1
|
Csiszar A, Ungvari A, Patai R, Gulej R, Yabluchanskiy A, Benyo Z, Kovacs I, Sotonyi P, Kirkpartrick AC, Prodan CI, Liotta EM, Zhang XA, Toth P, Tarantini S, Sorond FA, Ungvari Z. Atherosclerotic burden and cerebral small vessel disease: exploring the link through microvascular aging and cerebral microhemorrhages. GeroScience 2024:10.1007/s11357-024-01139-7. [PMID: 38639833 DOI: 10.1007/s11357-024-01139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Cerebral microhemorrhages (CMHs, also known as cerebral microbleeds) are a critical but frequently underestimated aspect of cerebral small vessel disease (CSVD), bearing substantial clinical consequences. Detectable through sensitive neuroimaging techniques, CMHs reveal an extensive pathological landscape. They are prevalent in the aging population, with multiple CMHs often being observed in a given individual. CMHs are closely associated with accelerated cognitive decline and are increasingly recognized as key contributors to the pathogenesis of vascular cognitive impairment and dementia (VCID) and Alzheimer's disease (AD). This review paper delves into the hypothesis that atherosclerosis, a prevalent age-related large vessel disease, extends its pathological influence into the cerebral microcirculation, thereby contributing to the development and progression of CSVD, with a specific focus on CMHs. We explore the concept of vascular aging as a continuum, bridging macrovascular pathologies like atherosclerosis with microvascular abnormalities characteristic of CSVD. We posit that the same risk factors precipitating accelerated aging in large vessels (i.e., atherogenesis), primarily through oxidative stress and inflammatory pathways, similarly instigate accelerated microvascular aging. Accelerated microvascular aging leads to increased microvascular fragility, which in turn predisposes to the formation of CMHs. The presence of hypertension and amyloid pathology further intensifies this process. We comprehensively overview the current body of evidence supporting this interconnected vascular hypothesis. Our review includes an examination of epidemiological data, which provides insights into the prevalence and impact of CMHs in the context of atherosclerosis and CSVD. Furthermore, we explore the shared mechanisms between large vessel aging, atherogenesis, microvascular aging, and CSVD, particularly focusing on how these intertwined processes contribute to the genesis of CMHs. By highlighting the role of vascular aging in the pathophysiology of CMHs, this review seeks to enhance the understanding of CSVD and its links to systemic vascular disorders. Our aim is to provide insights that could inform future therapeutic approaches and research directions in the realm of neurovascular health.
Collapse
Affiliation(s)
- Anna Csiszar
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anna Ungvari
- Department of Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary.
| | - Roland Patai
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rafal Gulej
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Zoltan Benyo
- Institute of Translational Medicine, Semmelweis University, 1094, Budapest, Hungary
- Cerebrovascular and Neurocognitive Disorders Research Group, HUN-REN, Semmelweis University, 1094, Budapest, Hungary
| | - Illes Kovacs
- Department of Ophthalmology, Semmelweis University, 1085, Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Peter Sotonyi
- Department of Vascular and Endovascular Surgery, Heart and Vascular Centre, Semmelweis University, 1122, Budapest, Hungary
| | - Angelia C Kirkpartrick
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin I Prodan
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Eric M Liotta
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Xin A Zhang
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Peter Toth
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
- Neurotrauma Research Group, Szentagothai Research Centre, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Farzaneh A Sorond
- Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
| |
Collapse
|
2
|
Mukli P, Pinto CB, Owens CD, Csipo T, Lipecz A, Szarvas Z, Peterfi A, Langley ACDCP, Hoffmeister J, Racz FS, Perry JW, Tarantini S, Nyúl-Tóth Á, Sorond FA, Yang Y, James JA, Kirkpatrick AC, Prodan CI, Toth P, Galindo J, Gardner AW, Sonntag WE, Csiszar A, Ungvari Z, Yabluchanskiy A. Impaired Neurovascular Coupling and Increased Functional Connectivity in the Frontal Cortex Predict Age-Related Cognitive Dysfunction. Adv Sci (Weinh) 2024; 11:e2303516. [PMID: 38155460 PMCID: PMC10962492 DOI: 10.1002/advs.202303516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/19/2023] [Indexed: 12/30/2023]
Abstract
Impaired cerebrovascular function contributes to the genesis of age-related cognitive decline. In this study, the hypothesis is tested that impairments in neurovascular coupling (NVC) responses and brain network function predict cognitive dysfunction in older adults. Cerebromicrovascular and working memory function of healthy young (n = 21, 33.2±7.0 years) and aged (n = 30, 75.9±6.9 years) participants are assessed. To determine NVC responses and functional connectivity (FC) during a working memory (n-back) paradigm, oxy- and deoxyhemoglobin concentration changes from the frontal cortex using functional near-infrared spectroscopy are recorded. NVC responses are significantly impaired during the 2-back task in aged participants, while the frontal networks are characterized by higher local and global connection strength, and dynamic FC (p < 0.05). Both impaired NVC and increased FC correlate with age-related decline in accuracy during the 2-back task. These findings suggest that task-related brain states in older adults require stronger functional connections to compensate for the attenuated NVC responses associated with working memory load.
Collapse
Affiliation(s)
- Peter Mukli
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, H-1094, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Camila B Pinto
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
| | - Cameron D Owens
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
| | - Tamas Csipo
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Agnes Lipecz
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Zsofia Szarvas
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Anna Peterfi
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Ana Clara da Costa Pinaffi Langley
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
| | - Jordan Hoffmeister
- Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Frigyes Samuel Racz
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, H-1094, Hungary
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, 78712, USA
| | - Jonathan W Perry
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
| | - Stefano Tarantini
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Ádám Nyúl-Tóth
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Farzaneh A Sorond
- Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Yuan Yang
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Tulsa, OK, 73019, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Rehabilitation Sciences, University of Oklahoma Health Science Center, Oklahoma City, OK, 73117, USA
| | - Judith A James
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK, 73104, USA
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | | | - Calin I Prodan
- Veterans Affairs Medical Center, Oklahoma City, OK, 73104, USA
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Peter Toth
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, H-7623, Hungary
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, H-7624, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, H-7624, Hungary
| | - Juliette Galindo
- Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, USA
| | - William E Sonntag
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
| | - Anna Csiszar
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Zoltan Ungvari
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Andriy Yabluchanskiy
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| |
Collapse
|
3
|
Krefman AE, Stephen J, Carolan P, Sedaghat S, Mansolf M, Soumare A, Gross AL, Aiello AE, Singh-Manoux A, Ikram MA, Helmer C, Tzourio C, Satizabal C, Levine DA, Lloyd-Jones D, Briceño EM, Sorond FA, Wolters FJ, Himali J, Launer LJ, Zhao L, Haan M, Lopez OL, Debette S, Seshadri S, Judd SE, Hughes TM, Gudnason V, Scholtens D, Allen NB. Cohort Profile: Dementia Risk Prediction Project (DRPP). Int J Epidemiol 2024; 53:dyae012. [PMID: 38339864 PMCID: PMC10858348 DOI: 10.1093/ije/dyae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Affiliation(s)
- Amy E Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Stephen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Padraig Carolan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maxwell Mansolf
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aïcha Soumare
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison E Aiello
- Robert N Butler Columbia Aging Center and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, Bordeaux, France
| | - Claudia Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily M Briceño
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Farzaneh A Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Departments of Radiology & Nuclear Medicine, and Alzheimer Centre Erasmus MC, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jayandra Himali
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Haan
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Oscar L Lopez
- Departments of Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stéphanie Debette
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy M Hughes
- Departments of Internal Medicine and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
4
|
Romay MC, Knutsen RH, Ma F, Mompeón A, Hernandez GE, Salvador J, Mirkov S, Batra A, Sullivan DP, Procissi D, Buchanan S, Kronquist E, Ferrante EA, Muller WA, Walshon J, Steffens A, McCortney K, Horbinski C, Tournier‑Lasserve E, Sonabend AM, Sorond FA, Wang MM, Boehm M, Kozel BA, Iruela-Arispe ML. Age-related loss of Notch3 underlies brain vascular contractility deficiencies, glymphatic dysfunction, and neurodegeneration in mice. J Clin Invest 2024; 134:e166134. [PMID: 38015629 PMCID: PMC10786701 DOI: 10.1172/jci166134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
Vascular aging affects multiple organ systems, including the brain, where it can lead to vascular dementia. However, a concrete understanding of how aging specifically affects the brain vasculature, along with molecular readouts, remains vastly incomplete. Here, we demonstrate that aging is associated with a marked decline in Notch3 signaling in both murine and human brain vessels. To clarify the consequences of Notch3 loss in the brain vasculature, we used single-cell transcriptomics and found that Notch3 inactivation alters regulation of calcium and contractile function and promotes a notable increase in extracellular matrix. These alterations adversely impact vascular reactivity, manifesting as dilation, tortuosity, microaneurysms, and decreased cerebral blood flow, as observed by MRI. Combined, these vascular impairments hinder glymphatic flow and result in buildup of glycosaminoglycans within the brain parenchyma. Remarkably, this phenomenon mirrors a key pathological feature found in brains of patients with CADASIL, a hereditary vascular dementia associated with NOTCH3 missense mutations. Additionally, single-cell RNA sequencing of the neuronal compartment in aging Notch3-null mice unveiled patterns reminiscent of those observed in neurodegenerative diseases. These findings offer direct evidence that age-related NOTCH3 deficiencies trigger a progressive decline in vascular function, subsequently affecting glymphatic flow and culminating in neurodegeneration.
Collapse
Affiliation(s)
- Milagros C. Romay
- Department of Cell and Development Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Feiyang Ma
- Department of Cell and Development Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ana Mompeón
- Department of Cell and Development Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gloria E. Hernandez
- Department of Cell and Development Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Jocelynda Salvador
- Department of Cell and Development Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Snezana Mirkov
- Department of Cell and Development Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ayush Batra
- Department of Pathology
- Department of Neurology, and
| | | | - Daniele Procissi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Samuel Buchanan
- Department of Cell and Development Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elise Kronquist
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Elisa A. Ferrante
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
- Laboratory of Cardiovascular Regenerative Medicine, NIH, Bethesda, Maryland, USA
| | | | - Jordain Walshon
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alicia Steffens
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kathleen McCortney
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Craig Horbinski
- Department of Pathology
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elisabeth Tournier‑Lasserve
- Inserm NeuroDiderot, Université Paris Cité, Paris, France
- Service de Génétique Neurovasculaire, Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Adam M. Sonabend
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Northwestern Medicine Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Michael M. Wang
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Manfred Boehm
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
- Laboratory of Cardiovascular Regenerative Medicine, NIH, Bethesda, Maryland, USA
| | - Beth A. Kozel
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
| | - M. Luisa Iruela-Arispe
- Department of Cell and Development Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
5
|
Stulberg EL, Sachdev PS, Murray AM, Cramer SC, Sorond FA, Lakshminarayan K, Sabayan B. Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review. J Clin Med 2023; 12:7413. [PMID: 38068464 PMCID: PMC10706919 DOI: 10.3390/jcm12237413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 01/22/2024] Open
Abstract
Significant advancements have been made in recent years in the acute treatment and secondary prevention of stroke. However, a large proportion of stroke survivors will go on to have enduring physical, cognitive, and psychological disabilities from suboptimal post-stroke brain health. Impaired brain health following stroke thus warrants increased attention from clinicians and researchers alike. In this narrative review based on an open timeframe search of the PubMed, Scopus, and Web of Science databases, we define post-stroke brain health and appraise the body of research focused on modifiable vascular, lifestyle, and psychosocial factors for optimizing post-stroke brain health. In addition, we make clinical recommendations for the monitoring and management of post-stroke brain health at major post-stroke transition points centered on four key intertwined domains: cognition, psychosocial health, physical functioning, and global vascular health. Finally, we discuss potential future work in the field of post-stroke brain health, including the use of remote monitoring and interventions, neuromodulation, multi-morbidity interventions, enriched environments, and the need to address inequities in post-stroke brain health. As post-stroke brain health is a relatively new, rapidly evolving, and broad clinical and research field, this narrative review aims to identify and summarize the evidence base to help clinicians and researchers tailor their own approach to integrating post-stroke brain health into their practices.
Collapse
Affiliation(s)
- Eric L. Stulberg
- Department of Neurology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW 2052, Australia;
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Minneapolis, MN 55415, USA;
- Department of Medicine, Geriatrics Division, Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
| | - Steven C. Cramer
- Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA;
- California Rehabilitation Institute, Los Angeles, CA 90067, USA
| | - Farzaneh A. Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Behnam Sabayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Neurology, Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
| |
Collapse
|
6
|
Stamm B, Lineback CM, Tang M, Jia DT, Chrenka E, Sorond FA, Sabayan B. Diffusion Restriction in the Splenium: A Comparative Study of Cytotoxic Lesions of the Corpus Callosum (CLOCCs) versus Lesions of Vascular Etiology. J Clin Med 2023; 12:6979. [PMID: 38002594 PMCID: PMC10671863 DOI: 10.3390/jcm12226979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Cytotoxic lesions of the corpus callosum (CLOCCs) have broad differential diagnoses. Differentiating these lesions from lesions of vascular etiology is of high clinical significance. We compared the clinical and radiological characteristics and outcomes between vascular splenial lesions and CLOCCs in a retrospective cohort study. We examined the clinical and radiologic characteristics and outcomes in 155 patients with diffusion restriction in the splenium of the corpus callosum. Patients with lesions attributed to a vascular etiology (N = 124) were older (64.1 vs. 34.6 years old, p < 0.001) and had >1 vascular risk factor (91.1% vs. 45.2%, p < 0.001), higher LDL and A1c levels, and echocardiographic abnormalities (all p ≤ 0.05). CLOCCs (N = 31) more commonly had midline splenial involvement (p < 0.001) with only splenial diffusion restriction (p < 0.001), whereas vascular etiology lesions were more likely to have multifocal areas of diffusion restriction (p = 0.002). The rate of in-hospital mortality was significantly higher in patients with vascular etiology lesions (p = 0.04). Across vascular etiology lesions, cardio-embolism was the most frequent stroke mechanism (29.8%). Our study shows that corpus callosum diffusion restricted lesions of vascular etiology and CLOCCs are associated with different baseline, clinical, and radiological characteristics and outcomes. Accurately differentiating these lesions is important for appropriate treatment and secondary prevention.
Collapse
Affiliation(s)
- Brian Stamm
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Mengxuan Tang
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55415, USA
| | - Dan Tong Jia
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Ella Chrenka
- Healthpartners Institute, Healthpartners, Bloomington, MN 55425, USA
| | - Farzaneh A. Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Behnam Sabayan
- Hennepin Healthcare Research Institute, Department of Neurology, Hennepin County Medical Center, Minneapolis, MN 55404, USA
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| |
Collapse
|
7
|
Affiliation(s)
- Philip B Gorelick
- Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| |
Collapse
|
8
|
Abstract
The call to optimize brain health is now a local, regional and global priority. Organizations such as the World Health Organization, Centers for Disease Control and Prevention and Alzheimer's Association, American Academy of Neurology, World Federation of Neurology, and others have developed recommendations for the maintenance of brain health. Brain health definitions range from broad to narrow in scope and may focus on cognition or encompass broader core components such as cerebral, mental and social domains. In this manuscript we will explore various definitions of brain health and its core components, the importance of cognitive and functional domains, and briefly introduce the concept of cognitive medicine in the context of brain health.
Collapse
Affiliation(s)
- Philip B. Gorelick
- Davee Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625N. Michigan Avenue Suite 1150, Chicago, IL 60611, USA
| | - Farzaneh A. Sorond
- Davee Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625N. Michigan Avenue Suite 1150, Chicago, IL 60611, USA
| |
Collapse
|
9
|
Abstract
INTRODUCTION We assessed the association between visit-to-visit blood pressure variability (BPV) up to 12 years and subsequent dementia risk, and tested the modifying effect of antihypertensive medications. METHODS We studied 2234 participants from two community-based cohorts of older adults with normal cognition or mild cognitive impairment. Participants were followed through annual assessments for up to 27 years. Visit-to-visit BPV was quantified over 3, 6, 9, and 12 years, respectively. RESULTS Higher systolic BPV (SBPV) during 3, 6, 9, and 12 years was associated with a subsequent increased risk of dementia, with hazard ratios ranging from 1.02 (95% confidence interval [CI]: 1.01-1.04) to 1.10 (95% CI: 1.05-1.16). The association between SBPV and dementia risk was stronger among participants not taking calcium channel blockers (p-for interaction < 0.05). DISCUSSION Among older adults, long-term exposure to higher visit-to-visit SBPV is associated with an increased risk of dementia later in life, and calcium channel blockers may modify this association. HIGHLIGHTS Among adults aged >65, higher systolic blood pressure variability spanning 3-12 years is associated with an increased risk of dementia later in life. Single blood pressure measurement or mean blood pressure levels does not seem to associate with dementia risk among older adults. The association between systolic blood pressure variability and dementia risk is stronger among those not taking calcium channel blocker medications.
Collapse
Affiliation(s)
- Simin Mahinrad
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David A. Bennett
- Department of Neurological Sciences and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Farzaneh A. Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Philip B. Gorelick
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
10
|
Sabayan B, Doyle S, Rost NS, Sorond FA, Lakshminarayan K, Launer LJ. The role of population-level preventive care for brain health in ageing. Lancet Healthy Longev 2023; 4:e274-e283. [PMID: 37201543 PMCID: PMC10339354 DOI: 10.1016/s2666-7568(23)00051-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 05/20/2023] Open
Abstract
Over the past several decades, a worldwide demographic transition has led to an increasing number of older adults with chronic neurological conditions. These conditions, which have a profound effect on the cognitive function and physical ability of older adults, also have a long preclinical phase. This feature provides a unique opportunity to implement preventive measures for high-risk groups and the population as a whole, and therefore to reduce the burden of neurological diseases. The concept of brain health has emerged as the overarching theme to define overall brain function independently of underlying pathophysiological processes. We review the concept of brain health from the ageing and preventive care perspectives, discuss the mechanisms underpinning ageing and brain ageing, highlight the interplay of various forces resulting in deviation from brain health towards brain disease, and provide an overview of strategies to promote brain health with a life-course approach.
Collapse
Affiliation(s)
- Behnam Sabayan
- Department of Neurology, HealthPartners Neuroscience Center, St Paul, MN, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Sara Doyle
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Farzaneh A Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| |
Collapse
|
11
|
Iadecola C, Smith EE, Anrather J, Gu C, Mishra A, Misra S, Perez-Pinzon MA, Shih AY, Sorond FA, van Veluw SJ, Wellington CL. The Neurovasculome: Key Roles in Brain Health and Cognitive Impairment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2023; 54:e251-e271. [PMID: 37009740 PMCID: PMC10228567 DOI: 10.1161/str.0000000000000431] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Preservation of brain health has emerged as a leading public health priority for the aging world population. Advances in neurovascular biology have revealed an intricate relationship among brain cells, meninges, and the hematic and lymphatic vasculature (the neurovasculome) that is highly relevant to the maintenance of cognitive function. In this scientific statement, a multidisciplinary team of experts examines these advances, assesses their relevance to brain health and disease, identifies knowledge gaps, and provides future directions. METHODS Authors with relevant expertise were selected in accordance with the American Heart Association conflict-of-interest management policy. They were assigned topics pertaining to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS The neurovasculome, composed of extracranial, intracranial, and meningeal vessels, as well as lymphatics and associated cells, subserves critical homeostatic functions vital for brain health. These include delivering O2 and nutrients through blood flow and regulating immune trafficking, as well as clearing pathogenic proteins through perivascular spaces and dural lymphatics. Single-cell omics technologies have unveiled an unprecedented molecular heterogeneity in the cellular components of the neurovasculome and have identified novel reciprocal interactions with brain cells. The evidence suggests a previously unappreciated diversity of the pathogenic mechanisms by which disruption of the neurovasculome contributes to cognitive dysfunction in neurovascular and neurodegenerative diseases, providing new opportunities for the prevention, recognition, and treatment of these conditions. CONCLUSIONS These advances shed new light on the symbiotic relationship between the brain and its vessels and promise to provide new diagnostic and therapeutic approaches for brain disorders associated with cognitive dysfunction.
Collapse
|
12
|
Chow FC, Zhao F, He Y, Song X, Zhang J, Ao D, Wu Y, Hou B, Sorond FA, Ances BM, Letendre S, Heaton RK, Shi C, Feng F, Zhu Y, Wang H, Li T. Brief Report: Sex Differences in the Association Between Cerebrovascular Function and Cognitive Health in People Living With HIV in Urban China. J Acquir Immune Defic Syndr 2023; 92:217-222. [PMID: 36318881 DOI: 10.1097/qai.0000000000003127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiometabolic and cerebrovascular disease are strong independent contributors to cognitive impairment in people living with HIV. Data suggest that cardiovascular risk may play a greater role in cognitive health in women than in men with HIV. METHODS We performed a cross-sectional study of 104 participants with virologically suppressed HIV from 2 clinics in urban China. Participants underwent neuropsychological testing from which we calculated T scores globally and in 5 cognitive domains. We assessed cerebral vasoreactivity of the middle cerebral arteries in response to breath holding. We constructed linear regression models to determine associations between cerebrovascular and cognitive function overall and stratified by sex. RESULTS Women were younger than men (48 versus 51 years, P = 0.053), had fewer years of education (9 years versus 12 years, P = 0.004), and fewer cardiometabolic risk factors (0 versus 1 factor, P = 0.008). In a model with all participants, cerebrovascular function was significantly associated with global cognition (2.74 higher T score per 1-point higher cerebral vasoreactivity [SE 1.30], P = 0.037). Cerebrovascular function remained significantly associated with global cognition among women (4.15 higher T score [SE 1.78], P = 0.028) but not men (1.70 higher T score [SE 1.74], P = 0.33). The relationships between cerebrovascular function and specific cognitive domains followed a similar pattern, with significant associations present among women but not men. CONCLUSIONS Women with well-controlled HIV may be more vulnerable to the effect of cerebrovascular injury on cognitive health than men. Studies evaluating strategies to protect against cognitive impairment in people living with HIV should include adequate representation of women and stratification of analyses by sex.
Collapse
Affiliation(s)
- Felicia C Chow
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA
| | - Fang Zhao
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Yun He
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Xiaojing Song
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangxia Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Donghui Ao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuchen Wu
- Department of Hematology, Tiantan Hospital, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Beau M Ances
- Department of Neurology and Hope Center for Neurological Disorders, Washington University, St. Louis, MO
| | - Scott Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Chuan Shi
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China; and
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanling Wang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
13
|
Yang Y, Knol MJ, Wang R, Mishra A, Liu D, Luciano M, Teumer A, Armstrong N, Bis JC, Jhun MA, Li S, Adams HHH, Aziz NA, Bastin ME, Bourgey M, Brody JA, Frenzel S, Gottesman RF, Hosten N, Hou L, Kardia SLR, Lohner V, Marquis P, Maniega SM, Satizabal CL, Sorond FA, Valdés Hernández MC, van Duijn CM, Vernooij MW, Wittfeld K, Yang Q, Zhao W, Boerwinkle E, Levy D, Deary IJ, Jiang J, Mather KA, Mosley TH, Psaty BM, Sachdev PS, Smith JA, Sotoodehnia N, DeCarli CS, Breteler MMB, Ikram MA, Grabe HJ, Wardlaw J, Longstreth WT, Launer LJ, Seshadri S, Debette S, Fornage M. Epigenetic and integrative cross-omics analyses of cerebral white matter hyperintensities on MRI. Brain 2023; 146:492-506. [PMID: 35943854 PMCID: PMC9924914 DOI: 10.1093/brain/awac290] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Cerebral white matter hyperintensities on MRI are markers of cerebral small vessel disease, a major risk factor for dementia and stroke. Despite the successful identification of multiple genetic variants associated with this highly heritable condition, its genetic architecture remains incompletely understood. More specifically, the role of DNA methylation has received little attention. We investigated the association between white matter hyperintensity burden and DNA methylation in blood at ∼450 000 cytosine-phosphate-guanine (CpG) sites in 9732 middle-aged to older adults from 14 community-based studies. Single CpG and region-based association analyses were carried out. Functional annotation and integrative cross-omics analyses were performed to identify novel genes underlying the relationship between DNA methylation and white matter hyperintensities. We identified 12 single CpG and 46 region-based DNA methylation associations with white matter hyperintensity burden. Our top discovery single CpG, cg24202936 (P = 7.6 × 10-8), was associated with F2 expression in blood (P = 6.4 × 10-5) and co-localized with FOLH1 expression in brain (posterior probability = 0.75). Our top differentially methylated regions were in PRMT1 and in CCDC144NL-AS1, which were also represented in single CpG associations (cg17417856 and cg06809326, respectively). Through Mendelian randomization analyses cg06809326 was putatively associated with white matter hyperintensity burden (P = 0.03) and expression of CCDC144NL-AS1 possibly mediated this association. Differentially methylated region analysis, joint epigenetic association analysis and multi-omics co-localization analysis consistently identified a role of DNA methylation near SH3PXD2A, a locus previously identified in genome-wide association studies of white matter hyperintensities. Gene set enrichment analyses revealed functions of the identified DNA methylation loci in the blood-brain barrier and in the immune response. Integrative cross-omics analysis identified 19 key regulatory genes in two networks related to extracellular matrix organization, and lipid and lipoprotein metabolism. A drug-repositioning analysis indicated antihyperlipidaemic agents, more specifically peroxisome proliferator-activated receptor-alpha, as possible target drugs for white matter hyperintensities. Our epigenome-wide association study and integrative cross-omics analyses implicate novel genes influencing white matter hyperintensity burden, which converged on pathways related to the immune response and to a compromised blood-brain barrier possibly due to disrupted cell-cell and cell-extracellular matrix interactions. The results also suggest that antihyperlipidaemic therapy may contribute to lowering risk for white matter hyperintensities possibly through protection against blood-brain barrier disruption.
Collapse
Affiliation(s)
- Yunju Yang
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science at Houston, Houston, TX 77030, USA
| | - Maria J Knol
- Department of Epidemiology, Erasmus MC University Medical Center, 3015 GD, Rotterdam, The Netherlands
| | - Ruiqi Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Aniket Mishra
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, F-33000 Bordeaux, France
| | - Dan Liu
- Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Michelle Luciano
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9JZ, UK
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald 17475, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald 17475, Germany
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Bialystok, 15-269, Poland
| | - Nicola Armstrong
- Mathematics and Statistics, Curtin University, 6845 Perth, Australia
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 02115, USA
| | - Min A Jhun
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA
| | - Shuo Li
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Hieab H H Adams
- Department of Epidemiology, Erasmus MC University Medical Center, 3015 GD, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, 3015 GD, Rotterdam, The Netherlands
| | - Nasir Ahmad Aziz
- Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurology, Faculty of Medicine, University of Bonn, 53127 Bonn, Germany
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, EH8 9AB, UK
| | - Mathieu Bourgey
- Canadian Centre for Computational Genomics, McGill University, Montréal, Quebec, Canada H3A 0G1
- Department for Human Genetics, McGill University Genome Centre, McGill University, Montréal, Quebec, Canada H3A 0G1
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 02115, USA
| | - Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald 17475, Germany
| | - Rebecca F Gottesman
- Stroke Branch, National Institutes of Neurological Disorders and Stroke, Bethesda, MD 20814, USA
| | - Norbert Hosten
- Department of Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA
| | - Valerie Lohner
- Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Pascale Marquis
- Canadian Centre for Computational Genomics, McGill University, Montréal, Quebec, Canada H3A 0G1
- Department for Human Genetics, McGill University Genome Centre, McGill University, Montréal, Quebec, Canada H3A 0G1
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, EH8 9AB, UK
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX 78229, USA
- The Framingham Heart Study, Framingham, MA 01701, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 02115, USA
| | - Farzaneh A Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Maria C Valdés Hernández
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, EH8 9AB, UK
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC University Medical Center, 3015 GD, Rotterdam, The Netherlands
- Nuffield Department of Population Health, Oxford University, Oxford, OX3 7LF, UK
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, 3015 GD, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, 3015 GD, Rotterdam, The Netherlands
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald 17475, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17475 Rostock, Germany
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
- The Framingham Heart Study, Framingham, MA 01701, USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA
| | - Eric Boerwinkle
- Human Genetics Center, School of Public Health, University of Texas Health Science at Houston, Houston, TX 77030, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Daniel Levy
- The Framingham Heart Study, Framingham, MA 01701, USA
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20814, USA
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9JZ, UK
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Karen A Mather
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
- Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Thomas H Mosley
- The Memory Impairment Neurodegenerative Dementia (MIND) Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 02115, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98104, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
- Neuropsychiatric Institute, The Prince of Wales Hospital, University of New South Wales, Randwick, NSW 2031, Australia
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 02115, USA
| | - Charles S DeCarli
- Department of Neurology and Center for Neuroscience, University of California at Davis, Sacramento, CA 95816, USA
| | - Monique M B Breteler
- Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, 53127 Bonn, Germany
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, 3015 GD, Rotterdam, The Netherlands
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald 17475, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17475 Rostock, Germany
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, EH8 9AB, UK
| | - W T Longstreth
- Department of Epidemiology, University of Washington, Seattle, WA 98104, USA
- Department of Neurology, University of Washington, Seattle, WA 98104, USA
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD 20814, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX 78229, USA
- The Framingham Heart Study, Framingham, MA 01701, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 02115, USA
| | - Stephanie Debette
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, F-33000 Bordeaux, France
- Department of Neurology, Boston University School of Medicine, Boston, MA 02115, USA
- CHU de Bordeaux, Department of Neurology, F-33000 Bordeaux, France
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science at Houston, Houston, TX 77030, USA
- Human Genetics Center, School of Public Health, University of Texas Health Science at Houston, Houston, TX 77030, USA
| |
Collapse
|
14
|
Stamm B, Chrenka E, Lineback C, Tang M, Jia DT, Sorond FA, Sabayan B. Abstract WP105: Diffusion Restriction In The Splenium: A Comparative Study Of Cytotoxic Lesions Of The Corpus Callosum (CLOCCs) Versus Vascular Lesions. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Diffusion restriction within the splenium of the corpus callosum poses a clinical challenge. Whereas cytotoxic lesions of the corpus callosum (CLOCC) have broad differential diagnoses and often favorable prognosis, vascular splenial lesions may require acute stroke evaluation and initiation of secondary stroke prevention. Differentiating these lesions is of clinical significance; however, no prior studies have compared them. We sought to compare the clinical and radiological characteristics and outcomes between vascular splenial lesions and CLOCCs.
Methods:
This was a retrospective cohort study using more than 10 years of clinical data (1/1/2009 to 8/1/2020). Patients with diffusion restriction in the splenium of the corpus callosum, either due to a vascular etiology or CLOCC, were included. Baseline, clinical, and radiologic characteristics and outcomes (including discharge medications and in-hospital mortality rates) were ascertained and compared between the two groups.
Results:
There were 124 vascular and 31 CLOCC cases. Vascular patients were older than CLOCC patients (64.1 vs 34.6, p<0.001) and more frequently had: >1 vascular risk factor (91.1% vs 45.2%, p<.001); were taking antiplatelet (p<0.001) and statin medications (p<0.001) on admission; had elevated LDL (p=.027) and A1c (p<.001); and had echocardiogram abnormalities (p=.001). CLOCCs more commonly had midline splenial involvement (p<.001) and only splenium affected (p<.001), whereas vascular cases had more multifocal areas of other diffusion restriction (p=.002). The rate of in-hospital mortality was significantly higher in patients with vascular pathologies (p=.043).
Conclusions:
In this large and long-term retrospective study, vascular and CLOCC splenial lesions had distinct baseline, clinical, and radiological characteristics and outcomes. Accurately differentiating these lesions is important for appropriate secondary stroke complications and prevention.
Collapse
|
15
|
Gorelick PB, Sorond FA. Practical Aspects of Cognitive Impairment and the Dementias. Clin Geriatr Med 2023. [DOI: 10.1016/s0749-0690(22)00075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
Sorond FA, Gorelick PB. Brain Reserve, Resilience, and Cognitive Stimulation Across the Lifespan: How Do These Factors Influence Risk of Cognitive Impairment and the Dementias? Clin Geriatr Med 2023; 39:151-160. [PMID: 36404028 DOI: 10.1016/j.cger.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the absence of effective treatments for dementia, maintaining cognitive health in old age is one of the major challenges facing aging societies. Interventions for cognitive health that are tailored to the person are more likely to bring the best benefits with a minimum burden. We review the existing literature on this topic and discuss the role of the primary care physician.
Collapse
Affiliation(s)
- Farzaneh A Sorond
- Department of Neurology, Division of Stroke, Northwestern University, Feinberg School of Medicine, 625 North Michigan Avenue, 11th Floor, Chicago, IL 60611, USA.
| | - Philip B Gorelick
- Department of Neurology, Division of Stroke, Northwestern University, Feinberg School of Medicine, 625 North Michigan Avenue, 11th Floor, Chicago, IL 60611, USA
| |
Collapse
|
17
|
Gorelick PB, Sorond FA. Preface. Clin Geriatr Med 2022; 39:xiii-xv. [DOI: 10.1016/j.cger.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
18
|
Mahinrad S, Tan CO, Ma Y, Aristova M, Milstead AL, Lloyd‐Jones D, Schnell S, Markl M, Sorond FA. Intracranial Blood Flow Quantification by Accelerated Dual-venc 4D Flow MRI: Comparison With Transcranial Doppler Ultrasound. J Magn Reson Imaging 2022; 56:1256-1264. [PMID: 35146822 PMCID: PMC9363520 DOI: 10.1002/jmri.28115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Dual-venc 4D flow MRI, recently introduced for the assessment of intracranial hemodynamics, may provide a promising complementary approach to well-established tools such as transcranial Doppler ultrasound (TCD) and overcome some of their disadvantages. However, data comparing intracranial flow measures from dual-venc 4D flow MRI and TCD are lacking. PURPOSE To compare cerebral blood flow velocity measures derived from dual-venc 4D flow MRI and TCD. STUDY TYPE Prospective cohort. SUBJECTS A total of 25 healthy participants (56 ± 4 years old, 44% female). FIELD STRENGTH/SEQUENCE A 3 T/dual-venc 4D flow MRI using a time-resolved three-dimensional phase-contrast sequence with three-dimensional velocity encoding. ASSESSMENT Peak velocity measurements in bilateral middle cerebral arteries (MCA) were quantified from dual-venc 4D flow MRI and TCD. The MRI data were quantified by two independent observers (S.M and Y.M.) and TCD was performed by a trained technician (A.L.M.). We assessed the agreement between 4D flow MRI and TCD measures, and the interobserver agreement of 4D flow MRI measurements. STATISTICAL TESTS Peak velocity from MRI and TCD was compared using Bland-Altman analysis and coefficient of variance. Intraclass correlation coefficient (ICC) was used to assess MRI interobserver agreement. A P value < 0.05 was considered statistically significant. RESULTS There was excellent interobserver agreement in dual-venc 4D flow MRI-based measurements of peak velocity in bilateral MCA (ICC = 0.97 and 0.96 for the left and right MCA, respectively). Dual-venc 4D flow MRI significantly underestimated peak velocity in the left and right MCA compared to TCD (bias = 0.13 [0.59, -0.33] m/sec and 0.15 [0.47, -0.17] m/sec, respectively). The coefficient of variance between dual-venc 4D flow MRI and TCD measurements was 26% for the left MCA and 22% for the right MCA. DATA CONCLUSION There was excellent interobserver agreement for the assessment of MCA peak velocity using dual-venc 4D flow MRI, and ≤20% under-estimation compared with TCD. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Simin Mahinrad
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Can Ozan Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cerebrovascular Research LaboratorySpaulding Rehabilitation HospitalBostonMassachusettsUSA
- Department of RadiologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Yue Ma
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of RadiologyShengjing Hospital of China Medical UniversityChina
| | - Maria Aristova
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
| | - Andrew L. Milstead
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Donald Lloyd‐Jones
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Susanne Schnell
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Institute of Physics, Department of Medical PhysicsUniversity of GreifswaldGermany
| | - Michael Markl
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
| | - Farzaneh A. Sorond
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| |
Collapse
|
19
|
Affiliation(s)
- Farzaneh A Sorond
- Davee Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
20
|
Muratoglu SC, Charette MF, Galis ZS, Greenstein AS, Daugherty A, Joutel A, Kozel BA, Wilcock DM, Collins EC, Sorond FA, Howell GR, Hyacinth HI, Lloyd KKC, Stenmark KR, Boehm M, Kahn ML, Corriveau R, Wells S, Bussey TJ, Sukoff Rizzo SJ, Iruela-Arispe ML. Perspectives on Cognitive Phenotypes and Models of Vascular Disease. Arterioscler Thromb Vasc Biol 2022; 42:831-838. [PMID: 35510549 PMCID: PMC9233038 DOI: 10.1161/atvbaha.122.317395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical investigations have established that vascular-associated medical conditions are significant risk factors for various kinds of dementia. And yet, we are unable to associate certain types of vascular deficiencies with specific cognitive impairments. The reasons for this are many, not the least of which are that most vascular disorders are multi-factorial and the development of vascular dementia in humans is often a multi-year or multi-decade progression. To better study vascular disease and its underlying causes, the National Heart, Lung, and Blood Institute of the National Institutes of Health has invested considerable resources in the development of animal models that recapitulate various aspects of human vascular disease. Many of these models, mainly in the mouse, are based on genetic mutations, frequently using single-gene mutations to examine the role of specific proteins in vascular function. These models could serve as useful tools for understanding the association of specific vascular signaling pathways with specific neurological and cognitive impairments related to dementia. To advance the state of the vascular dementia field and improve the information sharing between the vascular biology and neurobehavioral research communities, National Heart, Lung, and Blood Institute convened a workshop to bring in scientists from these knowledge domains to discuss the potential utility of establishing a comprehensive phenotypic cognitive assessment of a selected set of existing mouse models, representative of the spectrum of vascular disorders, with particular attention focused on age, sex, and rigor and reproducibility. The workshop highlighted the potential of associating well-characterized vascular disease models, with validated cognitive outcomes, that can be used to link specific vascular signaling pathways with specific cognitive and neurobehavioral deficits.
Collapse
Affiliation(s)
- Selen C Muratoglu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (S.C.M., M.F.C., Z.S.G.)
| | - Marc F Charette
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (S.C.M., M.F.C., Z.S.G.)
| | - Zorina S Galis
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (S.C.M., M.F.C., Z.S.G.)
| | - Adam S Greenstein
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.S.G.)
| | - Alan Daugherty
- Saha Cardiovascular Research Center (A.D.), University of Kentucky, Lexington
| | - Anne Joutel
- Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Descartes, France (A.J.)
| | - Beth A Kozel
- Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (B.A.K., M.B.)
| | - Donna M Wilcock
- Sanders-Brown Center on Aging, Department of Neuroscience (D.M.W.), University of Kentucky, Lexington
| | | | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL (F.A.S.)
| | - Gareth R Howell
- The Jackson Laboratory, Bar Harbor, ME (G.R.H.)
- Graduate Program of Genetics, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA (G.R.H.)
| | - Hyacinth I Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH (H.I.H.)
| | - Kent K C Lloyd
- Mutant Mouse Resource and Research Center (MMRRC) at the University of California, Davis (K.K.C.L.)
| | - Kurt R Stenmark
- Developmental Lung Biology and Cardiovascular Pulmonary Research Laboratories, University of Colorado, Denver (K.R.S.)
| | - Manfred Boehm
- Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (B.A.K., M.B.)
| | - Mark L Kahn
- Department of Medicine and Cardiovascular Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia (M.L.K.)
| | - Roderick Corriveau
- National Institute for Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (R.C.)
| | - Sara Wells
- Mary Lyon Centre, Harwell Campus, MRC Harwell Institute, Oxfordshire, United Kingdom (S.W.)
| | - Timothy J Bussey
- Translational Neuroscience Group, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (T.J.B.)
| | - Stacey J Sukoff Rizzo
- Department of Medicine-Aging Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA (S.J.S.R.)
| | - M Luisa Iruela-Arispe
- Department of Cell and Developmental Biology, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.L.I.-A.)
| |
Collapse
|
21
|
Whitehead SN, Bruno A, Burns JM, Carmichael ST, Csiszar A, Edwards JD, Elahi FM, Faraco G, Gould DB, Gustafson DR, Hachinski V, Rosenberg G, Sorond FA, Shih AY, Tse KH, Ungvari Z, Wilcock DM, Zuloaga KL, Barone FC. Expanding the horizon of research into the pathogenesis of the white matter diseases: Proceedings of the 2021 Annual Workshop of the Albert Research Institute for White Matter and Cognition. GeroScience 2022; 44:25-37. [PMID: 34606040 PMCID: PMC8488071 DOI: 10.1007/s11357-021-00461-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
White matter pathologies are critically involved in the etiology of vascular cognitive impairment-dementia (VCID), Alzheimer's disease (AD), and Alzheimer's disease and related diseases (ADRD), and therefore need to be considered a treatable target ( Roseborough A, Hachinski V, Whitehead S. White matter degeneration - a treatable target? Roseborough et al. JAMA Neurol [Internet]. 2020 Apr 27;77(7):793-4, [1] . To help address this often-missed area of research, several workshops have been sponsored by the Leo and Anne Albert Charitable Trust since 2015, resulting in the incorporation of "The Albert Research Institute for White Matter and Cognition" in 2020. The first annual "Institute" meeting was held virtually on March 3-4, 2021. The Institute provides a forum and workspace for communication and support of the advancement of white matter science and research to better understand the evolution and prevention of dementia. It serves as a platform for young investigator development, to introduce new data and debate biology mechanisms and new ideas, and to encourage and support new research collaborations and directions to clarify how white matter changes, with other genetic and health risk factors, contribute to cognitive impairment. Similar to previous Albert Trust-sponsored workshops (Barone et al. in J Transl Med 14:1-14, [2]; Sorond et al. in GeroScience 42:81-96, [3]), established expert investigators were identified and invited to present. Opportunities to attend and present were also extended by invitation to talented research fellows and younger scientists. Also, updates on institute-funded research collaborations were provided and discussed. The summary that follows is a synopsis of topics and discussion covered in the workshop.
Collapse
Affiliation(s)
- Shawn N Whitehead
- Department of Anatomy and Cell Biology, Western University, London, ON, N6A 3K7, Canada.
| | - Askiel Bruno
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, 30912, USA
| | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Jodi D Edwards
- University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, K1G 5Z3, Canada
| | - Fanny M Elahi
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Giuseppe Faraco
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Douglas B Gould
- Departments of Ophthalmology and Anatomy, and Institute for Human Genetics, School of Medicine, University of California, San Francisco, 94143, USA
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York Downstate Health Sciences University, New York, Brooklyn, 11203, USA
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON, N6A 5C1, Canada
| | - Gary Rosenberg
- UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, 87106, USA
| | | | - Andy Y Shih
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute; Department of Pediatrics; Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kai Hei Tse
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Donna M Wilcock
- Sanders-Brown Center on Aging; Department of Neurology, Department of Behavioral Science, University of Kentucky, Lexington, KY, 40536, USA
| | - Kristen L Zuloaga
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, 12208, USA
| | - Frank C Barone
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| |
Collapse
|
22
|
Lineback C, Mahinrad S, Chen Y, parrish T, Lloyd-jones D, Sorond FA. Abstract WMP19: Cumulative Vascular Risk Factors Exposure During Young Adulthood And Brain Structure In Midlife. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wmp19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Vascular risk factors (VRF) are known contributors to brain health in old age, with minority populations disproportionately impacted. The role of duration and severity of exposure to VRF remains unclear. We examined the association between cumulative exposures to VRF (cVRF) from young adulthood to midlife and midlife brain health, while addressing racial differences.
Methods:
142 participants (39% black, 42% women) from the Coronary Artery Risk Development in Young Adults study with longitudinal VRF data over 30 years and a brain MRI at Y30 were included. Cumulative blood pressure (cBP), cholesterol, BMI, smoking, and glucose was calculated as the mean of two measures across two consecutive visits, multiplied by the number of years between visits from Y0 to Y30. Multivariate linear regression models including all VRF, demographics, and medications were used to assess the independent association of cVRF with brain MRI outcomes across races.
Results:
Higher cSBP was associated with lower total brain, gray matter, and hippocampal volumes in blacks, but not in whites (interaction p<0.05, Table1), independent of other cVRF. Similarly, higher cDBP was associated with lower total brain and hippocampal volumes only in blacks, but not in whites (interaction p<0.05, Table1). However, when examining these relationships across comparable cBP exposure levels, race differences were no longer significant. There was no interaction between race and other cVRF in relation to white matter hyperintensities, gray matter thickness or cerebral perfusion (interaction p>0.05).
Conclusions:
Exposure to higher BP across young adulthood is associated with midlife brain structure, possibly irrespective of race. Given higher level of cBP exposure in minorities, our observations should encourage clinicians to be aggressive in addressing hypertension in young adults, especially in young minority populations as a potential target to narrow disparities in brain health.
Collapse
Affiliation(s)
| | | | - Yufen Chen
- Radiology, Northwestern Memorial Hosp, Chicago, IL
| | | | | | | |
Collapse
|
23
|
Mahinrad S, Sorond FA, Gorelick PB. Hypertension and cognitive dysfunction: a review of mechanisms, life-course observational studies and clinical trial results. Rev Cardiovasc Med 2021; 22:1429-1449. [PMID: 34957783 DOI: 10.31083/j.rcm2204148] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/06/2022] Open
Abstract
Hypertension is one of the most prevalent vascular risk factors and a leading cause of disability and mortality worldwide. The negative impact of hypertension on brain health is substantial. Already well-established as a risk factor for cerebrovascular disease, hypertension also has been shown to increase the risk for cognitive impairment and dementia. Mounting evidence from epidemiological studies suggests that hypertension, particularly in midlife, is associated with late-life cognitive impairment and the development of dementia. The link between late-life hypertension and cognitive function is, however, less clear. Experimental and neuroimaging studies have revealed complexities of mechanisms underlying the link between hypertension and cognitive function. Furthermore, the effect of blood pressure lowering on cognitive function, the optimal target and timing of the intervention, and the optimal antihypertensive agent in the context of cognitive function remain unclear. In this review, we discuss contemporary science on the link between hypertension and cognitive function by reviewing experimental, neuroimaging, and life-course observational studies. Furthermore, we provide a detailed review of randomized clinical trials addressing the effect of blood pressure lowering on cognitive function. Finally, unanswered questions, challenges, and other considerations for blood pressure lowering are highlighted.
Collapse
Affiliation(s)
- Simin Mahinrad
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Farzaneh A Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Philip B Gorelick
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| |
Collapse
|
24
|
Mukli P, Csipo T, Lipecz A, Stylianou O, Racz FS, Owens CD, Perry JW, Tarantini S, Sorond FA, Kellawan JM, Purebl G, Yang Y, Sonntag WE, Csiszar A, Ungvari ZI, Yabluchanskiy A. Sleep deprivation alters task-related changes in functional connectivity of the frontal cortex: A near-infrared spectroscopy study. Brain Behav 2021; 11:e02135. [PMID: 34156165 PMCID: PMC8413792 DOI: 10.1002/brb3.2135] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 01/05/2023] Open
Abstract
Sleep deprivation (SD) is known to be associated with decreased cognitive performance; however, the underlying mechanisms are poorly understood. As interactions between distinct brain regions depend on mental state, functional brain networks established by these connections typically show a reorganization during task. Hence, analysis of functional connectivity (FC) could reveal the task-related change in the examined frontal brain networks. Our objective was to assess the impact of SD on static FC in the prefrontal and motor cortices and find whether changes in FC correlate with changes in neuropsychological scores. Healthy young male individuals (n = 10, 27.6 ± 3.7 years of age) participated in the study. A battery of tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and 48 channel functional near-infrared spectroscopy (fNIRS) measurements were performed before and after 24 hr of SD. Network metrics were obtained by graph theoretical analysis using the fNIRS records in resting state and during finger-tapping sessions. During task, SD resulted in a significantly smaller decrease in the number and strength of functional connections (characterizing FC) in the frontal cortex. Changes in the global connection strengths correlated with decreased performance in the paired association learning test. These results indicate a global impact of SD on functional brain networks in the frontal lobes.
Collapse
Affiliation(s)
- Peter Mukli
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
- Department of PhysiologyFaculty of MedicineSemmelweis UniversityBudapestHungary
- International Training Program in GeroscienceDoctoral School of Basic and Translational Medicine/Department of Public HealthSemmelweis UniversityBudapestHungary
| | - Tamas Csipo
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
- International Training Program in GeroscienceDoctoral School of Basic and Translational Medicine/Department of Public HealthSemmelweis UniversityBudapestHungary
- Division of Clinical PhysiologyDepartment of CardiologyFaculty of MedicineUniversity of DebrecenDebrecenHungary
| | - Agnes Lipecz
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
- International Training Program in GeroscienceDoctoral School of Basic and Translational Medicine/Department of Public HealthSemmelweis UniversityBudapestHungary
- Department of OphthalmologyJosa Andras HospitalNyiregyhazaHungary
| | - Orestis Stylianou
- Department of PhysiologyFaculty of MedicineSemmelweis UniversityBudapestHungary
- Institute of Translational MedicineSemmelweis UniversityBudapestHungary
| | - Frigyes Samuel Racz
- Department of PhysiologyFaculty of MedicineSemmelweis UniversityBudapestHungary
| | - Cameron D. Owens
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Jonathan W. Perry
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Stefano Tarantini
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
- International Training Program in GeroscienceDoctoral School of Basic and Translational Medicine/Department of Public HealthSemmelweis UniversityBudapestHungary
- Department of Health Promotion SciencesCollege of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Farzaneh A. Sorond
- Division of Stroke and Neurocritical CareDepartment of NeurologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Jeremy M. Kellawan
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
- Department of Health and Exercise ScienceUniversity of OklahomaNormanOKUSA
| | - György Purebl
- Institute of Behavioral SciencesSemmelweis UniversityBudapestHungary
| | - Yuan Yang
- Stephenson School of Biomedical EngineeringThe University of OklahomaTulsaOKUSA
| | - William E. Sonntag
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Anna Csiszar
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
- International Training Program in GeroscienceTheoretical Medicine Doctoral School/Departments of Cell Biology and Molecular Medicine and Medical Physics and InformaticsUniversity of SzegedSzegedHungary
| | - Zoltan I. Ungvari
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
- International Training Program in GeroscienceDoctoral School of Basic and Translational Medicine/Department of Public HealthSemmelweis UniversityBudapestHungary
- Department of Health Promotion SciencesCollege of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
- International Training Program in GeroscienceTheoretical Medicine Doctoral School/Departments of Cell Biology and Molecular Medicine and Medical Physics and InformaticsUniversity of SzegedSzegedHungary
| | - Andriy Yabluchanskiy
- Oklahoma Center for Geroscience and Healthy Brain AgingDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| |
Collapse
|
25
|
Lazar RM, Howard VJ, Kernan WN, Aparicio HJ, Levine DA, Viera AJ, Jordan LC, Nyenhuis DL, Possin KL, Sorond FA, White CL. A Primary Care Agenda for Brain Health: A Scientific Statement From the American Heart Association. Stroke 2021; 52:e295-e308. [PMID: 33719523 DOI: 10.1161/str.0000000000000367] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A healthy brain is critical for living a longer and fuller life. The projected aging of the population, however, raises new challenges in maintaining quality of life. As we age, there is increasing compromise of neuronal activity that affects functions such as cognition, also making the brain vulnerable to disease. Once pathology-induced decline begins, few therapeutic options are available. Prevention is therefore paramount, and primary care can play a critical role. The purpose of this American Heart Association scientific statement is to provide an up-to-date summary for primary care providers in the assessment and modification of risk factors at the individual level that maintain brain health and prevent cognitive impairment. Building on the 2017 American Heart Association/American Stroke Association presidential advisory on defining brain health that included "Life's Simple 7," we describe here modifiable risk factors for cognitive decline, including depression, hypertension, physical inactivity, diabetes, obesity, hyperlipidemia, poor diet, smoking, social isolation, excessive alcohol use, sleep disorders, and hearing loss. These risk factors include behaviors, conditions, and lifestyles that can emerge before adulthood and can be routinely identified and managed by primary care clinicians.
Collapse
|
26
|
Ingo C, Kurian S, Higgins J, Mahinrad S, Jenkins LM, Gorelick PB, Lloyd-jones DM, Sorond FA. Abstract P326: Vascular Risk Factors in Adulthood and Increased Diffusion Complexity of Neural Tissue Structure. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
We performed a region of interest diffusion tensor imaging (DTI) and advanced diffusion complexity analysis of neural tissue to determine the impact of vascular health on novel diffusivity metrics in midlife adults.
Methods:
As shown in Table 1, 77 participants (26 black, 35 female) at year 30 visit in the Coronary Artery Risk Development in Young Adults (CARDIA) longitudinal study were scanned with an advanced diffusion-weighted imaging and FLAIR protocol. Fractional anisotropy (FA) and non-linear diffusion complexity, C, measures were estimated. Cumulative vascular measures were tracked from baseline up to year 30 examination. Partial correlation analyses assessed the association between cumulative vascular measures and diffusion metrics in these participants.
Results:
As shown in Figure 1, higher systolic blood pressure exposure was associated with increased complexity, C, (red) and decreased FA (blue). Additionally, in the white matter of black participants, who exhibited a higher cumulative vascular risk exposure, FA was lower and complexity was higher in comparison to white matter in white participants.
Conclusion:
Higher burden of vascular risk factor exposure from adulthood to midlife is associated with changes in the diffusion properties of neural tissue in midlife. These diffusion measures may reflect novel markers of axonal disruption, increased inflammation, and/or increased glial proliferation. These new results suggest that microstructural changes in neural tissue are sensitive to vascular health during young adulthood and are possibly therapeutic targets in interventions focused on preserving neural tissue health across life.
Collapse
|
27
|
SABAYAN B, Mahinrad S, Sedaghat S, Liotta EM, Sorond FA. Abstract P596: How Common Are Microembolic Signals After Cerebrovascular Events and Are They Related to Recurrent Admissions? Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Microembolic signals (MES) identified by transcranial Doppler (TCD) reflect an ongoing embolic phenomenon with implications for the recurrence of cerebrovascular events and complications. In this study, we investigated the prevalence of MES detected after stroke or transient ischemic attack (TIA) and studied their relationship with future re-admissions.
Method:
This clinical cohort study is comprised of 961 consecutive patients (mean age 65 years, 59% male) admitted to Northwestern Memorial Hospital with the diagnosis of acute stroke (n: 872) or TIA (n: 89) and underwent TCD evaluation. TCD is performed within the first 48 hours of admission as a routine component of stroke etiology evaluation at our institution. After discharge, patients were followed for an average of 18 months for any hospital readmissions. Cox regression models were used to estimate risk of re-admissions in relation to MES.
Results:
MES were detected in 99 (10%, 95% CI; 8-12%) patients. During the follow up period, 356 patients had emergency room re-admissions. Compared to patients without MES, those with MES were younger (
p
=0.007) and had longer index hospital stay (
p
=0.008). Patients with MES, as compared to patients without MES, had 1.56-fold (hazard ratio 95% CI=1.15, 2.13;
p
=0.005) higher risk of readmission. This association was independent of age, sex, race, smoking, history of hyperlipidemia, diabetes, atrial fibrillation, history of pulmonary emboli, deep vein thrombosis, hypertension, coronary artery disease and heart failure.
Conclusion:
We show that MES are present in one tenth of patients admitted with stroke or TIA, and they are associated with higher risk of re-admission. These data highlight the importance of embolic signals in stroke complication risk stratification and suggest the need for prospective clinical trials targeting MES in secondary stroke risk and complication prevention.
Collapse
|
28
|
Chow FC, Ma Y, Manion M, Rupert A, Lambert-Messerlian G, Bushnell CD, Cedars MI, Sereti I, Sorond FA, Hsue PY, Tien PC. Factors associated with worse cerebrovascular function in aging women with and at risk for HIV. AIDS 2021; 35:257-266. [PMID: 33229895 PMCID: PMC7789911 DOI: 10.1097/qad.0000000000002755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Women may be disproportionately impacted by the negative effect of HIV on cerebrovascular risk. We examined the association of HIV, sex, menopause, and immune activation with cerebrovascular function among women with HIV (WWH) and at risk for HIV from the Women's Interagency HIV Study and men with HIV. DESIGN Cross-sectional. METHODS Participants were aged at least 40 years with coronary heart disease or at least one cardiometabolic risk factor. All persons with HIV were on antiretroviral therapy with undetectable viral load. Cerebral vasoreactivity was assessed by the transcranial Doppler breath-holding test, with lower vasoreactivity corresponding to worse cerebrovascular function. Menopausal status was determined by anti-Müllerian hormone level. We used mixed effects linear regression to identify factors associated with cerebral vasoreactivity. RESULTS Mean cerebral vasoreactivity was similar in WWH (n = 33) and women at risk for HIV (n = 16). A trend toward higher cerebral vasoreactivity in WWH compared with men with HIV (n = 37) was no longer present after excluding women on estrogen replacement therapy (n = 3). In women, menopausal status was not significantly associated with cerebral vasoreactivity. WWH with higher cardiovascular risk (-0.14 for each additional cardiometabolic risk factor, P = 0.038), sCD163 (-0.20 per doubling, P = 0.033), and proportion of CD4+CX3CR1+ T cells (-0.14 per doubling, P = 0.028) had lower cerebral vasoreactivity. CONCLUSION Among older women at high cardiovascular risk, women with virologically suppressed HIV and women at risk for HIV had similar cerebrovascular function. Our findings, which must be interpreted in the context of the small sample, highlight the contribution of traditional cardiometabolic risk factors and immune activation to cerebrovascular risk in WWH.
Collapse
Affiliation(s)
- Felicia C. Chow
- Weill Institute for Neurosciences, Department of Neurology, and Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA
| | - Yifei Ma
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Maura Manion
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Adam Rupert
- AIDS Monitoring Laboratory, Frederick National Laboratory for Cancer Research
| | - Geralyn Lambert-Messerlian
- Departments of Pathology and Laboratory Medicine and Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC
| | - Marcelle I. Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | | - Priscilla Y. Hsue
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA
| | - Phyllis C. Tien
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California, USA
| |
Collapse
|
29
|
Mahinrad S, Shownkeen M, Sedaghat S, Yaffe K, Hausdorff JM, Lloyd-Jones DM, Gorelick PB, Sorond FA. Vascular health across young adulthood and midlife cerebral autoregulation, gait, and cognition. Alzheimers Dement 2020; 17:745-754. [PMID: 33283978 DOI: 10.1002/alz.12246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION To test the association of vascular health (VH) across young adulthood with midlife dynamic cerebral autoregulation (dCA), gait, and cognition; and to test whether dCA is a modifying factor. METHODS We studied 196 participants from the Coronary Artery Risk Development in Young Adults cohort who were followed over 30 years. VH was assessed at each visit according to American Heart Association recommendations. At year 30, dCA was measured using transcranial Doppler ultrasound and several gait and cognitive domains were assessed. RESULTS Worse VH from baseline through year 7, but not at year 30, was associated with less efficient dCA (all P < .05). Worse VH at all visits was associated with slower gait speed, and at year 7 with worse executive and global cognition (all P < .05). The association of baseline VH and midlife gait, but not cognition, was moderated by dCA (interaction P < .05). CONCLUSIONS VH as early as young adulthood may influence midlife brain health, and dCA may modify this relationship.
Collapse
Affiliation(s)
- Simin Mahinrad
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Meghana Shownkeen
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sanaz Sedaghat
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University, Chicago, Illinois, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Philip B Gorelick
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Farzaneh A Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
30
|
Abstract
Background Elevated natriuretic peptides (NP) are associated with adverse cerebrovascular conditions including stroke, cerebral small vessel disease, and dementia. However, the mechanisms underlying these associations remain unclear. In this study, we examined the relationship of NT‐proBNP (N‐terminal pro brain NP) and NT‐proANP (N‐terminal pro atrial NP) with cerebrovascular function, measured by cerebral autoregulation. Methods and Results We included 154 participants (mean age 56±4 years old) from the CARDIA (Coronary Artery Risk Development in Young Adults) cohort. NT‐proBNP and NT‐proANP were measured in blood samples from the year 25 examination using electrochemiluminescence Immunoassay and enzyme‐linked immunoassay, respectively. Dynamic cerebral autoregulation (dCA) was assessed at the year 30 examination by transcranial Doppler ultrasound, using transfer function analysis (phase and gain) of spontaneous blood pressure and flow velocity oscillations, where lower phase and higher gain reflect less efficient cerebral autoregulation. We used multivariable linear regression models adjusted for demographics, vascular risk factors, and history of kidney and cardiac diseases. Higher NT‐proBNP levels at year 25 were associated with lower phase (β [95% CI]=−5.30 lower degrees of phase [−10.05 to −0.54]) and higher gain (β [95% CI]=0.06 higher cm/s per mm Hg of gain [0.004–0.12]) at year 30. Similarly, higher NT‐proANP levels were associated with lower phase (β [95% CI]=−9.08 lower degrees of phase [−16.46 to −1.70]). Conclusions Higher circulating levels of NT‐proBNP and NT‐proANP are associated with less efficient dCA 5 years later. These findings link circulating NP to cerebral autoregulation and may be one mechanism tying NP to adverse cerebrovascular outcomes.
Collapse
Affiliation(s)
- Simin Mahinrad
- Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL
| | - Behnam Sabayan
- Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL
| | - Chaney R Garner
- Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Farzaneh A Sorond
- Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL
| |
Collapse
|
31
|
Hextrum S, Minhas JS, Liotta EM, Sorond FA, Naidech AM, Maas MB. Hypocapnia, ischemic lesions, and outcomes after intracerebral hemorrhage. J Neurol Sci 2020; 418:117139. [PMID: 32949919 DOI: 10.1016/j.jns.2020.117139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND An association between spontaneous hyperventilation, delayed cerebral ischemia, and poor clinical outcomes has been reported in subarachnoid hemorrhage. We evaluated the relationship between early pCO2 changes, ischemic lesions and outcomes in patients with intracerebral hemorrhage (ICH). METHODS Consecutive patients with spontaneous ICH were enrolled in an observational cohort study conducted between 2006 and 2019. Patient characteristics and discharge outcome were prospectively recorded. Arterial blood gas (ABG) measurements and mechanical ventilation settings in the first 72 h of admission were retrospectively collected. MRI images were adjudicated for diffusion-restricted lesions consistent with ischemia and distant from the hematoma. We examined the associations between pCO2 changes, ischemic lesions, and discharge outcomes by univariate and adjusted analyses. RESULTS ABG data were available for 220 patients. Hyperventilation occurred in 52 (28%) cases and was not associated with clinical severity. Lower initial pCO2 was associated with greater risk of in-hospital death (OR 0.94 per mmHg, 95%CI [0.89, 0.996], p = 0.042) after adjustment for ICH Score, pneumonia and mechanical ventilation requirements. MRI data were available for 33 patients. Lower pCO2 was associated with a higher risk of ischemic lesions, except in patients with low initial systolic blood pressure (p < 0.05 for main and blood pressure interaction effects), after adjustment for other predictors. CONCLUSIONS In ICH patients with spontaneous ventilation, lower pCO2 was independently associated with greater risk of in-hospital death. In patients with elevated initial blood pressure, who undergo blood pressure reduction per guideline recommendations, lower pCO2 was associated with increased risk to develop ischemic lesions.
Collapse
Affiliation(s)
- Shannon Hextrum
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Eric M Liotta
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | | | - Andrew M Naidech
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Matthew B Maas
- Department of Neurology, Northwestern University, Chicago, IL, USA.
| |
Collapse
|
32
|
Liotta EM, Karvellas CJ, Kim M, Batra A, Naidech A, Prabhakaran S, Sorond FA, Kimberly WT, Maas MB. Serum osmolality, cerebrospinal fluid specific gravity and overt hepatic encephalopathy severity in patients with liver failure. Liver Int 2020; 40:1977-1986. [PMID: 32020734 PMCID: PMC7398828 DOI: 10.1111/liv.14400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/09/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Hepatic encephalopathy (HE) is a leading contributor to morbidity in liver disease. While hyperammonaemia plays a key role, the mechanisms of cerebral toxicity are unclear. We hypothesized that serum hyperosmolality contributes to HE during acute (ALF) and acute-on-chronic liver failure (ACLF) through mechanisms that affect the water and solute composition of the cerebral environment. METHODS We performed a retrospective analysis of serum osmolality, cerebral spinal fluid (CSF) solute density (specific gravity, determined from computed tomography attenuation) and clinical HE severity (Glasgow Coma Score [GCS]) at the time of intensive care admission in a prospectively identified cohort of liver failure patients with overt HE. RESULTS Seventy-three patients (39 ALF and 34 ACLF) were included, of whom 28 (38%) were comatose. Serum osmolality (303.9 ± 15.4 mOsm/kg) was elevated despite normal serum sodium (136.6 ± 6.3 mEq/L). Increased osmolality was independently associated with more severe encephalopathy (ordinal adjusted OR 0.26 [95% CI 0.22, 0.31] for higher GCS per standard deviation increase in osmolality) and lower CSF-specific gravity (linear adjusted β = -0.039 [95% CI -0.069, -0.009] Hounsfield unit per 1 mOsm/kg). CONCLUSIONS In the context of related research, these data suggest that hyperosmolality increases brain exposure to metabolic toxins by blood-brain barrier alteration and may be a unique therapeutic target.
Collapse
Affiliation(s)
- Eric M. Liotta
- Northwestern University, Feinberg School of Medicine, Division of Stroke and Neurocritical Care
| | | | - Minjee Kim
- Northwestern University, Feinberg School of Medicine, Division of Stroke and Neurocritical Care
| | - Ayush Batra
- Northwestern University, Feinberg School of Medicine, Division of Stroke and Neurocritical Care
| | - Andrew Naidech
- Northwestern University, Feinberg School of Medicine, Division of Stroke and Neurocritical Care
| | | | - Farzaneh A. Sorond
- Northwestern University, Feinberg School of Medicine, Division of Stroke and Neurocritical Care
| | | | - Matthew B. Maas
- Northwestern University, Feinberg School of Medicine, Division of Stroke and Neurocritical Care
| |
Collapse
|
33
|
Jor’dan AJ, Manor B, Iloputaife I, Habtemariam DA, Bean JF, Sorond FA, Lipsitz LA. Diminished Locomotor Control Is Associated With Reduced Neurovascular Coupling in Older Adults. J Gerontol A Biol Sci Med Sci 2020; 75:1516-1522. [PMID: 30629129 PMCID: PMC7357586 DOI: 10.1093/gerona/glz006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Walking, especially while dual-tasking, requires functional activation of cognitive brain regions and their connected neural networks. This study examined the relationship between neurovascular coupling (NVC), as measured by the change in cerebral blood flow in response to performing a cognitive executive task, and dual-task walking performance. METHODS Seventy community-dwelling older adults aged 84 ± 5 years within the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly (MOBILIZE) Boston Study were divided into LOW (n = 35) and HIGH (n = 35) NVC. NVC was quantified by transcranial Doppler ultrasound and stratified by the median change in cerebral blood flow velocity of the middle cerebral artery induced by the performance of the n-back task of executive function. Walking metrics included walking speed, step width, stride length, stride time, stride time variability, and double-support time from single- and dual-task walking conditions, as well as the "cost" of dual-tasking. RESULTS During both single- and dual-task walking, older adults with LOW NVC displayed narrower step width (p = .02 and p = .02), shorter stride length (p = .01 and p = .02), and longer double-support time (p = .03 and p = .002) when compared with the HIGH group. During single-task walking only, LOW NVC was also linked to slower walking speed (p = .02). These associations were independent of age, height, hypertension, atrial fibrillation, and assistive device. The LOW and HIGH NVC groups did not differ in dual-task costs to walking performance. CONCLUSION In older adults, diminished capacity to regulate cerebral blood flow in response to an executive function task is linked to worse walking performance under both single- and dual-task conditions, but not necessarily dual-task costs.
Collapse
Affiliation(s)
- Azizah J Jor’dan
- New England Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Massachusetts
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston Massachusetts
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston Massachusetts
| | - Ikechukwu Iloputaife
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Daniel A Habtemariam
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Jonathan F Bean
- New England Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | | | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston Massachusetts
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
34
|
Das AS, Regenhardt RW, LaRose S, Monk AD, Castro PM, Sheriff FG, Sorond FA, Vaitkevicius H. Microembolic Signals Detected by Transcranial Doppler Predict Future Stroke and Poor Outcomes. J Neuroimaging 2020; 30:882-889. [PMID: 32648610 DOI: 10.1111/jon.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Although transcranial Doppler detects microembolic signals (MES) in numerous settings, the practical significance of such findings remains unclear. METHODS Clinical information from ischemic stroke or transient ischemic attack patients (n = 248) who underwent embolic monitoring from January 2015 to December 2018 was obtained. RESULTS MES were found in 15% of studies and ischemic recurrence was seen in 11% of patients (over 7 ± 6 days). Patients with MES had more lacunes than those without MES (1 ± 3 vs. 1 ± 2, P = .016), were more likely to have ischemic recurrence (37% vs. 6%, P < .001), undergo a future revascularization procedure (26% vs. 10%, P = .005), have a longer length of stay (9 vs. 4 days, P = .043), and have worse functional disability at discharge (modified Rankin Scale 3-6, 66% vs. 34%, P < .001). After controlling for several relevant cofactors, patients with MES were more likely to have ischemic recurrence (HR 4.90, 95% CI 2.16-11.09, P < .001), worse functional disability (OR 3.31, 95% CI 1.22-8.99, P = .019), and longer length of stays (β = .202, P < .001). CONCLUSIONS MES may help to risk stratify patients as their presence is associated with ischemic recurrence and worse outcomes.
Collapse
Affiliation(s)
- Alvin S Das
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sarah LaRose
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew D Monk
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pedro M Castro
- Department of Neurology, Centro Hospital Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Faheem G Sheriff
- Department of Neurosurgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Farzaneh A Sorond
- Department of Neurology, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, IL
| | - Henrikas Vaitkevicius
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
35
|
Jenkins LM, Garner CR, Kurian S, Higgins JP, Parrish TB, Sedaghat S, Nemeth AJ, Lloyd-Jones DM, Launer LJ, Hausdorff JM, Wang L, Sorond FA. Cumulative Blood Pressure Exposure, Basal Ganglia, and Thalamic Morphology in Midlife. Hypertension 2020; 75:1289-1295. [PMID: 32223376 DOI: 10.1161/hypertensionaha.120.14678] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High blood pressure (BP) negatively affects brain structure and function. Hypertension is associated with white matter hyperintensities, cognitive and mobility impairment in late-life. However, the impact of BP exposure from young adulthood on brain structure and function in mid-life is unclear. Identifying early brain structural changes associated with BP exposure, before clinical onset of cognitive dysfunction and mobility impairment, is essential for understanding mechanisms and developing interventions. We examined the effect of cumulative BP exposure from young adulthood on brain structure in a substudy of 144 (61 female) individuals from the CARDIA (Coronary Artery Risk Development in Young Adults) study. At year 30 (Y30, ninth visit), participants (56±4 years old) completed brain magnetic resonance imaging and gait measures (pace, rhythm, and postural control). Cumulative systolic and diastolic BP (cumulative systolic blood pressure, cDBP) over 9 visits were calculated, multiplying mean values between 2 consecutive visits by years between visits. Surface-based analysis of basal ganglia and thalamus was achieved using FreeSurfer-initiated Large Deformation Diffeomorphic Metric Mapping. Morphometric changes were regressed onto cumulative BP to localize regions of shape variation. Y30 white matter hyperintensity volumes were small and positively correlated with cumulative BP but not gait. Negative morphometric associations with cumulative systolic blood pressure were seen in the caudate, putamen, nucleus accumbens, pallidum, and thalamus. A concave right medial putamen shape mediated the relationship between cumulative systolic blood pressure and stride width. Basal ganglia and thalamic morphometric changes, rather than volumes, may be earlier manifestation of gray matter structural signatures of BP exposure that impact midlife gait.
Collapse
Affiliation(s)
- Lisanne M Jenkins
- From the Department of Psychiatry and Behavioral Sciences (L.M.J., L.W.), Northwestern University, Chicago, IL
| | - Chaney R Garner
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL
| | - Shawn Kurian
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL
| | - James P Higgins
- Department of Radiology (J.P.H., T.B.P., A.J.N., L.W.), Northwestern University, Chicago, IL
| | - Todd B Parrish
- Department of Radiology (J.P.H., T.B.P., A.J.N., L.W.), Northwestern University, Chicago, IL
| | - Sanaz Sedaghat
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL.,Department of Preventive Medicine (S.S., D.M.L.-J.), Northwestern University, Chicago, IL
| | - Alexander J Nemeth
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL.,Department of Radiology (J.P.H., T.B.P., A.J.N., L.W.), Northwestern University, Chicago, IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine (S.S., D.M.L.-J.), Northwestern University, Chicago, IL
| | | | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center (J.M.H.)
| | - Lei Wang
- From the Department of Psychiatry and Behavioral Sciences (L.M.J., L.W.), Northwestern University, Chicago, IL.,Department of Radiology (J.P.H., T.B.P., A.J.N., L.W.), Northwestern University, Chicago, IL
| | - Farzaneh A Sorond
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL
| |
Collapse
|
36
|
Chen MM, Mahinrad S, Srivastava AK, Liotta E, Bernstein RA, Gorelick PB, Sorond FA. Abstract WP266: Microembolic Signals and Association With Stroke Etiology in Ischemic Stroke. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Microembolic signals (MES) detected by the transcranial Doppler ultrasound (TCD) have established prognostic value for stroke recurrence in patients with carotid stenosis. However, the frequency of MES in the context of other stroke etiologies remains unknown.
Methods:
All stroke admissions to Northwestern Memorial hospital between 2016-2018 who underwent TCD within the first 48 hours of admission were reviewed. Final stroke diagnosis was extracted from chart review. Presence or absence of MES was extracted from clinical TCD reports. Frequency of stroke etiology among MES groups were compared using chi-squared test.
Results:
A total of 789 patient charts were reviewed (mean age 62±17 years, 55% male). MES were present in 95 patients. Demographics and medical history of patients were not different among those with and without MES. Compared to patients without MES, those with MES were more frequently diagnosed with cardioembolic stroke (36.4% vs 21%,
p
=0.001) and less frequently with small vessel disease stroke (5.7% vs 24%,
p
<0.001). However, there was no difference in the frequency of cryptogenic strokes between patients with and without MES (
p
=0.844). Among patients with MES, the most frequent etiologies of stroke were cardioembolic (36.4%), cryptogenic (19.3%), large vessel disease (17.1%), and small vessel disease (5.7%).
Conclusion:
TCD detection of MES is seen across all stroke subtypes and may provide additional information for risk stratification in secondary stroke prevention. We are currently reviewing the prognostic utility of MES for stroke recurrence in this cohort.
Collapse
Affiliation(s)
- Michael M Chen
- Neurology, Northwestern Univ Memorial Hosp Div of Stroke and Neurocritical Care, Chicago, IL
| | - Simin Mahinrad
- Neurology, Northwestern Univ Memorial Hosp Div of Stroke and Neurocritical Care, Chicago, IL
| | - Arth K Srivastava
- Neurology, Northwestern Univ Memorial Hosp Div of Stroke and Neurocritical Care, Chicago, IL
| | - Eric Liotta
- Stroke and Neurocritical Care, Northwestern Univ Memorial Hosp Div of Stroke and Neurocritical Care, Chicago, IL
| | - Richard A Bernstein
- Stroke and Neurocritical Care, Northwestern Univ Memorial Hosp Div of Stroke and Neurocritical Care, Chicago, IL
| | - Philip B Gorelick
- Stroke and Neurocritical Care, Northwestern Univ Memorial Hosp Div of Stroke and Neurocritical Care, Chicago, IL
| | - Farzaneh A Sorond
- Stroke and Neurocritical Care, Northwestern Univ Memorial Hosp Div of Stroke and Neurocritical Care, Chicago, IL
| |
Collapse
|
37
|
Nadkarni NA, Maas MB, Batra A, Kim M, Manno EM, Sorond FA, Prabhakaran S, Naidech AM, Liotta EM. Elevated Cerebrospinal Fluid Protein Is Associated with Unfavorable Functional Outcome in Spontaneous Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:104605. [PMID: 31932209 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE Subarachnoid hemorrhage (SAH) is a devastating neurologic event for which markers to assess poor outcome are needed. Elevated cerebrospinal fluid (CSF) protein may result from inflammation and blood-brain barrier (BBB) disruption that occurs during SAH. We sought to determine if CSF protein level is associated with functional outcome after SAH. METHODS We prospectively collected single-center demographic and clinical data for consecutive patients admitted with spontaneous SAH. Inclusion required an external ventricular drain and daily CSF protein and cellular counts starting within 48 hours of symptom onset and extending through 7 days after onset. Seven-day average CSF protein was determined from daily measured values after correcting for contemporaneous CSF red blood cell (RBC) count. Three-month functional outcome was assessed by telephone interview with good outcome defined as modified Rankin score 0-3. Variables univariately associated with outcome at P less than .25 and measures of hemorrhage volume were included for binary logistic regression model development. RESULTS The study included 130 patients (88% aneurysmal SAH, 69% female, 54.8 ± 14.8 years, Glasgow Coma Scale [GCS] 14 [7-15]). Three-month outcome assessment was complete in 112 (86%) patients with good functional outcome in 74 (66%). CSF protein was lower in good outcome (35.3 [20.4-49.7] versus 80.5 [40.5-115.5] mg/dL; P < .001). CSF protein was not associated with cerebral vasospasm, but delayed radiographic infarction on 3 to 12-month neuroimaging was associated with higher CSF protein (46.3 [32.0-75.0] versus 30.2 [20.4-47.8] mg/dL; P = .023). Good 3-month outcome was independently associated with lower CSF protein (odds ratios [OR] .39 [.23-.70] for 75th versus 25th percentile of protein; P = .001) and higher admission GCS (OR 1.23 [1.10-1.37] for good outcome per GCS point increase; P < .001). Parenchymal hematoma predicted worse outcome (OR 6.31 [1.58-25.25]; P = .009). Results were similar after excluding nonaneurysmal SAH and after including CSF RBC count, CT score, and intraventricular hemorrhage volume in models. CONCLUSIONS Elevated average CSF protein is associated with poor outcome after spontaneous SAH. Further research should investigate if elevated CSF protein identifies patients in whom mechanisms such as BBB disruption contribute to poor outcome.
Collapse
Affiliation(s)
- Neil A Nadkarni
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Matthew B Maas
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Ayush Batra
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Minjee Kim
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Edward M Manno
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Shyam Prabhakaran
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Andrew M Naidech
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Eric M Liotta
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois.
| |
Collapse
|
38
|
Swor DE, Thomas LF, Maas MB, Grimaldi D, Manno EM, Sorond FA, Batra A, Kim M, Prabhakaran S, Naidech AM, Liotta EM. Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage. Neurocrit Care 2020; 30:244-250. [PMID: 30756320 DOI: 10.1007/s12028-019-00684-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. METHODS We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1-4 h. We defined being febrile as having a temperature of ≥ 38 °C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher's exact, Mann-Whitney U, or Spearman's rho correlation tests. Variables associated with fever at p ≤ 0.2 were entered in a logistic regression model of being febrile within 14 days. RESULTS There were 248 patients (median age 63 [54-74] years, 125 [50.4%] female, median ICH Score 1 [0-2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08-3.60] vs. 2.55 [1.58-5.72] msec, p = 0.001). Lower HRV was associated with more febrile days (R = - 0.22, p < 0.001). After adjustment, lower HRV was independently associated with greater odds of fever occurrence (OR 0.92 [95% CI 0.87-0.97] with each msec increase in SDNN, p = 0.002). CONCLUSIONS HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.
Collapse
Affiliation(s)
- Dionne E Swor
- Department of Neurology, Northwestern University, Chicago, USA
| | - Leena F Thomas
- Department of Neurology, Northwestern University, Chicago, USA
| | - Matthew B Maas
- Department of Neurology, Northwestern University, Chicago, USA
| | | | - Edward M Manno
- Department of Neurology, Northwestern University, Chicago, USA
| | | | - Ayush Batra
- Department of Neurology, Northwestern University, Chicago, USA
| | - Minjee Kim
- Department of Neurology, Northwestern University, Chicago, USA
| | | | | | - Eric M Liotta
- Department of Neurology, Northwestern University, Chicago, USA.
| |
Collapse
|
39
|
Sorond FA, Whitehead S, Arai K, Arnold D, Carmichael ST, De Carli C, Duering M, Fornage M, Flores-Obando RE, Graff-Radford J, Hamel E, Hess DC, Ihara M, Jensen MK, Markus HS, Montagne A, Rosenberg G, Shih AY, Smith EE, Thiel A, Tse KH, Wilcock D, Barone F. Proceedings from the Albert Charitable Trust Inaugural Workshop on white matter and cognition in aging. GeroScience 2019; 42:81-96. [PMID: 31811528 DOI: 10.1007/s11357-019-00141-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 12/13/2022] Open
Abstract
This third in a series of vascular cognitive impairment (VCI) workshops, supported by "The Leo and Anne Albert Charitable Trust," was held from February 8 to 12 at the Omni Resort in Carlsbad, CA. This workshop followed the information gathered from the earlier two workshops suggesting that we focus more specifically on brain white matter in age-related cognitive impairment. The Scientific Program Committee (Frank Barone, Shawn Whitehead, Eric Smith, and Rod Corriveau) assembled translational, clinical, and basic scientists with unique expertise in acute and chronic white matter injury at the intersection of cerebrovascular and neurodegenerative etiologies. As in previous Albert Trust workshops, invited participants addressed key topics related to mechanisms of white matter injury, biomarkers of white matter injury, and interventions to prevent white matter injury and age-related cognitive decline. This report provides a synopsis of the presentations and discussions by the participants, including the existing knowledge gaps and the delineation of the next steps towards advancing our understanding of white matter injury and age-related cognitive decline. Workshop discussions and consensus resulted in action by The Albert Trust to (1) increase support from biannual to annual "White Matter and Cognition" workshops; (2) provide funding for two collaborative, novel research grants annually submitted by meeting participants; and (3) coordinate the formation of the "Albert Research Institute for White Matter and Cognition." This institute will fill a gap in white matter science, providing white matter and cognition communications, including annual updates from workshops and the literature and interconnecting with other Albert Trust scientific endeavors in cognition and dementia, and providing support for newly established collaborations between seasoned investigators and to the development of talented young investigators in the VCI-dementia (VCID) and white matter cognition arena.
Collapse
Affiliation(s)
- Farzaneh A Sorond
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA.
| | - Shawn Whitehead
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Ken Arai
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Douglas Arnold
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - S Thomas Carmichael
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Charles De Carli
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Marco Duering
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Myriam Fornage
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Rafael E Flores-Obando
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Jonathan Graff-Radford
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Edith Hamel
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - David C Hess
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Massafumi Ihara
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Majken K Jensen
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Hugh S Markus
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Axel Montagne
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Gary Rosenberg
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Andy Y Shih
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Eric E Smith
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Alex Thiel
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Kai Hei Tse
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Donna Wilcock
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| | - Frank Barone
- Department of Neurology, Division Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, suite 1150, Chicago, IL, 60611, USA
| |
Collapse
|
40
|
Mahinrad S, Kurian S, Garner CR, Sedaghat S, Nemeth AJ, Moscufo N, Higgins JP, Jacobs DR, Hausdorff JM, Lloyd-Jones DM, Sorond FA. Cumulative Blood Pressure Exposure During Young Adulthood and Mobility and Cognitive Function in Midlife. Circulation 2019; 141:712-724. [PMID: 31747780 DOI: 10.1161/circulationaha.119.042502] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High blood pressure (BP) is a known risk factor for mobility and cognitive impairment in older adults. This study tested the association of cumulative BP exposure from young adulthood to midlife with gait and cognitive function in midlife. Furthermore, we tested whether these associations were modified by cerebral white matter hyperintensity (WMH) burden. METHODS We included 191 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults), a community-based cohort of young individuals followed over 30 years. Cumulative BP was calculated as the area under the curve (mm Hg×years) from baseline up to year 30 examination. Gait and cognition were assessed at the year 30 examination. Cerebral WMH was available at year 30 in a subset of participants (n=144) who underwent magnetic resonance imaging. Multiple linear regression models were used to assess the association of cumulative BP exposure with gait and cognition. To test effect modification by WMH burden, participants were stratified at the median of WMH and tested for interaction. RESULTS Higher cumulative systolic and diastolic BPs were associated with slower walking speed (both P=0.010), smaller step length (P=0.011 and 0.005, respectively), and higher gait variability (P=0.018 and 0.001, respectively). Higher cumulative systolic BP was associated with lower cognitive performance in the executive (P=0.021), memory (P=0.015), and global domains (P=0.010), and higher cumulative diastolic BP was associated with lower cognitive performance in the memory domain (P=0.012). All associations were independent of socio-demographics and vascular risk factors (body mass index, smoking, diabetes mellitus and total cholesterol). The association between cumulative BP and gait was moderated by WMH burden (interaction P<0.05). However, the relation between cumulative BP and cognitive function was not different based on the WMH burden (interaction P>0.05). CONCLUSIONS Exposure to higher BP levels from young to midlife is associated with worse gait and cognitive performance in midlife. Furthermore, WMH moderates the association of cumulative BP exposure with gait, but not with cognitive function in midlife. The mechanisms underpinning the impact of BP exposure on brain structure and function must be investigated in longitudinal studies using a life course approach.
Collapse
Affiliation(s)
- Simin Mahinrad
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shawn Kurian
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Chaney R Garner
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sanaz Sedaghat
- Preventive Medicine (S.S., D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexander J Nemeth
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Radiology, Division of Neuroradiology (A.J.N.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nicola Moscufo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.M.)
| | - James P Higgins
- Radiology and Biomedical Engineering (J.P.H.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.Jr.)
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel (J.M.H.).,Sagol School of Neuroscience and Department of Physical Therapy, Tel Aviv University, Israel (J.M.H.).,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University, Chicago, IL (J.M.H.)
| | - Donald M Lloyd-Jones
- Preventive Medicine (S.S., D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Farzaneh A Sorond
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
41
|
Kim M, Liotta EM, Zee PC, Ganger DR, Ladner DP, Karmarkar A, Peipert JD, Sorond FA, Prabhakaran S, Reid KJ, Naidech AM, Maas MB. Impaired cognition predicts the risk of hospitalization and death in cirrhosis. Ann Clin Transl Neurol 2019; 6:2282-2290. [PMID: 31631586 PMCID: PMC6856598 DOI: 10.1002/acn3.50924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/14/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022] Open
Abstract
Objective Cognitive impairment, detected in up to 80% of patients with liver cirrhosis, is associated with negative health outcomes but is underdiagnosed in the clinical setting due to the lack of practical testing method. This single‐center prospective observational study aimed to test the feasibility and prognostic utility of in‐clinic cognitive assessment of patients with liver cirrhosis using the NIH Toolbox cognition battery (NIHTB). Methods Patients recruited from a hepatology/transplant clinic underwent cognitive assessments using West‐Haven Grade (WHG) and NIHTB between November 2016 and August 2018 and were prospectively followed until December 2018. The primary outcome was a composite end point of hospitalization related to overt hepatic encephalopathy (OHE) and all‐cause mortality during follow‐up, evaluated by a Cox proportional hazards regression model that adjusted for a priori covariates (age and MELD‐Na). Results Among 127 patients (median age 60 years, 48 [38%] women) assessed, cognitive performance was significantly impaired in 82 [78%] patients with WHG 0 and 22 [100%] patients with WHG 1 and 2. Over a median of 347 days follow‐up, 18 OHE and 8 deaths were observed. Lower cognitive performance was associated with an increased risk of OHE/death adjusting for age and MELD‐Na. Subclinical cognitive impairment detected by NIH Toolbox in WHG 0 patients was significantly associated with greater mortality. Median time to complete the two prognostically informative NIH Toolbox tests was 9.4 min. Interpretation NIH Toolbox may enable a rapid cognitive screening in the outpatient setting and identify patients at high risk for death and hospitalization for severe encephalopathy.
Collapse
Affiliation(s)
- Minjee Kim
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois.,Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois.,Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Northwestern University, Chicago, Illinois
| | - Eric M Liotta
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois.,Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Northwestern University, Chicago, Illinois.,Division of Organ Transplantation, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Daniel R Ganger
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Northwestern University, Chicago, Illinois.,Division of Organ Transplantation, Department of Surgery, Northwestern University, Chicago, Illinois.,Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Daniela P Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Northwestern University, Chicago, Illinois.,Division of Organ Transplantation, Department of Surgery, Northwestern University, Chicago, Illinois.,Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Ameeta Karmarkar
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - John D Peipert
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Northwestern University, Chicago, Illinois.,Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | | | - Kathryn J Reid
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Andrew M Naidech
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois.,Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Northwestern University, Chicago, Illinois.,Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Matthew B Maas
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois.,Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois
| |
Collapse
|
42
|
Csipo T, Mukli P, Lipecz A, Tarantini S, Bahadli D, Abdulhussein O, Owens C, Kiss T, Balasubramanian P, Nyúl-Tóth Á, Hand RA, Yabluchanska V, Sorond FA, Csiszar A, Ungvari Z, Yabluchanskiy A. Assessment of age-related decline of neurovascular coupling responses by functional near-infrared spectroscopy (fNIRS) in humans. GeroScience 2019; 41:495-509. [PMID: 31676966 PMCID: PMC6885078 DOI: 10.1007/s11357-019-00122-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 12/31/2022] Open
Abstract
Preclinical studies provide strong evidence that age-related impairment of neurovascular coupling (NVC) plays a causal role in the pathogenesis of vascular cognitive impairment (VCI). NVC is a critical homeostatic mechanism in the brain, responsible for adjustment of local cerebral blood flow to the energetic needs of the active neuronal tissue. Recent progress in geroscience has led to the identification of critical cellular and molecular mechanisms involved in neurovascular aging, identifying these pathways as targets for intervention. In order to translate the preclinical findings to humans, there is a need to assess NVC in geriatric patients as an endpoint in clinical studies. Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique that enables the investigation of local changes in cerebral blood flow, quantifying task-related changes in oxygenated and deoxygenated hemoglobin concentrations. In the present overview, the basic principles of fNIRS are introduced and the application of this technique to assess NVC in older adults with implications for the design of studies on the mechanistic underpinnings of VCI is discussed.
Collapse
Affiliation(s)
- Tamas Csipo
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Division of Clinical Physiology, Department of Cardiology / Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Peter Mukli
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Agnes Lipecz
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Dhay Bahadli
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Osamah Abdulhussein
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Cameron Owens
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Tamas Kiss
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Priya Balasubramanian
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Ádám Nyúl-Tóth
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Institute of Biophysics, Biological Research Centre, Szeged, Hungary
| | - Rachel A Hand
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Valeriya Yabluchanska
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Bon Secours, St. Francis Family Medicine Center, Midlothian, VA, USA
| | - Farzaneh A Sorond
- Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.
| |
Collapse
|
43
|
Purkayastha S, Sorond FA, Lyng S, Frantz J, Murphy MN, Hynan LS, Sabo T, Bell KR. Impaired Cerebral Vasoreactivity Despite Symptom Resolution in Sports-Related Concussion. J Neurotrauma 2019; 36:2385-2390. [PMID: 30693827 DOI: 10.1089/neu.2018.5861] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) is associated with increased risk of later-life neurodegeneration and dementia. However, the underpinning mechanisms are poorly understood, and secondary injury resulting from perturbed physiological processes plays a significant role. Cerebral vasoreactivity (CVR), a measure of hemodynamic reserve, is known to be impaired in TBI. However, the temporal course of this physiological perturbation is not established. We examined CVR and clinical symptoms on day 3 (T1), day 21 (T2), and day 90 (T3) after concussion in collegiate athletes and cross-sectionally in non-injured controls. Changes in middle cerebral artery blood flow velocity (MCAV; transcranial Doppler ultrasonography) were measured during changes in end-tidal CO2 (PetCO2) at normocapnia, hypercapnia (inspiring 8% CO2), and hypocapnia (hyperventilation). CVR was determined as the slope of the linear relationship and expressed as percent change in MCAV per mmHg change in PetCO2. CVR was attenuated during the acute phase T1 (1.8 ± 0.4U; p = 0.0001), subacute phases T2 (2.0 ± 0.4U; p = 0.0017), and T3 (1.9 ± 0.6U; p = 0.023) post-concussion compared to the controls (2.3 ± 0.3U). Concussed athletes exhibited higher symptom number (2.5 ± 3.0 vs. 12.1 ± 7.0; p < 0.0001) and severity (4.2 ± 6.0 vs. 29.5 ± 23.0; p < 0.0001), higher Patient Health Questionnaire-9 score (2.2 ± 2.0 vs. 9.1 ± 6.0; p = 0.0003) at T1. However, by T2, symptoms had resolved. We show that CVR is impaired as early as 4 days and remains impaired up to 3 months post-injury despite symptom resolution. Persistent perturbations in CVR may therefore be involved in secondary injury. Future studies with a larger sample size and longer follow-up period are needed to validate this finding and delineate the duration of this vulnerable period.
Collapse
Affiliation(s)
- Sushmita Purkayastha
- 1Department of Applied Physiology and Wellness, Simmons School of Education and Human Development, Southern Methodist University, Dallas, Texas.,2Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Farzaneh A Sorond
- 3Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sydney Lyng
- 1Department of Applied Physiology and Wellness, Simmons School of Education and Human Development, Southern Methodist University, Dallas, Texas
| | - Justin Frantz
- 1Department of Applied Physiology and Wellness, Simmons School of Education and Human Development, Southern Methodist University, Dallas, Texas
| | - Megan N Murphy
- 1Department of Applied Physiology and Wellness, Simmons School of Education and Human Development, Southern Methodist University, Dallas, Texas
| | - Linda S Hynan
- 4Department of Clinical Science and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tonia Sabo
- 5Department of Pediatrics/Division of Pediatric Neurology & Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen R Bell
- 2Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
44
|
Abstract
Despite advances in earlier diagnosis and available aggressive treatments for vascular risk factors, stroke remains a leading cause of death and long-term disability worldwide. Disparities exist in stroke risk, rates of stroke, and treatment. Stroke is a heterogeneous disease with multiple additive risk factors and causes. Primary prevention of stroke focusing on risk factor modification plays an important role in reducing the burden of stroke in an aging population. Secondary prevention of recurrent strokes relies on the workup and a tailored treatment targeted at the mechanisms responsible for the incident stroke or transient ischemic attack.
Collapse
Affiliation(s)
- Fan Z Caprio
- Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 North Michigan Avenvue, Suite 1150, Chicago, IL 60611, USA.
| | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 625 North Michigan Avenvue, Suite 1150, Chicago, IL 60611, USA
| |
Collapse
|
45
|
Tchalla A, Wellenius GA, Boyer S, Travison TG, Habtemariam D, Gagnon M, Iloputaife I, Sorond FA, Dantoine T, Lipsitz LA. High levels of an endothelial dysfunction marker (sVCAM-1) are associated with injurious and recurrent falls and mortality over a 5-year interval in an older population. Exp Gerontol 2018; 106:1-7. [PMID: 29481968 DOI: 10.1016/j.exger.2018.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 11/15/2022]
Abstract
We investigated the association between elevated plasma concentrations of circulating soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) and injurious falls and mortality over a 5-year period. We studied the prospective relationship between levels of circulating adhesion molecules and falls in 680 community-dwelling participants in the MOBILIZE Boston Study. The mean sVCAM-1 (±SD) concentration was 1192 ± 428 ng/mL. Over 5-years of follow-up, 10.2% of participants died. The baseline sVCAM-1 (±SD) concentration was 1434 ± 511 ng/mL in those who died vs. 1162 ± 402 ng/mL in those who survived (P < 0.0001). sVCAM-1 level was associated with recurrent falls (P < 0.01); compared to the lowest quintile, the highest quintile of sVCAM-1 was associated with increased risk of injurious falls [multivariable adjusted Incidence Rate Ratio = 1.9, 95% CI (1.2-2.9), P = 0.009]. On survival analysis, the highest sVCAM-1 quintile was associated with the greatest mortality over 5 years (log-rank test, P < 0.0001). The adjusted hazard ratio was 2.4 [95% CI (2.1-2.7), P = 0.002]. High sVCAM-1 blood concentration was strongly associated with recurrent falls, injurious falls, and mortality in older adults.
Collapse
Affiliation(s)
- Achille Tchalla
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Limoges University, IFR 145 GEIST, EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges F-87025, France..
| | | | - Sophie Boyer
- Limoges University, IFR 145 GEIST, EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges F-87025, France
| | - Thomas G Travison
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Margaret Gagnon
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | | | - Farzaneh A Sorond
- Department of Neurology, Stroke Division, Brigham and Women's Hospital, 45 Francis St, Boston, MA 02115, USA
| | - Thierry Dantoine
- Limoges University, IFR 145 GEIST, EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges F-87025, France
| | - Lewis A Lipsitz
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
46
|
Maas MB, Naidech AM, Kim M, Batra A, Manno EM, Sorond FA, Prabhakaran S, Liotta EM. Medication History versus Point-of-Care Platelet Activity Testing in Patients with Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27:1167-1173. [PMID: 29310956 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/01/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE We evaluated whether reduced platelet activity detected by point-of-care (POC) testing is a better predictor of hematoma expansion and poor functional outcomes in patients with intracerebral hemorrhage (ICH) than a history of antiplatelet medication exposure. METHODS Patients presenting with spontaneous ICH were enrolled in a prospective observational cohort study that collected demographic, clinical, laboratory, and radiographic data. We measured platelet activity using the PFA-100 (Siemens AG, Germany) and VerifyNow-ASA (Accumetrics, CA) systems on admission. We performed univariate and adjusted multivariate analyses to assess the strength of association between those measures and (1) hematoma growth at 24 hours and (2) functional outcomes measured by the modified Rankin Scale (mRS) at 3 months. RESULTS We identified 278 patients for analysis (mean age 65 ± 15, median ICH score 1 [interquartile range 0-2]), among whom 164 underwent initial neuroimaging within 6 hours of symptom onset. Univariate association with hematoma growth was stronger for antiplatelet medication history than POC measures, which was confirmed in multivariable models (β 3.64 [95% confidence interval [CI] 1.02-6.26], P = .007), with a larger effect size measured in the under 6-hour subgroup (β 7.20 [95% CI 3.35-11.1], P < .001). Moreover, antiplatelet medication history, but not POC measures of platelet activity, was independently associated with poor outcome at 3 months (mRS 4-6) in the under 6-hour subgroup (adjusted OR 3.6 [95% CI 1.2-11], P = .023). CONCLUSION A history of antiplatelet medication use better identifies patients at risk for hematoma growth and poor functional outcomes than POC measures of platelet activity after spontaneous ICH.
Collapse
Affiliation(s)
- Matthew B Maas
- Division of Stroke and Critical Care, Department of Neurology, Northwestern University, Chicago, Illinois.
| | - Andrew M Naidech
- Division of Stroke and Critical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Minjee Kim
- Division of Stroke and Critical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Ayush Batra
- Division of Stroke and Critical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Edward M Manno
- Division of Stroke and Critical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Farzaneh A Sorond
- Division of Stroke and Critical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Shyam Prabhakaran
- Division of Stroke and Critical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Eric M Liotta
- Division of Stroke and Critical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| |
Collapse
|
47
|
Abstract
Sex and gender, as biological and social factors, significantly influence health outcomes. Among the biological factors, sex differences in vascular physiology may be one specific mechanism contributing to the observed differences in clinical presentation, response to treatment, and clinical outcomes in several vascular disorders. This review focuses on the cerebrovascular bed and summarizes the existing literature on sex differences in cerebrovascular hemodynamics to highlight the knowledge deficit that exists in this domain. The available evidence is used to generate mechanistically plausible and testable hypotheses to underscore the unmet need in understanding sex-specific mechanisms as targets for more effective therapeutic and preventive strategies.
Collapse
Affiliation(s)
- Cristina Duque
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Neurology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Steven K Feske
- Division of Stroke, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
48
|
van der Velpen IF, Yancy CW, Sorond FA, Sabayan B. Impaired Cardiac Function and Cognitive Brain Aging. Can J Cardiol 2017; 33:1587-1596. [DOI: 10.1016/j.cjca.2017.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/16/2017] [Accepted: 07/16/2017] [Indexed: 12/25/2022] Open
|
49
|
Tchalla AE, Wellenius GA, Sorond FA, Gagnon M, Iloputaife I, Travison TG, Dantoine T, Lipsitz LA. Elevated Soluble Vascular Cell Adhesion Molecule-1 Is Associated With Cerebrovascular Resistance and Cognitive Function. J Gerontol A Biol Sci Med Sci 2017; 72:560-566. [PMID: 27317684 DOI: 10.1093/gerona/glw099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/13/2016] [Indexed: 11/13/2022] Open
Abstract
Background Elevated plasma soluble vascular cell adhesion molecule-1 (sVCAM-1) is a presumed marker of endothelial dysfunction, both in the brain and systemic circulation. Impairments in memory and cognition have been associated with cardiovascular diseases, but little is known about their relationships to abnormal cerebral endothelial function. Methods We studied the cross-sectional association between sVCAM-1 and markers of cerebrovascular hemodynamics and cognitive function in 680 community-dwelling participants in the MOBILIZE Boston Study, aged 65 years and older. Cognitive function was assessed using the Hopkins Verbal Learning Memory Test and Trail Making Tests (TMTs) A and B. Global cognitive impairment was defined as Mini-Mental State Examination (MMSE) score less than 24. sVCAM-1 was measured by ELISA assay. Beat-to-beat blood flow velocity (BFV) and cerebrovascular resistance (CVR = mean arterial pressure / BFV) in the middle cerebral artery were assessed at rest by transcranial Doppler ultrasound. Results sVCAM-1 concentrations were higher among participants with an MMSE score <24 versus ≥24 (1,201±417 vs 1,122±494ng/mL). In regression models adjusted for sociodemographic characteristics and health conditions, increasing levels of sVCAM-1 were linearly associated with higher resting CVR (p = .006) and lower performance on the Hopkins Verbal Learning Memory (immediate recall and delayed recall) and adjusted TMT B tests (p < .05). Higher levels of sVCAM-1 were also associated with global cognitive impairment on the MMSE (odds ratio = 3.9; 95% confidence interval: 1.4-10.9; p = .011). Conclusions In this cohort of elderly participants, we observed a cross-sectional association between elevated sVCAM-1 levels and both cognitive impairment and increased cerebrovascular resistance. Longitudinal studies are needed to determine whether elevated sVCAM-1 is a cause or consequence of cerebrovascular damage.
Collapse
Affiliation(s)
- Achille E Tchalla
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Geriatric Medicine, Limoges University, Limoges, France
| | | | - Farzaneh A Sorond
- Department of Neurology, Stroke Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Margaret Gagnon
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | | | - Thomas G Travison
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Thierry Dantoine
- Department of Geriatric Medicine, Limoges University, Limoges, France
| | - Lewis A Lipsitz
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
50
|
Liotta EM, Prabhakaran S, Sangha RS, Bush RA, Long AE, Trevick SA, Potts MB, Jahromi BS, Kim M, Manno EM, Sorond FA, Naidech AM, Maas MB. Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage. Neurology 2017; 89:813-819. [PMID: 28747450 DOI: 10.1212/wnl.0000000000004249] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/31/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH). METHODS Patients presenting with spontaneous ICH were enrolled in an observational cohort study that prospectively collected demographic, clinical, laboratory, radiographic, and outcome data. We performed univariate and adjusted multivariate analyses to assess for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, and in-hospital hematoma growth as radiographic measures of hemostasis, and functional outcome measured by the modified Rankin Scale (mRS) at 3 months. RESULTS We included 290 patients for analysis. Admission serum magnesium was 2.0 ± 0.3 mg/dL. Lower admission magnesium levels were associated with larger initial hematoma volumes on univariate (p = 0.02), parsimoniously adjusted (p = 0.002), and fully adjusted models (p = 0.006), as well as greater hematoma growth (p = 0.004, p = 0.005, and p = 0.008, respectively) and larger final hematoma volumes (p = 0.02, p = 0.001, and p = 0.002, respectively). Lower admission magnesium level was associated with worse functional outcomes at 3 months (i.e., higher mRS; odds ratio 0.14, 95% confidence interval 0.03-0.64, p = 0.011) after adjustment for age, admission Glasgow Coma Scale score, initial hematoma volume, time from symptom onset to initial CT, and hematoma growth, with evidence that the effect of magnesium is mediated through hematoma growth. CONCLUSIONS These data support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH.
Collapse
Affiliation(s)
- Eric M Liotta
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL.
| | - Shyam Prabhakaran
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Rajbeer S Sangha
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Robin A Bush
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Alan E Long
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Stephen A Trevick
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Matthew B Potts
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Babak S Jahromi
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Minjee Kim
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Edward M Manno
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Farzaneh A Sorond
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Andrew M Naidech
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Matthew B Maas
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| |
Collapse
|