus on detecting a single type of artifact (e.g., motion, Eddy currents, etc.). In this work, we propose a deep learning-based automated multiclass artifact classifier for dMRI volumes. Our proposed framework operates in 2 steps. In the first step, the model predicts labels associated with 3D mutually exclusive collectively exhaustive (MECE) sub-volumes or "slabs" extracted from whole dMRI volumes. In the second step, through a voting process, the model outputs the artifact class present in the whole volume under investigation. We used two different datasets for training and evaluating our model. Specifically, we utilized 2,494 poor-quality dMRI volumes from the Adolescent Brain Cognitive Development (ABCD) and 4,226 from the Healthy Brain Network (HBN) dataset. Our results demonstrate accurate multiclass volume-level main artifact type prediction with 96.61 and 97.52% average accuracies on the ABCD and HBN test sets, respectively. Finally, in order to demonstrate the effectiveness of the proposed framework in dMRI pre-processing pipelines, we conducted a proof-of-concept dMRI analysis exploring the relationship between whole-brain fractional anisotropy (FA) and participant age, to test whether the use of our model improves the brain-age association.
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Affiliation(s)
- Nabil Ettehadi
- Heffner Biomedical Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Pratik Kashyap
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Xuzhe Zhang
- Heffner Biomedical Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Yun Wang
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - David Semanek
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Karan Desai
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Jia Guo
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
- Zuckerman Institute, Columbia University, New York, NY, United States
| | - Jonathan Posner
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Andrew F. Laine
- Heffner Biomedical Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, United States
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7
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Tract-specific statistics based on diffusion-weighted probabilistic tractography. Commun Biol 2022; 5:138. [PMID: 35177755 PMCID: PMC8854429 DOI: 10.1038/s42003-022-03073-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 01/24/2022] [Indexed: 11/09/2022] Open
Abstract
Diffusion-weighted neuroimaging approaches provide rich evidence for estimating the structural integrity of white matter in vivo, but typically do not assess white matter integrity for connections between two specific regions of the brain. Here, we present a method for deriving tract-specific diffusion statistics, based upon predefined regions of interest. Our approach derives a population distribution using probabilistic tractography, based on the Nathan Kline Institute (NKI) Enhanced Rockland sample. We determine the most likely geometry of a path between two regions and express this as a spatial distribution. We then estimate the average orientation of streamlines traversing this path, at discrete distances along its trajectory, and the fraction of diffusion directed along this orientation for each participant. The resulting participant-wise metrics (tract-specific anisotropy; TSA) can then be used for statistical analysis on any comparable population. Based on this method, we report both negative and positive associations between age and TSA for two networks derived from published meta-analytic studies (the “default mode” and “what-where” networks), along with more moderate sex differences and age-by-sex interactions. The proposed method can be applied to any arbitrary set of brain regions, to estimate both the spatial trajectory and DWI-based anisotropy specific to those regions. Andrew Reid et al. use publicly available data to present a method for deriving tract-specific statistics based on diffusion-weighted MRI, based upon arbitrarily-defined regions of interest. Their approach enables them to report both negative and positive associations between age and tract-specific anisotropy along with more moderate sex differences and age-by-sex interactions.
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8
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van Aalst J, Devrome M, Van Weehaeghe D, Rezaei A, Radwan A, Schramm G, Ceccarini J, Sunaert S, Koole M, Van Laere K. Regional glucose metabolic decreases with ageing are associated with microstructural white matter changes: a simultaneous PET/MR study. Eur J Nucl Med Mol Imaging 2021; 49:664-680. [PMID: 34398271 DOI: 10.1007/s00259-021-05518-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/02/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Human ageing is associated with a regional reduction in cerebral neuronal activity as assessed by numerous studies on brain glucose metabolism and perfusion, grey matter (GM) density and white matter (WM) integrity. As glucose metabolism may impact energetics to maintain myelin integrity, but changes in functional connectivity may also alter regional metabolism, we conducted a cross-sectional simultaneous FDG PET/MR study in a large cohort of healthy volunteers with a wide age range, to directly assess the underlying associations between reduced glucose metabolism, GM atrophy and decreased WM integrity in a single ageing cohort. METHODS In 94 healthy subjects between 19.9 and 82.5 years (mean 50.1 ± 17.1; 47 M/47F, MMSE ≥ 28), simultaneous FDG-PET, structural MR and diffusion tensor imaging (DTI) were performed. Voxel-wise associations between age and grey matter (GM) density, RBV partial-volume corrected (PVC) glucose metabolism, white matter (WM) fractional anisotropy (FA) and mean diffusivity (MD), and age were assessed. Clusters representing changes in glucose metabolism correlating significantly with ageing were used as seed regions for tractography. Both linear and quadratic ageing models were investigated. RESULTS An expected age-related reduction in GM density was observed bilaterally in the frontal, lateral and medial temporal cortex, striatum and cerebellum. After PVC, relative FDG uptake was negatively correlated with age in the inferior and midfrontal, cingulate and parietal cortex and subcortical regions, bilaterally. FA decreased with age throughout the entire brain WM. Four white matter tracts were identified connecting brain regions with declining glucose metabolism with age. Within these, relative FDG uptake in both origin and target clusters correlated positively with FA (0.32 ≤ r ≤ 0.71) and negatively with MD (- 0.75 ≤ r ≤ - 0.41). CONCLUSION After appropriate PVC, we demonstrated that regional cerebral glucose metabolic declines with age and that these changes are related to microstructural changes in the interconnecting WM tracts. The temporal course and potential causality between ageing effects on glucose metabolism and WM integrity should be further investigated in longitudinal cohort PET/MR studies.
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Affiliation(s)
- June van Aalst
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Martijn Devrome
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Donatienne Van Weehaeghe
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Ahmadreza Rezaei
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Ahmed Radwan
- Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Georg Schramm
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Jenny Ceccarini
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Michel Koole
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Koen Van Laere
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.
- UZ Leuven, Campus Gasthuisberg, Nucleaire Geneeskunde, E901, Herestraat 49, BE-3000 , Leuven, Belgium.
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9
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Shokri-Kojori E, Bennett IJ, Tomeldan ZA, Krawczyk DC, Rypma B. Estimates of brain age for gray matter and white matter in younger and older adults: Insights into human intelligence. Brain Res 2021; 1763:147431. [PMID: 33737067 PMCID: PMC8428193 DOI: 10.1016/j.brainres.2021.147431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 12/18/2022]
Abstract
Aging entails a multifaceted complex of changes in macro- and micro-structural properties of human brain gray matter (GM) and white matter (WM) tissues, as well as in intellectual abilities. To better capture tissue-specific brain aging, we combined volume and distribution properties of diffusivity indices to derive subject-specific age scores for each tissue. We compared age-related variance between younger and older adults for GM and WM age scores, and tested whether tissue-specific age scores could explain different effects of aging on fluid (Gf) and crystalized (Gc) intelligence in younger and older adults. Chronological age was strongly associated with GM (R2 = 0.73) and WM (R2 = 0.57) age scores. The GM age score accounted for significantly more variance in chronological age in younger relative to older adults (p < 0.001), whereas the WM age score accounted for significantly more variance in chronological age in older compared to younger adults (p < 0.025). Consistent with existing literature, younger adults outperformed older adults in Gf while older adults outperformed younger adults in Gc. The GM age score was negatively associated with Gf in younger adults (p < 0.02), whereas the WM age score was negatively associated with Gc in older adults (p < 0.02). Our results provide evidence for differences in the effects of age on GM and WM in younger versus older adults that may contribute to age-related differences in Gf and Gc.
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Affiliation(s)
- Ehsan Shokri-Kojori
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA.
| | - Ilana J Bennett
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA; Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Zuri A Tomeldan
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Daniel C Krawczyk
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA; Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Bart Rypma
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA; Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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10
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Johnson D, Ricciardi A, Brownlee W, Kanber B, Prados F, Collorone S, Kaden E, Toosy A, Alexander DC, Gandini Wheeler-Kingshott CAM, Ciccarelli O, Grussu F. Comparison of Neurite Orientation Dispersion and Density Imaging and Two-Compartment Spherical Mean Technique Parameter Maps in Multiple Sclerosis. Front Neurol 2021; 12:662855. [PMID: 34194382 PMCID: PMC8236830 DOI: 10.3389/fneur.2021.662855] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/17/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Neurite orientation dispersion and density imaging (NODDI) and the spherical mean technique (SMT) are diffusion MRI methods providing metrics with sensitivity to similar characteristics of white matter microstructure. There has been limited comparison of changes in NODDI and SMT parameters due to multiple sclerosis (MS) pathology in clinical settings. Purpose: To compare group-wise differences between healthy controls and MS patients in NODDI and SMT metrics, investigating associations with disability and correlations with diffusion tensor imaging (DTI) metrics. Methods: Sixty three relapsing-remitting MS patients were compared to 28 healthy controls. NODDI and SMT metrics corresponding to intracellular volume fraction (vin), orientation dispersion (ODI and ODE), diffusivity (D) (SMT only) and isotropic volume fraction (viso) (NODDI only) were calculated from diffusion MRI data, alongside DTI metrics (fractional anisotropy, FA; axial/mean/radial diffusivity, AD/MD/RD). Correlations between all pairs of MRI metrics were calculated in normal-appearing white matter (NAWM). Associations with expanded disability status scale (EDSS), controlling for age and gender, were evaluated. Patient-control differences were assessed voxel-by-voxel in MNI space controlling for age and gender at the 5% significance level, correcting for multiple comparisons. Spatial overlap of areas showing significant differences were compared using Dice coefficients. Results: NODDI and SMT show significant associations with EDSS (standardised beta coefficient −0.34 in NAWM and −0.37 in lesions for NODDI vin; 0.38 and −0.31 for SMT ODE and vin in lesions; p < 0.05). Significant correlations in NAWM are observed between DTI and NODDI/SMT metrics. NODDI vin and SMT vin strongly correlated (r = 0.72, p < 0.05), likewise NODDI ODI and SMT ODE (r = −0.80, p < 0.05). All DTI, NODDI and SMT metrics detect widespread differences between patients and controls in NAWM (12.57% and 11.90% of MNI brain mask for SMT and NODDI vin, Dice overlap of 0.42). Data Conclusion: SMT and NODDI detect significant differences in white matter microstructure between MS patients and controls, concurring on the direction of these changes, providing consistent descriptors of tissue microstructure that correlate with disability and show alterations beyond focal damage. Our study suggests that NODDI and SMT may play a role in monitoring MS in clinical trials and practice.
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Affiliation(s)
- Daniel Johnson
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom.,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Antonio Ricciardi
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Wallace Brownlee
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Baris Kanber
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Ferran Prados
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, United Kingdom.,e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Sara Collorone
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Enrico Kaden
- Department of Computer Science, Centre for Medical Image Computing, University College London, London, United Kingdom.,Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Ahmed Toosy
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom.,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Daniel C Alexander
- Department of Computer Science, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Claudia A M Gandini Wheeler-Kingshott
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Brain Magnetic Resonance Imaging (MRI) 3T Research Centre, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Olga Ciccarelli
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom.,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Francesco Grussu
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis (MS) Centre, University College London (UCL) Queen Square Institute of Neurology, University College London, London, United Kingdom.,Radiomics Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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11
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Pineda JCD, Kokubun K, Ikaga T, Yamakawa Y. Housing quality and behavior affect brain health and anxiety in healthy Japanese adults. Sci Rep 2021; 11:11999. [PMID: 34099762 PMCID: PMC8184752 DOI: 10.1038/s41598-021-91363-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
Countless studies in animals have shown how housing environments and behaviors can significantly affect anxiety and brain health, giving valuable insight as to whether this is applicable in the human context. The relationship between housing, behavior, brain health, and mental wellbeing in humans remains poorly understood. We therefore explored the interaction of housing quality, weekend/holiday sedentary behavior, brain structure, and anxiety in healthy Japanese adults. Whole-brain structural magnetic resonance imaging (MRI) methods based on gray matter volume and fractional anisotropy were used as markers for brain health. Correlation tests were conducted, and then adjusted for multiple comparisons using the False Discovery Rate method. Housing quality and weekend/holiday sedentary behavior were associated with fractional anisotropy, but not with gray matter volume. Fractional anisotropy showed significant associations with anxiety. Lastly, both weekend/holiday sedentary behavior and housing quality were indirectly associated with anxiety through fractional anisotropy. These results add to the limited evidence surrounding the relationship among housing, behavior, and the brain. Furthermore, these results show that behavior and housing qualities can have an indirect impact on anxiety through neurobiological markers such as fractional anisotropy.
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Affiliation(s)
| | | | - Toshiharu Ikaga
- Faculty of Science and Technology, Keio University, Yokohama, Kanagawa, Japan
| | - Yoshinori Yamakawa
- Open Innovation Institute, Kyoto University, Kyoto, Japan.,ImPACT Program of Council for Science, Technology and Innovation (Cabinet Office, Government of Japan), Chiyoda, Tokyo, Japan.,Institute of Innovative Research, Tokyo Institute of Technology, Meguro, Tokyo, Japan.,Office for Academic and Industrial Innovation, Kobe University, Kobe, Japan.,Brain Impact General Incorporated Association, Kyoto, Japan
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12
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Amoo M, O'Halloran PJ, Henry J, Husien MB, Brennan P, Campbell M, Caird J, Curley GF. Permeability of the Blood-Brain Barrier after Traumatic Brain Injury; Radiological Considerations. J Neurotrauma 2021; 39:20-34. [PMID: 33632026 DOI: 10.1089/neu.2020.7545] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability, especially in young persons, and constitutes a major socioeconomic burden worldwide. It is regarded as the leading cause of mortality and morbidity in previously healthy young persons. Most of the mechanisms underpinning the development of secondary brain injury are consequences of disruption of the complex relationship between the cells and proteins constituting the neurovascular unit or a direct result of loss of integrity of the tight junctions (TJ) in the blood-brain barrier (BBB). A number of changes have been described in the BBB after TBI, including loss of TJ proteins, pericyte loss and migration, and altered expressions of water channel proteins at astrocyte end-feet processes. There is a growing research interest in identifying optimal biological and radiological biomarkers of severity of BBB dysfunction and its effects on outcomes after TBI. This review explores the microscopic changes occurring at the neurovascular unit, after TBI, and current radiological adjuncts for its evaluation in pre-clinical and clinical practice.
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Affiliation(s)
- Michael Amoo
- National Centre for Neurosurgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,Beacon Academy, Beacon Hospital, Sandyford, Dublin, Ireland
| | - Philip J O'Halloran
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurosurgery, Royal London Hospital, Whitechapel, London, United Kingdom
| | - Jack Henry
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Mohammed Ben Husien
- National Centre for Neurosurgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul Brennan
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | | | - John Caird
- National Centre for Neurosurgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Gerard F Curley
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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13
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Transient changes in white matter microstructure during general anesthesia. PLoS One 2021; 16:e0247678. [PMID: 33770816 PMCID: PMC7997710 DOI: 10.1371/journal.pone.0247678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/10/2021] [Indexed: 01/01/2023] Open
Abstract
Cognitive dysfunction after surgery under general anesthesia is a well-recognized clinical phenomenon in the elderly. Physiological effects of various anesthetic agents have been studied at length. Very little is known about potential effects of anesthesia on brain structure. In this study we used Diffusion Tensor Imaging to compare the white matter microstructure of healthy control subjects under sevoflurane anesthesia with their awake state. Fractional Anisotropy, a white mater integrity index, transiently decreases throughout the brain during sevoflurane anesthesia and then returns back to baseline. Other DTI metrics such as mean diffusivity, axial diffusivity and radial diffusivity were increased under sevoflurane anesthesia. Although DTI metrics are age dependent, the transient changes due to sevoflurane were independent of age and sex. Volumetric analysis shows various white matter volumes decreased whereas some gray matter volumes increased during sevoflurane anesthesia. These results suggest that sevoflurane anesthesia has a significant, but transient, effect on white matter microstructure. In spite of the transient effects of sevoflurane anesthesia there were no measurable effects on brain white matter as determined by the DTI metrics at 2 days and 7 days following anesthesia. The role of white matter in the loss of consciousness under anesthesia will need to be studied and MRI studies with subjects under anesthesia will need to take these results into account.
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14
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Effects of Lifelong Musicianship on White Matter Integrity and Cognitive Brain Reserve. Brain Sci 2021; 11:brainsci11010067. [PMID: 33419228 PMCID: PMC7825624 DOI: 10.3390/brainsci11010067] [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: 12/01/2020] [Revised: 12/30/2020] [Accepted: 01/01/2021] [Indexed: 02/07/2023] Open
Abstract
There is a significant body of research that has identified specific, high-end cognitive demand activities and lifestyles that may play a role in building cognitive brain reserve, including volume changes in gray matter and white matter, increased structural connectivity, and enhanced categorical perception. While normal aging produces trends of decreasing white matter (WM) integrity, research on cognitive brain reserve suggests that complex sensory–motor activities across the life span may slow down or reverse these trends. Previous research has focused on structural and functional changes to the human brain caused by training and experience in both linguistic (especially bilingualism) and musical domains. The current research uses diffusion tensor imaging to examine the integrity of subcortical white matter fiber tracts in lifelong musicians. Our analysis, using Tortoise and ICBM-81, reveals higher fractional anisotropy, an indicator of greater WM integrity, in aging musicians in bilateral superior longitudinal fasciculi and bilateral uncinate fasciculi. Statistical methods used include Fisher’s method and linear regression analysis. Another unique aspect of this study is the accompanying behavioral performance data for each participant. This is one of the first studies to look specifically at musicianship across the life span and its impact on bilateral WM integrity in aging.
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15
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Shinn RL, Pancotto TE, Stadler KL, Werre SR, Rossmeisl JH. Magnetization transfer and diffusion tensor imaging in dogs with intervertebral disk herniation. J Vet Intern Med 2020; 34:2536-2544. [PMID: 33006411 PMCID: PMC7694818 DOI: 10.1111/jvim.15899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background Quantitative magnetic resonance imaging (QMRI) techniques of magnetization transfer ratio (MTR) and diffusion tensor imaging (DTI) provide microstructural information about the spinal cord. Objective Compare neurologic grades using the modified Frankel scale with MTR and DTI measurements in dogs with thoracolumbar intervertebral disk herniation (IVDH). Animals Fifty‐one dogs with thoracolumbar IVDH. Methods Prospective cohort study. Quantitative MRI measurements of the spinal cord were obtained at the region of compression. A linear regression generalized estimating equations model was used to compare QMRI measurements between different neurological grades after adjusting for age, weight, duration of clinical signs, and lesion location. Results Grade 5 (.79 × 10−3 mm2/s [median], .43−.91 [range]) and axial (1.47 × 10−3 mm2/s, .58−1.8) diffusivity were lower compared to grades 2 (1.003, .68−1.36; P = .02 and 1.81 × 10−3 mm2/s, 1.36−2.12; P < .001, respectively) and 3 (1.07 × 10−3 mm2/s, .77−1.5; P = .04 and 1.92 × 10−3 mm2/s, 1.83−2.37;P < .001, respectively). Compared to dogs with acute myelopathy, chronic myelopathy was associated with higher mean (1.02 × 10−3 mm2/s, .77−1.36 vs. .83 × 10−3 mm2/s, .64−1.5; P = .03) and radial diffusivity (.75 × 10−3 mm2/s, .38−1.04 vs. .44 × 10−3 mm2/s, .22−1.01; P = .008) and lower MTR (46.76, 31.8−56.43 vs. 54.4, 45.2−62.27; P = .004) and fractional anisotropy (.58, .4−0.75 vs. .7, .46−.85; P = .02). Fractional anisotropy was lower in dogs with a T2‐weighted intramedullary hyperintensity compared to those without (.7, .45−.85 vs. .54, .4−.8; P = .01). Conclusion and Clinical Relevance Mean diffusivity and AD could serve as surrogates of severity of spinal cord injury and are complementary to the clinical exam in dogs with thoracolumbar IVDH.
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Affiliation(s)
- Richard L Shinn
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Theresa E Pancotto
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | | | - Stephen R Werre
- Laboratory for Study Design and Statistical Analysis, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - John H Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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16
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Structural MRI outcomes and predictors of disease progression in amyotrophic lateral sclerosis. NEUROIMAGE-CLINICAL 2020; 27:102315. [PMID: 32593977 PMCID: PMC7327879 DOI: 10.1016/j.nicl.2020.102315] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/20/2022]
Abstract
Serial diffusion tensor (DT) MRI showed progression of white matter pathology in ALS. Early involvement of motor fibers and later spread to extra-motor regions was found. DT MRI measures of damage to the motor networks showed consistent worsening. These correlated with clinical progression and long-term functional prognosis. No significant cortical thinning was detected either at baseline or over time.
Background and aims Considering the great heterogeneity of amyotrophic lateral sclerosis (ALS), the identification of accurate prognostic predictors is fundamental for both the clinical practice and the design of treatment trials. This study aimed to explore the progression of clinical and structural brain changes in patients with ALS, and to assess magnetic resonance imaging (MRI) measures of brain damage as predictors of subsequent functional decline. Methods 50 ALS patients underwent clinical evaluations and 3 T MRI scans at regular intervals for a maximum of 2 years (total MRI scans = 164). MRI measures of cortical thickness, as well as diffusion tensor (DT) metrics of microstructural damage along white matter (WM) tracts were obtained. Voxel-wise regression models and longitudinal mixed-effects models were used to test the relationship between clinical decline and baseline and longitudinal MRI features. Results The rate of decline of the ALS Functional Rating Scale revised (ALSFRS-r) was significantly associated with the rate of fractional anisotropy (FA) decrease in the body of the corpus callosum (CC). Corticospinal tract (CST) and CC-body alterations had a faster progression in patients with higher baseline ALSFRS-r scores and greater CC-body disruption at baseline. Lower FA of the cerebral peduncle was associated with faster subsequent clinical progression. Conclusions In this longitudinal study, we identified a significant association between measures of WM damage of the motor tracts and functional decline in ALS patients. Our data suggest that a multiparametric approach including DT MRI measures of brain damage would provide an optimal method for an accurate stratification of ALS patients into prognostic classes.
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17
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Warrington S, Bryant KL, Khrapitchev AA, Sallet J, Charquero-Ballester M, Douaud G, Jbabdi S, Mars RB, Sotiropoulos SN. XTRACT - Standardised protocols for automated tractography in the human and macaque brain. Neuroimage 2020; 217:116923. [PMID: 32407993 PMCID: PMC7260058 DOI: 10.1016/j.neuroimage.2020.116923] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/27/2020] [Accepted: 05/01/2020] [Indexed: 01/19/2023] Open
Abstract
We present a new software package with a library of standardised tractography protocols devised for the robust automated extraction of white matter tracts both in the human and the macaque brain. Using in vivo data from the Human Connectome Project (HCP) and the UK Biobank and ex vivo data for the macaque brain datasets, we obtain white matter atlases, as well as atlases for tract endpoints on the white-grey matter boundary, for both species. We illustrate that our protocols are robust against data quality, generalisable across two species and reflect the known anatomy. We further demonstrate that they capture inter-subject variability by preserving tract lateralisation in humans and tract similarities stemming from twinship in the HCP cohort. Our results demonstrate that the presented toolbox will be useful for generating imaging-derived features in large cohorts, and in facilitating comparative neuroanatomy studies. The software, tractography protocols, and atlases are publicly released through FSL, allowing users to define their own tractography protocols in a standardised manner, further contributing to open science. A new software package for standardised and automated cross-species tractography. Homologous white matter bundles in the human and macaque brain. Human white matter tract atlases generated from large datasets (1000 subjects). Tractography protocols are standardised, but preserve individual variability. Generalisability across datasets shown using the HCP and the UK Biobank data.
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Affiliation(s)
- Shaun Warrington
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, UK.
| | - Katherine L Bryant
- Donders Institute for Brain, Cognition, & Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands; Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alexandr A Khrapitchev
- CRUK and MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK
| | - Jerome Sallet
- Wellcome Centre for Integrative Neuroimaging - Department of Experimental Psychology, University of Oxford, UK; Univ Lyon, Université Lyon 1, Inserm, Stem Cell and Brain Research Institute U1208, Bron, France
| | - Marina Charquero-Ballester
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Psychiatry, University of Oxford, UK
| | - Gwenaëlle Douaud
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Saad Jbabdi
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Rogier B Mars
- Donders Institute for Brain, Cognition, & Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands; Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stamatios N Sotiropoulos
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, UK; Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham, UK.
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18
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Faizy TD, Thaler C, Broocks G, Flottmann F, Leischner H, Kniep H, Nawabi J, Schön G, Stellmann JP, Kemmling A, Reddy R, Heit JJ, Fiehler J, Kumar D, Hanning U. The Myelin Water Fraction Serves as a Marker for Age-Related Myelin Alterations in the Cerebral White Matter - A Multiparametric MRI Aging Study. Front Neurosci 2020; 14:136. [PMID: 32153358 PMCID: PMC7050496 DOI: 10.3389/fnins.2020.00136] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/03/2020] [Indexed: 12/13/2022] Open
Abstract
Quantitative MRI modalities, such as diffusion tensor imaging (DTI) or magnetization transfer imaging (MTI) are sensitive to the neuronal effects of aging of the cerebral white matter (WM), but lack the specificity for myelin content. Myelin water imaging (MWI) is highly specific for myelin and may be more sensitive for the detection of changes in myelin content inside the cerebral WM microstructure. In this multiparametric imaging study, we evaluated the performance of myelin water fraction (MWF) estimates as a marker for myelin alterations during normal-aging. Multiparametric MRI data derived from DTI, MTI and a novel, recently-proposed MWF-map processing and reconstruction algorithm were acquired from 54 healthy subjects (aged 18-79 years) and region-based multivariate regression analysis was performed. MWFs significantly decreased with age in most WM regions (except corticospinal tract) and changes of MWFs were associated with changes of radial diffusivity, indicating either substantial alterations or preservation of myelin content in these regions. Decreases of fractional anisotropy and magnetization transfer ratio were associated with lower MWFs in commissural fiber tracts only. Mean diffusivity had no regional effects on MWF. We conclude that MWF estimates are sensitive for the assessment of age-related myelin alterations in the cerebral WM of normal-aging brains.
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Affiliation(s)
- Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Leischner
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Applied Biometrics and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Kemmling
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Muenster, Münster, Germany
| | - Ravinder Reddy
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dushyant Kumar
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Beaudet G, Tsuchida A, Petit L, Tzourio C, Caspers S, Schreiber J, Pausova Z, Patel Y, Paus T, Schmidt R, Pirpamer L, Sachdev PS, Brodaty H, Kochan N, Trollor J, Wen W, Armstrong NJ, Deary IJ, Bastin ME, Wardlaw JM, Munõz Maniega S, Witte AV, Villringer A, Duering M, Debette S, Mazoyer B. Age-Related Changes of Peak Width Skeletonized Mean Diffusivity (PSMD) Across the Adult Lifespan: A Multi-Cohort Study. Front Psychiatry 2020; 11:342. [PMID: 32425831 PMCID: PMC7212692 DOI: 10.3389/fpsyt.2020.00342] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022] Open
Abstract
Parameters of water diffusion in white matter derived from diffusion-weighted imaging (DWI), such as fractional anisotropy (FA), mean, axial, and radial diffusivity (MD, AD, and RD), and more recently, peak width of skeletonized mean diffusivity (PSMD), have been proposed as potential markers of normal and pathological brain ageing. However, their relative evolution over the entire adult lifespan in healthy individuals remains partly unknown during early and late adulthood, and particularly for the PSMD index. Here, we gathered and analyzed cross-sectional diffusion tensor imaging (DTI) data from 10 population-based cohort studies in order to establish the time course of white matter water diffusion phenotypes from post-adolescence to late adulthood. DTI data were obtained from a total of 20,005 individuals aged 18.1 to 92.6 years and analyzed with the same pipeline for computing skeletonized DTI metrics from DTI maps. For each individual, MD, AD, RD, and FA mean values were computed over their FA volume skeleton, PSMD being calculated as the 90% peak width of the MD values distribution across the FA skeleton. Mean values of each DTI metric were found to strongly vary across cohorts, most likely due to major differences in DWI acquisition protocols as well as pre-processing and DTI model fitting. However, age effects on each DTI metric were found to be highly consistent across cohorts. RD, MD, and AD variations with age exhibited the same U-shape pattern, first slowly decreasing during post-adolescence until the age of 30, 40, and 50 years, respectively, then progressively increasing until late life. FA showed a reverse profile, initially increasing then continuously decreasing, slowly until the 70s, then sharply declining thereafter. By contrast, PSMD constantly increased, first slowly until the 60s, then more sharply. These results demonstrate that, in the general population, age affects PSMD in a manner different from that of other DTI metrics. The constant increase in PSMD throughout the entire adult life, including during post-adolescence, indicates that PSMD could be an early marker of the ageing process.
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Affiliation(s)
- Grégory Beaudet
- Institute of Neurodegenerative Diseases (IMN), CNRS, CEA, Bordeaux, France.,Institute of Neurodegenerative Diseases (IMN), University of Bordeaux, Bordeaux, France
| | - Ami Tsuchida
- Institute of Neurodegenerative Diseases (IMN), CNRS, CEA, Bordeaux, France.,Institute of Neurodegenerative Diseases (IMN), University of Bordeaux, Bordeaux, France
| | - Laurent Petit
- Institute of Neurodegenerative Diseases (IMN), CNRS, CEA, Bordeaux, France.,Institute of Neurodegenerative Diseases (IMN), University of Bordeaux, Bordeaux, France
| | | | - Svenja Caspers
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany.,Institute for Anatomy I, Medical Faculty, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Jan Schreiber
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany
| | - Zdenka Pausova
- Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Physiology and Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Yash Patel
- Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Physiology and Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Tomas Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Neuropsychiatric Institute Prince of Wales Hospital, Randwick, NSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Neuropsychiatric Institute Prince of Wales Hospital, Randwick, NSW, Australia
| | - Nicole Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Neuropsychiatric Institute Prince of Wales Hospital, Randwick, NSW, Australia
| | - Julian Trollor
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Neuropsychiatric Institute Prince of Wales Hospital, Randwick, NSW, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Neuropsychiatric Institute Prince of Wales Hospital, Randwick, NSW, Australia
| | | | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Susana Munõz Maniega
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - A Veronica Witte
- Departmet of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Arno Villringer
- Departmet of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Stéphanie Debette
- Institute of Neurodegenerative Diseases (IMN), University of Bordeaux, Bordeaux, France.,Bordeaux Population Health Research Center, Inserm, Bordeaux, France.,Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Bernard Mazoyer
- Institute of Neurodegenerative Diseases (IMN), CNRS, CEA, Bordeaux, France.,Institute of Neurodegenerative Diseases (IMN), University of Bordeaux, Bordeaux, France
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Quantitative age-dependent differences in human brainstem myelination assessed using high-resolution magnetic resonance mapping. Neuroimage 2019; 206:116307. [PMID: 31669302 DOI: 10.1016/j.neuroimage.2019.116307] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022] Open
Abstract
Previous in-vivo magnetic resonance imaging (MRI)-based studies of age-related differences in the human brainstem have focused on volumetric morphometry. These investigations have provided pivotal insights into regional brainstem atrophy but have not addressed microstructural age differences. However, growing evidence indicates the sensitivity of quantitative MRI to microstructural tissue changes in the brain. These studies have largely focused on the cerebrum, with very few MR investigations addressing age-dependent differences in the brainstem, in spite of its central role in the regulation of vital functions. Several studies indicate early brainstem alterations in a myriad of neurodegenerative diseases and dementias. The paucity of MR-focused investigations is likely due in part to the challenges imposed by the small structural scale of the brainstem itself as well as of substructures within, requiring accurate high spatial resolution imaging studies. In this work, we applied our recently developed approach to high-resolution myelin water fraction (MWF) mapping, a proxy for myelin content, to investigate myelin differences with normal aging within the brainstem. In this cross-sectional investigation, we studied a large cohort (n = 125) of cognitively unimpaired participants spanning a wide age range (21-94 years) and found a decrease in myelination with age in most brainstem regions studied, with several regions exhibiting a quadratic association between myelin and age. We believe that this study is the first investigation of MWF differences with normative aging in the adult brainstem. Further, our results provide reference MWF values.
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Pareek V, Rallabandi VS, Roy PK. A Correlational Study between Microstructural White Matter Properties and Macrostructural Gray Matter Volume Across Normal Ageing: Conjoint DTI and VBM Analysis. MAGNETIC RESONANCE INSIGHTS 2018; 11:1178623X18799926. [PMID: 30349289 PMCID: PMC6194920 DOI: 10.1177/1178623x18799926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 07/08/2018] [Indexed: 11/17/2022]
Abstract
We investigate the relationship between Gray matter’s volume vis-a-vis White matter’s integrity indices, such Axial diffusivity, Radial diffusivity, Mean diffusivity, and Fractional anisotropy, in individuals undergoing healthy aging. We investigated MRI scans of 177 adults across 20 to 85 years. We used Voxel-based morphometry, and FDT-FSL analysis for estimation of Gray matter volume and White matter’s diffusion indices respectively. Across the life span, we observed an inter-relationship between the Gray matter and White matter, namely that both Axial diffusivity and Mean Diffusivity show strong correlation with Gray matter volume, along the aging process. Furthermore, across all ages the Fractional anisotropy and Mean diffusivity are found to be significantly reduced in females when compared to males, but there are no significant gender differences in Axial Diffusivity and Radial diffusivity. We conclude that for both genders across all ages, the Gray matter’s Volume is strongly correlated with White matter’s Axial Diffusivity and Mean Diffusivity, while being weakly correlated with Fractional Anisotropy. Our study clarifies the multi-scale relationship in brain tissue, by elucidating how the White matter’s micro-structural parameters influences the Gray matter’s macro-structural characteristics, during healthy aging across the life-span.
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Affiliation(s)
- Vikas Pareek
- National Neuroimaging Facility, National Brain Research Centre, Manesar, India
| | | | - Prasun K Roy
- Computational Neuroscience & Neuro-Imaging Laboratory, School of Biomedical Engineering, Indian Institute of Technology (BHU), Varanasi, India
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The Lifespan Trajectory of the Encoding-Retrieval Flip: A Multimodal Examination of Medial Parietal Cortex Contributions to Episodic Memory. J Neurosci 2018; 38:8666-8679. [PMID: 30143571 DOI: 10.1523/jneurosci.1702-17.2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 06/21/2018] [Accepted: 06/23/2018] [Indexed: 11/21/2022] Open
Abstract
The formation of episodic memories is associated with deactivation during encoding and activation during retrieval in the posteromedial cortex (PMC). We hypothesized that the encoding/retrieval (E/R) flip is a critical component of episodic memory across the lifespan because structural and metabolic changes in the PMC coincide with the fine tuning of the episodic memory system in development and the reductions of memory performance in aging. The aims of the present study were, first, to describe lifespan trajectories of PMC encoding and retrieval activity in 270 human participants (167 females) from 6 to 80 years of age. Our second goal was to construct a model for episodic memory development in which contributions from brain activity, cortical thickness (CT), and structural connectivity are accounted for. We found that modulation of neural activity in response to memory encoding and retrieval demands was not fully developed until adolescence and decreased from adulthood through old age. The magnitude of the E/R flip was related to source memory and 55% of the age-related variance in source memory performance during childhood and adolescence could be accounted for by the E/R flip, CT, and mean diffusivity together. However, only CT and the E/R flip provided unique contributions with which to explain memory performance. The results suggest that neural dynamics in the PMC is related to the development of episodic memory during childhood and adolescence. The similar trajectories of the E/R flip and episodic memory emergence and decline through development and aging further suggests that a lifelong relationship exists.SIGNIFICANCE STATEMENT Modulation of neural activity in the posteromedial cortex (PMC) in response to memory encoding/retrieval (E/R) demands (E/R flip) does not reach its peak until adolescence and decreases from adulthood through old age. The magnitude of the E/R flip is related to source memory and 55% of the age-related variance in source memory performance during childhood and adolescence can be accounted for by the E/R flip and brain structure together. The results suggest that neural dynamics in the PMC is related to the development of episodic memory function during childhood and adolescence and the similar trajectories of the E/R flip and episodic memory performance through development and aging suggests that a lifelong relationship exists.
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Hirsiger S, Koppelmans V, Mérillat S, Erdin C, Narkhede A, Brickman AM, Jäncke L. Executive Functions in Healthy Older Adults Are Differentially Related to Macro- and Microstructural White Matter Characteristics of the Cerebral Lobes. Front Aging Neurosci 2017; 9:373. [PMID: 29249957 PMCID: PMC5715235 DOI: 10.3389/fnagi.2017.00373] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/31/2017] [Indexed: 01/13/2023] Open
Abstract
Aging is associated with microstructural white matter (WM) changes. WM microstructural characteristics, measured with diffusion tensor imaging (DTI), are different in normal appearing white matter (NAWM) and WM hyperintensities (WMH). It is largely unknown how the microstructural properties of WMH are associated with cognition and if there are regional effects for specific cognitive domains. We therefore examined within 200 healthy older participants (a) differences in microstructural characteristics of NAWM and WMH per cerebral lobe; and (b) the association of macrostructural (WMH volume) and microstructural characteristics (within NAWM and WMH separately) of each lobe with measures of executive function and processing speed. Multi-modal imaging (i.e., T1, DTI, and FLAIR) was used to assess WM properties. The Stroop and the Trail Making Test were used to measure inhibition, task-switching (both components of executive function), and processing speed. We observed that age was associated with deterioration of white matter microstructure of the NAWM, most notably in the frontal lobe. Older participants had larger WMH volumes and lowest fractional anisotropy values within WMH were found in the frontal lobe. Task-switching was associated with cerebral NAWM volume and NAWM volume of all lobes. Processing speed was associated with total NAWM volume, and microstructural properties of parietal NAWM, the parietal WMH, and the temporal NAWM. Task-switching was related to microstructural properties of WMH of the frontal lobe and WMH volume of the parietal lobe. Our results confirm that executive functioning and processing speed are uniquely associated with macro- and microstructural properties of NAWM and WMH. We further demonstrate for the first time that these relationships differ by lobar region. This warrants the consideration of these distinct WM indices when investigating cognitive function.
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Affiliation(s)
- Sarah Hirsiger
- International Normal Aging and Plasticity Imaging Center, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Vincent Koppelmans
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States.,School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Susan Mérillat
- International Normal Aging and Plasticity Imaging Center, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Cornelia Erdin
- International Normal Aging and Plasticity Imaging Center, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Atul Narkhede
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Lutz Jäncke
- International Normal Aging and Plasticity Imaging Center, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.,Division of Neuropsychology, University of Zurich, Zurich, Switzerland.,Department of Special Education, King Abdulaziz University, Jeddah, Saudi Arabia
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McWhinney SR, Tremblay A, Chevalier TM, Lim VK, Newman AJ. Using CForest to Analyze Diffusion Tensor Imaging Data: A Study of White Matter Integrity in Healthy Aging. Brain Connect 2016; 6:747-758. [DOI: 10.1089/brain.2016.0451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sean R. McWhinney
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
| | - Antoine Tremblay
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
- Department of Linguistics, Saint Mary's University, Halifax, Canada
- NovaScape Data Analysis and Consulting, Halifax, Canada
| | | | - Vanessa K. Lim
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Aaron J. Newman
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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