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Jin P, Ye S, Ye H, Tong Q, Zhang Q. Urinary microalbumin/creatinine ratio is a predictor of the occurrence and severity of leukoaraiosis. Neuro Endocrinol Lett 2023; 44:528-536. [PMID: 38131176] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To investigate the correlation between the urinary microalbumin/creatinine ratio (UACR) and the occurrence and severity of leukoaraiosis. METHODS A total of 323 patients were retrospectively recruited. Demographic, clinical, and laboratory data were collected at the time of admission, and the UACR was calculated based on the levels of urinary microalbumin and creatinine. All patients showed improvement in cranial magnetic resonance imaging (MRI) examination. The subjects were divided into leukoaraiosis and non-leukoaraiosis groups according to the results of the cranial MRI examination. According to the Fazekas standard score, the patients in the leukoaraiosis group were divided into the mild leukoaraiosis group: Fazekas (1-2 points), moderate leukoaraiosis group: Fazekas (3-4points); and severe leukoaraiosis group: Fazekas (5-6 points). RESULTS A regression analysis was performed to adjust for confounding factors. (1) Compared with the non-leukoaraiosis group, UACR level was higher in the leukoaraiosis group at admission, and the difference between the groups was statistically significant (p < 0.05). (2) In the multivariate logistic regression analysis, UACR was correlated with the occurrence of leukoaraiosis, which may be an independent risk factor. (3) The UACR levels increased gradually in the mild, moderate and severe leukoaraiosis groups, and the difference was statistically significant (p< 0.05). (4) In the ordered multi-category logistic regression analysis, UACR was correlated with the severity of leukoaraiosis, which may be an independent risk factor. CONCLUSION UACR is associated with the occurrence and severity of leukoaraiosis, and may be an independent risk factor.
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Affiliation(s)
- PingPing Jin
- Department of Neurology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - ShanShan Ye
- Department of Neurology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Hua Ye
- Department of Neurology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - QiaoWen Tong
- Department of Neurology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - QingYuan Zhang
- Department of Neurology, Wenzhou People's Hospital, Wenzhou 325000, China
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Babulal GM, Chen L, Carr DB, Johnson AM, Shimony JS, Doherty J, Murphy S, Walker A, Domash H, Hornbeck R, Keefe S, Flores S, Raji CA, Morris JC, Ances BM, Benzinger TLS. Cortical atrophy and leukoaraiosis, imaging markers of cerebrovascular small vessel disease, are associated with driving behavior changes among cognitively normal older adults. J Neurol Sci 2023; 448:120616. [PMID: 36989588 PMCID: PMC10106438 DOI: 10.1016/j.jns.2023.120616] [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: 12/01/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) as measured by cortical atrophy and white matter hyperintensities [leukoaraiosis], captured via magnetic resonance imaging (MRI) are increasing in prevalence due to the growth of the aging population and an increase in cardiovascular risk factors in the population. CSVD impacts cognitive function and mobility, but it is unclear if it affects complex, functional activities like driving. METHODS In a cohort of 163 cognitively normal, community-dwelling older adults (age ≥ 65), we compared naturalistic driving behavior with mild/moderate leukoaraiosis, cortical atrophy, or their combined rating in a clinical composite termed, aging-related changes to those without any, over a two-and-a-half-year period. RESULTS Older drivers with mild or moderate cortical atrophy and aging-related changes (composite) experienced a greater decrease in the number of monthly trips which was due to a decrease in the number of trips made within a one-to-five-mile diameter from their residence. Older drivers with CSVD experience a larger reduction in daily driving behaviors than drivers without CSVD, which may serve as an early neurobehavioral marker for functional decline. CONCLUSIONS As CSVD markers, leukoaraiosis and cortical atrophy are standard MRI metrics that are widely available and can be used for screening individuals at higher risk for driving safety risk and decline in community mobility.
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Affiliation(s)
- Ganesh M Babulal
- Department of Neurology, Washington University in St. Louis, MO, USA; Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA; Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa; Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis, MO, USA
| | - David B Carr
- Department of Medicine, Division of Geriatrics & Nutritional Sciences, Washington University in St. Louis, MO, USA
| | - Ann M Johnson
- Center for Clinical Studies, Washington University in St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Jason Doherty
- Department of Neurology, Washington University in St. Louis, MO, USA
| | - Samantha Murphy
- Department of Neurology, Washington University in St. Louis, MO, USA
| | - Alexis Walker
- Department of Neurology, Washington University in St. Louis, MO, USA
| | - Hailee Domash
- Department of Neurology, Washington University in St. Louis, MO, USA
| | - Russ Hornbeck
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Sarah Keefe
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Shaney Flores
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Cyrus A Raji
- Department of Neurology, Washington University in St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University in St. Louis, MO, USA; Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University in St. Louis, MO 63110, USA
| | - Beau M Ances
- Department of Neurology, Washington University in St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University in St. Louis, MO 63110, USA
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University in St. Louis, MO 63110, USA
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Sharif MS, Goldberg EB, Walker A, Hillis AE, Meier EL. The contribution of white matter pathology, hypoperfusion, lesion load, and stroke recurrence to language deficits following acute subcortical left hemisphere stroke. PLoS One 2022; 17:e0275664. [PMID: 36288353 PMCID: PMC9604977 DOI: 10.1371/journal.pone.0275664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Aphasia, the loss of language ability following damage to the brain, is among the most disabling and common consequences of stroke. Subcortical stroke, occurring in the basal ganglia, thalamus, and/or deep white matter can result in aphasia, often characterized by word fluency, motor speech output, or sentence generation impairments. The link between greater lesion volume and acute aphasia is well documented, but the independent contributions of lesion location, cortical hypoperfusion, prior stroke, and white matter degeneration (leukoaraiosis) remain unclear, particularly in subcortical aphasia. Thus, we aimed to disentangle the contributions of each factor on language impairments in left hemisphere acute subcortical stroke survivors. Eighty patients with acute ischemic left hemisphere subcortical stroke (less than 10 days post-onset) participated. We manually traced acute lesions on diffusion-weighted scans and prior lesions on T2-weighted scans. Leukoaraiosis was rated on T2-weighted scans using the Fazekas et al. (1987) scale. Fluid-attenuated inversion recovery (FLAIR) scans were evaluated for hyperintense vessels in each vascular territory, providing an indirect measure of hypoperfusion in lieu of perfusion-weighted imaging. We found that language performance was negatively correlated with acute/total lesion volumes and greater damage to substructures of the deep white matter and basal ganglia. We conducted a LASSO regression that included all variables for which we found significant univariate relationships to language performance, plus nuisance regressors. Only total lesion volume was a significant predictor of global language impairment severity. Further examination of three participants with severe language impairments suggests that their deficits result from impairment in domain-general, rather than linguistic, processes. Given the variability in language deficits and imaging markers associated with such deficits, it seems likely that subcortical aphasia is a heterogeneous clinical syndrome with distinct causes across individuals.
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Affiliation(s)
- Massoud S. Sharif
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Alexandra Walker
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Cognitive Science, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Erin L. Meier
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
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Chang FG, Rost NS, Manson JE, Buring JE, Rist PM. Association between white matter hyperintensity volume and social functioning limitations among stroke survivors. J Stroke Cerebrovasc Dis 2022; 31:106720. [PMID: 36007263 PMCID: PMC9509456 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106720] [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: 05/12/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Existing literature on white matter hyperintensity volume (WMHV) in stroke patients has rarely focused on post-stroke outcomes related to social functioning limitations, such as transportation, social interaction, food preparation, grocery shopping, and housekeeping. Using prospective data from the VITamin D and OmegA-3 TriaL (VITAL) study, we evaluated the association between WMHV and social functioning limitations among 151 ischemic stroke patients. MATERIALS AND METHODS WMHV was ascertained from magnetic resonance imaging (MRI) collected at the time of the stroke event using a validated semiautomated method, and social functioning limitations were assessed using a stroke outcomes questionnaire administered a median of 1.25 years after the date of the MRI scan. Logistic regression was used to explore the association between WMHV and social functioning limitations. RESULTS After adjusting for age and sex, a statistically significant association was found between WMHV and limitations in social interaction (OR=2.82; 95% CI: 1.21-7.55). Increased risks were seen for limitations related to food preparation (OR=2.06; 95% CI: 0.99-4.54), transportation (OR=1.39; 95% CI: 0.85-2.27), and housekeeping (OR=1.37; 95% CI: 0.91-2.11); however, the associations did not reach statistical significance. We observed no association between WMHV and limitations in grocery shopping (OR=1.08; 95% CI: 0.61-1.89). CONCLUSIONS Future studies are needed to further explore the biological mechanisms underlying the relationship with limitations in social interaction and to replicate our findings using a larger and more diverse study sample.
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Affiliation(s)
- Flora G Chang
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
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Ren T, Sun S, Li B, Chen Y, Qu X, Li C, Deng X, Ni C. Study on the Correlation Between Ischemic Leukoaraiosis and Cerebral Large Artery Stenosis Using the Stages of the Preinfarction Period Based on the Result of Computed Tomography Perfusion. Neurologist 2021; 27:1-5. [PMID: 34842568 DOI: 10.1097/nrl.0000000000000350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The influence of cerebral large artery stenosis (CLAS) on ischemic leukoaraiosis (LA) remains elusive. Based on the proposed stages of the preinfarction period, this study aimed to adopt the staging system to assess the correlation between ischemic LA and CLAS. MATERIALS AND METHODS Patients with unilateral CLAS ≥50% and without cerebral stroke were screened. The severity and distribution of stenosis were evaluated on computed tomography angiography images. The degree of regional cerebral perfusion was rated according to the stages of preinfarction period: 0=normal, 1=stage Ia, 2=stage Ib, 3=stage IIa, 4=stage IIb. Stage I included stage Ia and stage Ib. Stage II included stage IIa and stage IIb. LA was scored with Fazakas scale on T2-weighted image and/or fluid-attenuated inversion recovery sequences. RESULTS The cohort consisted of 212 patients (mean age, 66.89±11.39 y), including 145 (68.40%) males. CLAS severity and distribution did not differ between patients with and without LA (P>0.05). Normal, stage I, and stage II had significantly different incidences of LA and hemispheric LA scores in the left and right hemispheres (P<0.05). The degree of regional cerebral perfusion was independently associated with LA in the left (P=0.0094) and right hemispheres (P=0.0091). CONCLUSIONS Ischemic LA is not directly related to CLAS but is independently associated with the degree of CLAS-induced cerebral hypoperfusion. The stages of the preinfarction period are helpful in identifying people at high risk of LA progression.
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Affiliation(s)
- Taojie Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Shifu Sun
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Bo Li
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Yuan Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Xiaofeng Qu
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Chunxing Li
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Xiaowen Deng
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Caifang Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
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Morotti A, Shoamanesh A, Oliveira-Filho J, Schlunk F, Romero JM, Jessel M, Ayres A, Vashkevich A, Schwab K, Cassarly C, Martin RH, Greenberg SM, Qureshi AI, Rosand J, Goldstein JN. White Matter Hyperintensities and Blood Pressure Lowering in Acute Intracerebral Hemorrhage: A Secondary Analysis of the ATACH-2 Trial. Neurocrit Care 2020; 32:180-186. [PMID: 31218636 DOI: 10.1007/s12028-019-00761-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/09/2023]
Abstract
BACKGROUND It is not clear whether subsets of patients with intracerebral hemorrhage (ICH) benefit from intensive blood pressure (BP) lowering. We evaluated whether white matter hyperintensities (WMH) burden influences response to this therapy. METHODS Retrospective secondary analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 trial. Patients were randomized to intensive (systolic BP target: 110-139 mmHg) versus standard (systolic BP target: 140-179 mmHg) BP treatment with intravenous nicardipine within 4.5 h from onset between May 2011 and September 2015. WMH were rated on magnetic resonance images (fluid-attenuated inversion recovery sequences), defining moderate-severe WMH as total Fazekas scale score ≥ 3 (range 0-6). The main outcome was death or major disability at 90 days (modified Rankin scale ≥ 3). The secondary outcome was ICH expansion, defined as hematoma growth > 33% from baseline to follow-up CT scan. Predictors of the outcomes of interest were explored with multivariable logistic regression. RESULTS A total of 195/1000 patients had MRI images available for analysis, of whom 161 (82.6%) had moderate-severe WMH. When compared to patients with none-mild WMH, those with moderate-severe WMH did not have an increased risk of death or major disability (adjusted relative risk: 1.83, 95% CI 0.71-4.69) or ICH expansion (adjusted relative risk: 1.14, 95% CI 0.38-3.37). WMH burden did not modify the effect of intensive BP treatment on outcome (all p for interaction ≥ 0.2). CONCLUSION The majority of acute ICH patients have moderate-severe WMH, but advanced small vessel disease burden marked by WMH does not influence ICH-related outcomes or response to intensive BP reduction.
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Affiliation(s)
- Andrea Morotti
- Department of Neurology and Neurorehabilitation, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Ashkan Shoamanesh
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Jamary Oliveira-Filho
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Frieder Schlunk
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Javier M Romero
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Michael Jessel
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Alison Ayres
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Anastasia Vashkevich
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Kristin Schwab
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Renee' Hebert Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Steven M Greenberg
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, USA
| | - Jonathan Rosand
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Henry and Allison Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Joshua N Goldstein
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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7
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Boulouis G, Bricout N, Benhassen W, Ferrigno M, Turc G, Bretzner M, Benzakoun J, Seners P, Personnic T, Legrand L, Trystram D, Rodriguez-Regent C, Charidimou A, Rost NS, Bracard S, Cordonnier C, Oppenheim C, Naggara O, Henon H. White matter hyperintensity burden in patients with ischemic stroke treated with thrombectomy. Neurology 2019; 93:e1498-e1506. [PMID: 31519778 PMCID: PMC6815208 DOI: 10.1212/wnl.0000000000008317] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/11/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION To determine the influence of white matter hyperintensity (WMH) burden on functional outcome, rate of symptomatic intracerebral hemorrhage (sICH), and procedural success in patients with acute ischemic stroke (AIS) treated by mechanical thrombectomy (MT) with current stentriever/aspiration devices. METHODS Patients with AIS due to large vessel occlusion (LVO) from the Thrombectomie des Artères Cérébrales (THRACE) trial and prospective cohorts from 2 academic comprehensive stroke centers treated with MT were pooled and retrospectively analyzed. WMH volumes were obtained by semiautomated planimetric segmentation and tested in association with the rate of favorable outcome (90-day functional independence), substantial recanalization after MT, and sICH. RESULTS A total of 496 participants were included between 2015 and 2018 (50% female, mean age 68.1 ± 15.0 years). Overall, 434 (88%) patients presented with detectable WMH (mean ± SD 4.93 ± 7.7). Patients demonstrated increasingly worse outcomes with increasing WMH volumes (odds ratio [aOR]1.05 per 1-cm3 increase for unfavorable outcome, 95% confidence interval [CI] 1.01-1.06, p = 0.014). Fifty-seven percent of patients in the first quartile of WMH volume vs 28% in the fourth quartile demonstrated favorable outcome (p < 0.001). WMH severity was not associated with sICH rate (aOR 0.99, 95% CI 0.93-1.04, p = 0.66), nor did it influence recanalization success (aOR 0.99, 95% CI 0.96-1.02, p = 0.84). CONCLUSION Our study provides evidence that in patients with AIS due to LVO and high burden of WMH as assessed by pretreatment MRI, the safety and efficacy profiles of MT are similar to those in patients with lower WMH burden and confirms that they are at higher risk of unfavorable outcome. Because more than a quarter of patients in the highest WMH quartile experienced favorable 3 months outcome, WMH burden may not be a good argument to deny MT. CLINICALTRIALSGOV IDENTIFIER NCT01062698.
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Affiliation(s)
- Grégoire Boulouis
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Nicolas Bricout
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Wagih Benhassen
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Marc Ferrigno
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Guillaume Turc
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Martin Bretzner
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Joseph Benzakoun
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Pierre Seners
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Thomas Personnic
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Laurence Legrand
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Denis Trystram
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Christine Rodriguez-Regent
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Andreas Charidimou
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Natalia S Rost
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Serge Bracard
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Charlotte Cordonnier
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Catherine Oppenheim
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Olivier Naggara
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
| | - Hilde Henon
- From the Neuroradiology Department (G.B., W.B., J.B., L.L., D.T., C.R.-R., C.O., O.N.) and Neurology Department (G.T., P.S.), Paris Descartes University, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris; Neuroradiology Department (N.B., M.B.), Université de Lille (M.F., T.P., C.C., H.H.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, France; J. Philip Kistler Stroke Research Center (A.C., N.S.R.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; and Neuroradiology Department (S.B.), Lorraine University, INSERM U1254 CHRU Nancy, France
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8
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Abstract
PURPOSE OF REVIEW Subclinical cerebrovascular disease (sCVD) is highly prevalent in older adults. The main neuroimaging findings of sCVD include white matter hyperintensities and silent brain infarcts on T2-weighted MRI and cerebral microbleeds on gradient echo or susceptibility-weighted MRI. In this paper, we will review the epidemiology of sCVD, the current evidence for best medical management, and future directions for sCVD research. RECENT FINDINGS Numerous epidemiologic studies show that sCVD, in particular WMH, is an important risk factor for the development of dementia, stroke, worse outcomes after stroke, gait instability, late-life depression, and death. Effective treatment of sCVD could have major consequences for the brain health of a substantial portion of older Americans. Despite the link between sCVD and many vascular risk factors, such as hypertension or hyperlipidemia, the optimal medical treatment of sCVD remains uncertain. Given the clinical equipoise about the risk versus benefit of aggressive medical management for sCVD, clinical trials to examine pragmatic, evidence-based approaches to management of sCVD are needed. Such a trial could provide much needed guidance on how to manage a common clinical scenario facing internists and neurologists in practice.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, UT, USA.
| | - Chelsea Meyer
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - J Scott McNally
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Matthew Alexander
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Lee Chung
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
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9
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Chen H, Li Y, Liu Q, Shi Q, Wang J, Shen H, Chen X, Ma J, Ai L, Zhang YM. Abnormal Interactions of the Salience Network, Central Executive Network, and Default-Mode Network in Patients With Different Cognitive Impairment Loads Caused by Leukoaraiosis. Front Neural Circuits 2019; 13:42. [PMID: 31275116 PMCID: PMC6592158 DOI: 10.3389/fncir.2019.00042] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/28/2019] [Indexed: 12/31/2022] Open
Abstract
Leukoaraiosis (LA) is associated with cognitive impairment in the older people which can be demonstrated in functional connectivity (FC) based on resting-state functional magnetic resonance imaging (rs-fMRI). This study is to explore the FC changes in LA patients with different cognitive status by three network models. Fifty-three patients with LA were divided into three groups: the normal cognition (LA-NC; n = 14, six males), mild cognitive impairment (LA-MCI; n = 27, 13 males), and vascular dementia (LA-VD; n = 12, six males), according to the Mini Mental State Exam (MMSE) and Clinical Dementia Rating (CDR). The three groups and 30 matched healthy controls (HCs; 11 males) underwent rs-fMRI. The data of rs-fMRI were analyzed by independent components analysis (ICA) and region of interest (ROI) analysis by the REST toolbox. Then the FC was respectively analyzed by the default-mode network (DMN), salience networks (SNs) and the central executive network (CEN) with their results compared among the different groups. For inter-brain network analysis, there were negative FC between the SN and DMN in LA groups, and the FC decreased when compared with HC group. While there were enhanced inter-brain network FC between the SN and CEN as well as within the SN. The FC in patients with LA can be detected by different network models of rs-fMRI. The multi-model analysis is helpful for the further understanding of the cognitive changes in those patients.
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Affiliation(s)
- Hongyan Chen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuexiu Li
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, National Clinical Research Center for Neurological Diseases, Beijing, China
- Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing, China
| | - Qi Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qingli Shi
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, National Clinical Research Center for Neurological Diseases, Beijing, China
- Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Pinggu Hospital, Beijing, China
| | - Jingfang Wang
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, National Clinical Research Center for Neurological Diseases, Beijing, China
- Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, General Hospital of The Yang Tze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Huicong Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuzhu Chen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Ma
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Ai
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Mei Zhang
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, National Clinical Research Center for Neurological Diseases, Beijing, China
- Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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10
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Ko EJ, Choi KH, Kwon SU. The Relationship Between Leukoaraiosis Involving Contralateral Corticobulbar Tract and Dysphagia in Patients with Acute Unilateral Corona Radiata Infarction with Corticobulbar Tract Involvement. Dysphagia 2018; 34:654-664. [PMID: 30465078 DOI: 10.1007/s00455-018-9963-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Received: 11/21/2017] [Accepted: 11/14/2018] [Indexed: 02/04/2023]
Abstract
This study investigated the impact of leukoaraiosis (LA) involving the contralateral corticobulbar tract (CBT) on dysphagia in patients with unilateral corona radiata (CR) infarction with CBT involvement. Patients admitted to the Department of Neurology (September 2011-August 2014) were evaluated; those with a first episode of acute unilateral CR infarction involving the CBT and with LA were included. The 'Case' group comprised patients with LA involving the contralateral CBT; the 'Control' group comprised patients with LA not involving the contralateral CBT. The primary outcome was the feeding method at discharge; secondary outcomes were the feeding method at admission and results of the bedside swallowing test, videofluoroscopic swallowing study (VFSS), videofluoroscopic dysphagia scale, penetration-aspiration scale, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA NOMS), oral transit time, and pharyngeal transit time. Infarct size was measured using brain magnetic resonance imaging; LA severity was rated using the Fazekas scale. Eighty-one patients were included (mean age 64.6 ± 11.5 years; 64% male; Case group: 20, 5 underwent VFSS; Control group: 67, 11 underwent VFSS). The Case group was older and had higher total Fazekas scale score than the Control group. The feeding method at discharge and ASHA NOMS score were significantly worse in the Case group than in the Control group. Multivariate analysis revealed that LA involving the contralateral CBT independently predicted the feeding method at discharge and ASHA NOMS score. In conclusion, LA involving the contralateral CBT is associated with dysphagia in patients with unilateral CR infarction involving the CBT.
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Affiliation(s)
- Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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11
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Yang CM, Hung CL, Su HC, Lin HJ, Chen CH, Lin CC, Hu HH, Lin SH, Sung PS. Leukoaraiosis and risk of intracranial hemorrhage and outcome after stroke thrombolysis. PLoS One 2018; 13:e0196505. [PMID: 29715283 PMCID: PMC5929505 DOI: 10.1371/journal.pone.0196505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The impact of leukoaraiosis on the risk of symptomatic intracerebral hemorrhage (SICH) after stroke thrombolysis is conflicting, and the data on Asian populations are lacking. Therefore, in this study, we assessed the association between leukoaraiosis and SICH, and the association between leukoaraiosis and the 90-day functional outcome in the Asian population. METHODS Data were collected from a two-center prospective registry of acute ischemic stroke patients given intravenous tissue plasminogen activator between 2006 and 2014. A total of 614 pretreatment brain CT and 455 posttreatment MRI were retrospectively assessed using two different rating scales for the presence of leukoaraiosis. Outcome measures were the occurrence of SICH with three definitions and any hemorrhage after thrombolysis and functional outcome at 3 months. RESULTS Of the 614 patients assessed, 30.3% showed severe leukoaraiosis on the baseline brain CT. The SICH rate was 4.6% - 7.2% based on different definitions, and overall, 24.9% of patients showed any post-tPA hemorrhage. No association was observed between the severity of leukoaraiosis and SICH, regardless of having used different leukoaraiosis rating scales or as assessment using different imaging modalities. However, severe leukoaraiosis was independently associated with poor functional outcome at 3 months (OR 1.96, 95% C1 1.24-3.11, P = 0.004) after adjustment for confounders. CONCLUSIONS Our results showed no association between leukoaraiosis and the risk of SICH. Although the presence of severe leukoaraiosis predicted a poor functional outcome after stroke, IV thrombolysis might not be withheld in acute ischemic stroke patients solely based on the presence of severe leukoaraiosis on pre-thrombolytic CT scans.
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Affiliation(s)
- Chun-Ming Yang
- Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Ling Hung
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Chen Su
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huey-Juan Lin
- Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chou-Ching Lin
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han-Hwa Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pi-Shan Sung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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12
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Mayasi Y, Goddeau RP, Moonis M, Silver B, Jun-O'Connell AH, Puri AS, Henninger N. Leukoaraiosis Attenuates Diagnostic Accuracy of Large-Vessel Occlusion Scales. AJNR Am J Neuroradiol 2018; 39:317-322. [PMID: 29170268 DOI: 10.3174/ajnr.a5473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/07/2017] [Accepted: 10/02/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prehospital stroke scales may help identify patients likely to have large-vessel occlusion to facilitate rapid triage to thrombectomy-capable stroke centers. Scale misclassification may result in inaccurate decisions and possible harm. Pre-existing leukoaraiosis has been shown to attenuate the association between deficit type and stroke severity. We sought to determine whether leukoaraiosis affects the predictive ability of 5 commonly used large-vessel occlusion scales. MATERIALS AND METHODS We retrospectively analyzed 274 consecutive patients with stroke with available brain MR imaging and vessel imaging. We used the following large-vessel occlusion scales: the 3-Item Stroke Scale; Field Assessment Stroke Triage for Emergency Destination; Rapid Arterial Occlusion Evaluation; Vision, Aphasia, Neglect score; and Cincinnati Prehospital Stroke Severity Scale. For diagnostic scale accuracy, we assessed sensitivity, specificity, positive predictive value, negative predictive value, and κ. Multivariable logistic regression was used to determine the predictive ability of the scales after adjustment for leukoaraiosis and potential confounders. RESULTS In unadjusted analyses, all scales predicted the presence of large-vessel occlusion (n = 46, P < .01 each), though diagnostic accuracy was attenuated among patients with moderate-to-severe leukoaraiosis. After adjustment, the Field Assessment Stroke Triage for Emergency Destination (OR = 3.2; 95% CI, 1.1-9.5; P = .033) and Rapid Arterial Occlusion Evaluation (OR = 3.7; 95% CI, 1.3-10.8; P = .015), but not the 3-Item Stroke Scale (OR = 5.4; 95% CI, 0.86-33.9; P = .073), Vision, Aphasia, Neglect score (OR = 2.5; 95% CI, 0.8-7.2), and Cincinnati Prehospital Stroke Severity Scale (OR = 2.8; 95% CI, 1.0-8.0), predicted large-vessel occlusion. CONCLUSIONS The diagnostic accuracy of the tested large-vessel occlusion scales was attenuated in the presence of moderate-to-severe leukoaraiosis. This information that may aid the design of future studies that require large-vessel occlusion scale screening of patients who are likely to have concomitant leukoaraiosis.
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Affiliation(s)
- Y Mayasi
- From the Department of Neurology (Y.M., R.P.G., M.M., B.S., A.H.J.-O., N.H.)
| | - R P Goddeau
- From the Department of Neurology (Y.M., R.P.G., M.M., B.S., A.H.J.-O., N.H.)
| | - M Moonis
- From the Department of Neurology (Y.M., R.P.G., M.M., B.S., A.H.J.-O., N.H.)
| | - B Silver
- From the Department of Neurology (Y.M., R.P.G., M.M., B.S., A.H.J.-O., N.H.)
| | - A H Jun-O'Connell
- From the Department of Neurology (Y.M., R.P.G., M.M., B.S., A.H.J.-O., N.H.)
| | - A S Puri
- Department of Radiology, Division of Neurointerventional Radiology (A.S.P.)
| | - N Henninger
- From the Department of Neurology (Y.M., R.P.G., M.M., B.S., A.H.J.-O., N.H.)
- Department of Psychiatry (N.H), University of Massachusetts Medical School, Worcester, Massachusetts
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13
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Wang S, Yuan J, Guo X, Teng L, Jiang H, Gu H, Hu W, Jiang T. Correlation between prefrontal-striatal pathway impairment and cognitive impairment in patients with leukoaraiosis. Medicine (Baltimore) 2017; 96:e6703. [PMID: 28445276 PMCID: PMC5413241 DOI: 10.1097/md.0000000000006703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Our study aimed to investigate the changes of white matter microstructure of cortico-subcortical pathways using diffusion tensor imaging (DTI), and to explore the relationship between abnormal parameters of DTI and cognitive function underlying in patients with leukoaraiosis (LA).A total of 42 patients with LA and 42 age- and sex-matched healthy controls were recruited from Beijing Chaoyang Hospital, Capital Medical University between January 2012 and December 2012. All the subjects underwent scans of conventional magnetic resonance imaging and DTI, and a comprehensive neuropsychological battery was utilized. The regions of interest (ROIs) were located at the white matter of centrum semiovale, anterior and posterior periventricular white matter, basal ganglia, corpus callosum. The averaged values of mean diffusivity (MD) and fractional anisotropy (FA) were quantified both within white matter lesions (WMLs) and normal appearing white matter (NAWM). A linear regression analysis was performed to assess the association between diffusion parameters and decline in cognitive domains.Patients with LA were associated with comprehensive cognitive function deficits. We found that significantly decreased FA and increased MD in WMLs at the 5 ROIs than that of NAWM and controls (P < .05). The values of FA in NAWM were significantly lower and MD in NAWM were significantly higher at centrum semiovale and posterior periventricular white matter than that of controls (P < .05). The values of FA in WMLs at anterior periventricular white matter were positively related to the performances of cognition in patients with LA (P < .05). The values of FA in NAWM located at anterior periventricular white matter were positively related to the score of Digit-symbol test (r = 0.446, P = .002). The values of FA in NAWM located at anterior periventricular white matter correlated inversely with the Z scores of executive function (r = -0.418, P = .03).In our study, patients with LA exhibited significant cognitive impairment especially in the domains of executive function. The technique of DTI revealed that the reduced FA and increased MD at the corresponding regions of cortico-subcortical pathways in patients with LA. DTI may be of great help for an early pathology of white matter microstructure underlying in patients with LA.
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Affiliation(s)
| | - Junliang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Afsar B, Sag AA, Yalcin CE, Kaya E, Siriopol D, Goldsmith D, Covic A, Kanbay M. Brain-kidney cross-talk: Definition and emerging evidence. Eur J Intern Med 2016; 36:7-12. [PMID: 27531628 DOI: 10.1016/j.ejim.2016.07.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 12/12/2022]
Abstract
Cross-talk is broadly defined as endogenous homeostatic signaling between vital organs such as the heart, kidneys and brain. Kidney-brain cross-talk remains an area with excitingly few publications despite its purported clinical relevance in the management of currently undertreated conditions such as resistant hypertension. Therefore, this review aims to establish an organ-specific definition for kidney-brain cross-talk and review the available and forthcoming literature on this topic.
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Affiliation(s)
- Baris Afsar
- Department of Medicine, Division of Nephrology, Konya Numune State Hospital, Konya, Turkey
| | - Alan A Sag
- Department of Radiology, Division of Interventional Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Can Ege Yalcin
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Eren Kaya
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Dimitrie Siriopol
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - David Goldsmith
- Renal and Transplantation Department, Guy's and St Thomas' Hospitals, London, UK
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
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Lin Q, Li Z, Wei R, Lei Q, Liu Y, Cai X. Increased Risk of Post-Thrombolysis Intracranial Hemorrhage in Acute Ischemic Stroke Patients with Leukoaraiosis: A Meta-Analysis. PLoS One 2016; 11:e0153486. [PMID: 27096292 PMCID: PMC4838243 DOI: 10.1371/journal.pone.0153486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/30/2016] [Indexed: 02/06/2023] Open
Abstract
Background Leukoaraiosis is common in patients with acute ischemic stroke. The results from many studies investigating the association between leukoaraiosis and intracranial hemorrhage after thrombolysis remain conflicting. Methods A meta-analysis was performed to compare the risk of post-thrombolytic intracranial hemorrhage in patients with and without leukoaraiosis. Relevant reports were identified by searching PubMed, EmBase, Cochrane Library, and ISI Web of Science through December 2015 using a combination of subjective and random terms. Eligible studies that were original articles with a clear definition of leukoaraiosis and intracranial hemorrhage were selected and analyzed. Funnel plots, Egger’s test, and Begg’s test were conducted to assess the publication bias. Sensitivity analysis was also performed to evaluate the influence of each individual study. Results Eleven trials that enrolled 6912 participants were included. There was a significantly increased risk for acute ischemic stroke patients with leukoaraiosis (odds ratio: 1.89, 95% confidence interval 1.51–2.37, P<0.001). Low heterogeneity and less publication bias was detected among these studies. The results of both computed tomography and magnetic resonance imaging performed on the subgroups of leukoaraiosis were significant. Furthermore, an association between leukoaraiosis and symptomatic intracranial hemorrhage was also confirmed. The odds ratios remained stable with no obvious variations on the sensitivity analysis. The limitations consisted of types of including trials and not matching some baseline variables. Conclusions The results of this meta-analysis show that leukoaraiosis approximately doubles the incidence of intracranial hemorrhage after thrombolytic therapy. However, it does not critically affect decision making regarding thrombolysis for patients with acute ischemic stroke. Additional investigations are required.
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Affiliation(s)
- Qianqian Lin
- Department of Neurology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhong Li
- Department of Neurology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- * E-mail:
| | - Rui Wei
- Department of Neurology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qingfeng Lei
- Department of Neurology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yunyun Liu
- Department of Neurology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaodong Cai
- Department of Neurology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Pías-Peleteiro JM, Aldrey JM, Fernández-Pajarín G, Ares-Pensado B, Jiménez-Martín I, Sesar Á, Pías-Peleteiro L, Castro A. [Delusional parasitosis associated to mild cognitive impairment of vascular causation. Good response to low doses of quetiapine]. Rev Neurol 2015; 61:334-335. [PMID: 26411279] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Yu K, Zhong T, Li L, Wang J, Chen Y, Zhou H. Significant Association between Carotid Artery Kinking and Leukoaraiosis in Middle-Aged and Elderly Chinese Patients. J Stroke Cerebrovasc Dis 2015; 24:1025-31. [PMID: 25817620 DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Received: 11/25/2014] [Revised: 12/25/2014] [Accepted: 12/26/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leukoaraiosis (LA) and carotid artery morphologic variations are 2 common imaging manifestations. The purpose of this study was to determine whether carotid artery morphologic variations are correlated with LA. METHODS A total of 702 patients, aged 50 years or older, admitted to our hospital from November 1, 2013, to January 30, 2014, were prospectively enrolled in this study. All participants underwent magnetic resonance imaging to assess the presence and severity of LA. Carotid artery morphologic variations were classified into tortuosity, kinking, and coiling by computed tomography angiography. Logistic regression analyses were performed to examine the relationship between carotid artery morphologic variations, its components, and LA. RESULTS The frequency of hemisphere with LA and carotid artery with carotid artery morphologic variations was 49.9% and 70.3% in the cohort, respectively. Carotid kinking was associated with an increased risk of ipsilateral LA after multivariable adjustment (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.57-3.36 for left side; OR, 2.51; 95% CI: 1.68-3.74 for right side), whereas carotid tortuosity and coiling were not related to LA. Moreover, the prevalence of carotid kinking gradually increased with advancing grades of ipsilateral LA. CONCLUSIONS The present study demonstrated that carotid artery kinking may be associated with an increased risk of LA in middle-aged and elderly Chinese patients. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Ke Yu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Tingting Zhong
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ling Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Junfeng Wang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yang Chen
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Huadong Zhou
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China.
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Abstract
BACKGROUND AND PURPOSE Leukoaraiosis is a common finding among patients with ischemic stroke and has been associated with poor stroke outcomes. Our aim was to ascertain whether the severity of pre-existing leukoaraiosis is associated with outcome in patients with acute ischemic stroke who are treated with endovascular stroke therapy. MATERIALS AND METHODS We retrospectively analyzed data from 129 consecutive, prospectively enrolled patients with stroke undergoing endovascular stroke therapy at a single tertiary care center between January 2006 and August 2013. Leukoaraiosis was assessed as supratentorial white matter hypoattenuation on admission head CT and graded as 0-2 (absent-to-moderate) versus 3-4 (severe) according to the van Swieten scale. We dichotomized the 90-day mRS into good (0-2 or return to baseline) versus poor (3-6) as the primary study outcome. Incremental multivariable logistic regression analyses were performed to identify independent predictors of a poor 90-day outcome. RESULTS In all multivariable models, severe leukoaraiosis was independently (P < .05) associated with a poor outcome at 90 days (fully adjusted model: OR, 6.37; 95% CI, 1.83-12.18; P = .004). The independent association between leukoaraiosis and a poor outcome remained when the analysis was restricted to patients who were alive at discharge (n = 87, P < .05). Last, among patients who were alive at discharge, those with severe leukoaraiosis had significantly less frequent improvement on the mRS from discharge to 90 days compared with patients with absent-to-moderate leukoaraiosis (P = .034). CONCLUSIONS The severity of pre-existing leukoaraiosis is independently associated with 90-day functional outcome in patients with stroke who underwent endovascular stroke therapy. These results highlight the need to further explore leukoaraiosis as a promising surrogate marker for poor outcome after endovascular stroke therapy to improve risk assessment, patient selection, and early prognostic accuracy.
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Affiliation(s)
- J Zhang
- From the Departments of Neurology (J.Z., N.H., R.P.G.)
| | - A S Puri
- Radiology (A.S.P.) Neurosurgery (A.S.P.)
| | - M A Khan
- Department of Neurology (M.A.K.), Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - R P Goddeau
- From the Departments of Neurology (J.Z., N.H., R.P.G.)
| | - N Henninger
- From the Departments of Neurology (J.Z., N.H., R.P.G.) Psychiatry (N.H.), University of Massachusetts Medical School, Worcester, Massachusetts
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Chen YF, Tseng YL, Lan MY, Lai SL, Su CS, Liu JS, Chang YY. The relationship of leukoaraiosis and the clinical severity of vascular Parkinsonism. J Neurol Sci 2014; 346:255-9. [PMID: 25240444 DOI: 10.1016/j.jns.2014.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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] [Received: 10/02/2013] [Revised: 08/13/2014] [Accepted: 09/03/2014] [Indexed: 11/19/2022]
Abstract
Vascular Parkinsonism (VP) is referred to as secondary Parkinsonian syndrome. It occurs with lacunar state or sub-cortical white matter micro-angiopathy and is highly associated with vascular risk factors and leukoaraiosis, also known as cerebral white matter lesions (WML). This study aimed to assess the prevalence of different vascular risk factors and WML in patients with VP, and their impact on clinical features. Sixty-two consecutive VP patients (70.2 ± 9.2 years) were evaluated for clinical severity using the Unified Parkinson's Disease Rating Scale (UPDRS). WML was assessed and scored on fluid-attenuated inversion recovery T2-weighted (FLAIR) magnetic resonance imaging (MRI). Cerebro-vascular risk factors, WML severity, and the UPDRS for clinical disability were analyzed statistically. There were no associations between WML score and age, sex, hypertension, diabetes, previous stroke, cardiac disease, cigarette smoking, or serum levels of cholesterol and triglyceride. The WML score positively correlated with UPDRS part I (p = 0.035) and part III (p = 0.041) scores. After adjustments for age, gender, stroke history, and use of levodopa, the WML score was associated with the UPDRS total (p = 0.020), part I (p = 0.012), part II (p = 0.039), and part III (p = 0.019) scores. The severity of WML is not associated with conventional vascular risk factors in VP patients but is significantly correlated with the UPDRS total and all sub-scores, which suggests that disruption of the cortico-sub-cortical circuits may lead to impaired mentation, behavior and mood, activities of daily living, and motor performance in these patients.
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Affiliation(s)
- Ying-Fa Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan; Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Lung Tseng
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Yu Lan
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan; Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Lon Lai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-San Su
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan; Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jia-Shou Liu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Yung-Yee Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan; Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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20
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Jedrychowska-Jamborska J, Kulig-Stochmal A, Kubicka-Trzaska A, Romanowska-Dixon B. [Leukoaraiosis as a cause of non-arteritic anterior ischemic optic neuropathy--a case report]. Klin Oczna 2014; 116:32-34. [PMID: 25137919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The paper presents the case of a 61-year-old man with specific symptoms of non-arteritic anterior ischemic optic neuropathy. The head computed tomographyscans revealed multiple leukoaraiotic lesions. Leukoaraiosis is a disease affecting small cerebral vessels. Its pathogenesis is associated with a chronic inflammatory process and ischemic vascular endothelial dysfunction which reduce the cerebral blood flow. It cannot be ruled out that this process, alongside with Horton disease, hypertension, diabetes and atherosclerosis, may also be involved in the pathogenesis of non-arteritic anterior ischemic optic neuropathy. leukoaraiosis, non-arteritic anterior ischemic optic neuropathy.
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Fang M, Feng C, Xu Y, Hua T, Jin AP, Liu XY. Microbleeds and silent brain infarctions are differently associated with cognitive dysfunction in patients with advanced periventricular leukoaraiosis. Int J Med Sci 2013; 10:1307-13. [PMID: 23983590 PMCID: PMC3752718 DOI: 10.7150/ijms.6430] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/23/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Leukoaraiosis, microbleeds, and silent brain infarctions are phenotypes of small vessel disease. Leukoaraiosis is the most prevalent, and advanced periventricular leukoaraiosis is regarded as a strong predictor of cognitive dysfunction. Microbleeds and silent brain infarctions sometimes coexist with leukoaraiosis. This study aims to analyze the effects of microbleeds and silent brain infarctions on cognitive function of patients with advanced periventricular leukoaraiosis. METHODS 227 patients with advanced periventricular leukoaraiosis were divided into control, MB, SBI, and MB&SBI groups. The presence and locations of microbleeds and silent brain infarctions were evaluated. Mini-Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test and Verbal Fluency Test were performed. Chi-square test and ANOVA to compare the characteristics of four groups, multiple linear regressions to identify the risk factors for cognitive dysfunction. RESULTS The scores in all four tests were lower in the MB and MB&SBI groups while only the scores in Clock Drawing Test and Verbal Fluency Test were lower in the SBI group than in the control group. Age and the presence of microbleeds were independent risk factors for the lower scores in all four tests, whereas the presence of silent brain infarctions was the only independent risk factor for the lower scores in Clock Drawing Test and Verbal Fluency Test. Lobar microbleeds had the most significant effect on cognitive function. CONCLUSION Microbleeds and silent brain infarctions were associated differently with cognitive impairment of patients with advanced periventricular leukoaraiosis. The effect of lobar microbleeds was the most significant.
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Affiliation(s)
- Min Fang
- 1. Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Chao Feng
- 1. Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Yu Xu
- 2. Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Ting Hua
- 2. Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Ai-Ping Jin
- 1. Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Xue-Yuan Liu
- 1. Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
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Li C, Ling X, Liu S, Xu A, Zhang Y, Xing S, Pei Z, Zeng J. Abnormalities of magnetic resonance spectroscopy and diffusion tensor imaging are correlated with executive dysfunction in patients with ischemic leukoaraiosis. J Clin Neurosci 2013; 19:718-22. [PMID: 22502913 DOI: 10.1016/j.jocn.2011.07.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 07/10/2011] [Accepted: 07/19/2011] [Indexed: 11/17/2022]
Abstract
Abnormal diffusion tensor imaging (DTI) results have been observed in the periventricular white matter in patients with ischemic leukoaraiosis (ILA). However, the underlying pathological changes and their relationship to cognitive impairments are obscure. In addition, damage in the thalamus, an important structure in the executive function network, has been suggested in ILA, but is poorly understood. Twenty patients with ILA and 20 healthy volunteers with similar ages and educational histories underwent DTI, magnetic resonance spectroscopy (MRS) and a neuropsychological assessment. In patients with ILA, we observed an increased mean diffusivity (MD) and decreased levels of N-acetylaspartate (NAA)/creatine (Cr) in the anterior and posterior periventricular region and the thalamus, as well as decreased fractional anisotropy (FA) in the anterior and posterior periventricular regions. MD and NAA/Cr levels in the anterior and posterior periventricular white matter and NAA/Cr levels in the thalamus were correlated with executive function. DTI and MRS abnormalities were consistent with axonal and/or neuronal loss and dysfunction in the anterior and posterior periventricular white matter and the thalamus. This study demonstrates that DTI and MRS techniques can be used to investigate pathological changes in the anterior and posterior periventricular white matter and the thalamus; these changes may be correlated with executive functional changes in patients with ILA.
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Affiliation(s)
- Chuo Li
- Department of Internal Medicine, Guangzhou Eighth People's Hospital, Guangzhou, China
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Park JH, Ryoo S, Kim SJ, Kim GM, Chung CS, Lee KH, Bang OY. Differential risk factors for lacunar stroke depending on the MRI (white and red) subtypes of microangiopathy. PLoS One 2012; 7:e44865. [PMID: 23024771 PMCID: PMC3443091 DOI: 10.1371/journal.pone.0044865] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 08/09/2012] [Indexed: 11/18/2022] Open
Abstract
Background Leukoaraiosis and cerebral microbleeds (CMB), which represent cerebral microangiopathy, commonly coexist in patients with acute lacunar stroke. Since they may have different impacts on stroke prognosis and treatment, it is important to know the factors associated with leukoaraiosis-predominant vs. CMB-predominant microangiopathies. Methods We prospectively recruited 226 patients with acute lacunar infarction and divided them into four groups according to the Fazekas’ score and the presence of CMB: mild, red (predominant CMB), white (predominant leukoaraiosis) and severe microangiopathy groups. For comparison, we also evaluated 50 patients with intracerebral hemorrhage (ICH). We evaluated the clinical and laboratory findings of microangiopathy subtypes in patients with acute lacunar stroke and then compared them with those of primary ICH. Results The risk factor profile was different among the groups. Patients with acute lacunar infarct but mild microangiopathy were younger, predominantly male, less hypertensive, and more frequently had smoking and heavy alcohol habits than other groups. The risk factor profile of red microangiopathy was similar to that of ICH but differed from that of white microangiopathy. The subjects in the white microangiopathy group were older and more frequently had diabetes than those in the red microangiopathy or ICH group. After adjustments for other factors, age [odds ratio (OR) 1.13; 95% confidence interval (CI) 1.08–1.18; p<0.001] and diabetes (OR 2.28; 95% CI 1.02–5.13; p = 0.045) were independently associated with white microangiopathy, and age (OR 1.05; 95% CI 1.01–1.08; p = 0.010) was independent predictor for red microangiopathy compared to mild microangiopathy. Conclusion Patients with acute lacunar infarction have a different risk factor profile depending on microangiopathic findings. Our results indicate that diabetes may be an one of determinants of white (leukoaraiosis-predominant) microangiopathy, whereas smoking and alcohol habits in relatively young people may be a determinants of mild microangiopahic changes in patients with lacunar infarction.
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Affiliation(s)
- Jae-Hyun Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sookyung Ryoo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Jae Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Ho Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Folsom AR, Yatsuya H, Mosley TH, Psaty BM, Longstreth WT. Risk of intraparenchymal hemorrhage with magnetic resonance imaging-defined leukoaraiosis and brain infarcts. Ann Neurol 2012; 71:552-9. [PMID: 22522444 DOI: 10.1002/ana.22690] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether the burden of leukoaraiosis and the number of brain infarcts, defined by magnetic resonance imaging (MRI), are prospectively and independently associated with intraparenchymal hemorrhage (IPH) incidence in a pooled population-based study. METHODS Among 4,872 participants initially free of clinical stroke in the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study, we assessed white matter grade (range, 0-9), reflecting increasing leukoaraiosis, and brain infarcts using MRI. Over a median of 13 years of follow-up, 71 incident, spontaneous IPH events occurred. RESULTS After adjustment for other IPH risk factors, the hazard ratios (95% confidence intervals) across white matter grades 0 to 1, 2, 3, and 4 to 9 were 1.00, 1.68 (0.86-3.30), 3.52 (1.80-6.89), and 3.96 (1.90-8.27), respectively (p for trend <0.0001). These hazard ratios were weakened only modestly (p for trend = 0.0003) with adjustment for MRI-defined brain infarcts. The IPH hazard ratios for 0, 1, 2, or ≥3 MRI-defined brain infarcts were 1.00, 1.97 (1.10-3.54), 2.00 (0.83-4.78), and 3.12 (1.31-7.43) (p for trend = 0.002), but these were substantially attenuated when adjusted for white matter grade (p for trend = 0.049). INTERPRETATION Greater MRI-defined burden of leukoaraiosis is a risk factor for spontaneous IPH. Spontaneous IPH should be added to the growing list of potential poor outcomes in people with leukoaraiosis.
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Affiliation(s)
- Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA.
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Jokinen H, Frederiksen KS, Garde E, Skimminge A, Siebner H, Waldemar G, Ylikoski R, Madureira S, Verdelho A, van Straaten ECW, Barkhof F, Fazekas F, Schmidt R, Pantoni L, Inzitari D, Erkinjuntti T. Callosal tissue loss parallels subtle decline in psychomotor speed. a longitudinal quantitative MRI study. The LADIS Study. Neuropsychologia 2012; 50:1650-5. [PMID: 22497753 DOI: 10.1016/j.neuropsychologia.2012.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 03/11/2012] [Accepted: 03/19/2012] [Indexed: 11/30/2022]
Abstract
Cross-sectional studies have suggested that corpus callosum (CC) atrophy is related to impairment in global cognitive function, mental speed, and executive functions in the elderly. Longitudinal studies confirming these findings have been lacking. We investigated whether CC tissue loss is associated with change in cognitive performance over time in subjects with age-related white matter lesions (WML). Two-hundred-fifty-three subjects, aged 65-84 years, were evaluated by using repeated MRI and neuropsychological evaluation at baseline and after 3 years. The effect of overall and regional CC tissue loss on cognitive decline was analyzed with hierarchical linear regression models. After controlling for age, sex, education, and baseline cognitive performance, the rates of tissue loss in the total CC area, and in rostrum/genu and midbody subregions were significantly associated with decline in a compound measure of cognitive speed and motor control, but not in those of executive functions, memory, or global cognitive function. Total CC area and midbody remained significant predictors of speed also after adjusting for baseline WML volume, WML progression, and global brain atrophy. However, the relationship between anterior CC and speed performance was mediated by WML volume. In conclusion, the overall and regional rate of CC tissue loss parallels longitudinal slowing of psychomotor performance. The adverse effect of CC tissue loss on psychomotor function may be driven by altered interhemispheric information transfer between homologous cortical areas.
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Affiliation(s)
- Hanna Jokinen
- Department of Neurology, Helsinki University Central Hospital Helsinki, Finland.
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Raji CA, Lopez OL, Kuller LH, Carmichael OT, Longstreth WT, Gach HM, Boardman J, Bernick CB, Thompson PM, Becker JT. White matter lesions and brain gray matter volume in cognitively normal elders. Neurobiol Aging 2011; 33:834.e7-16. [PMID: 21943959 DOI: 10.1016/j.neurobiolaging.2011.08.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [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: 12/08/2010] [Revised: 08/03/2011] [Accepted: 08/12/2011] [Indexed: 01/18/2023]
Abstract
Cerebral white matter lesions (WMLs) reflect small vessel disease, are common in elderly individuals, and are associated with cognitive impairment. We sought to determine the relationships between WMLs, age, gray matter (GM) volume, and cognition in the Cardiovascular Health Study (CHS). From the Cardiovascular Health Study we selected 740 cognitively normal controls with a 1.5 T magnetic resonance imaging (MRI) scan of the brain and a detailed diagnostic evaluation. WML severity was determined using a standardized visual rating system. GM volumes were analyzed using voxel-based morphometry implemented in the Statistical Parametric Mapping software. WMLs were inversely correlated with GM volume, with the greatest volume loss in the frontal cortex. Age-related atrophy was observed in the hippocampus and posterior cingulate cortex. Regression analyses revealed links among age, APOE*4 allele, hypertension, WMLs, GM volume, and digit symbol substitution test scores. Both advancing age and hypertension predict higher WML load, which is itself associated with GM atrophy. Longitudinal data are needed to confirm the temporal sequence of events leading to a decline in cognitive function.
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Affiliation(s)
- Cyrus A Raji
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
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Field TS, Benavente OR. Penetrating artery territory pontine infarction. Rev Neurol Dis 2011; 8:30-38. [PMID: 21769069] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pontine infarcts account for 25% of lacunar strokes. The primary morphologies are wedge-shaped tegmental, basal, and tegmentobasal infarcts, caused by disease of the paramedian basilar branches, and smaller, circumscribed lacunar infarcts attributed to lipohyalinosis. Roughly 60% of infarcts are paramedian. Both typical and atypical lacunar syndromes are seen with pontine infarcts, pure motor hemiparesis being the most common, followed by sensorimotor stroke and ataxic hemiparesis. Eye movement abnormalities and neuropsychological deficits are also commonly seen. Short-term functional prognosis is usually good with lacunar morphology; rostral, lateral or tegmental locations predict a more favorable prognosis.
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Affiliation(s)
- Thalia S Field
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Suades-González E, Jódar-Vicente M, Pérdrix-Solàs D. [Memory deficit in patients with subcortical vascular cognitive impairment versus Alzheimer-type dementia: the sensitivity of the 'word list' subtest on the Wechsler Memory Scale-III]. Rev Neurol 2009; 49:623-629. [PMID: 20013713] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Memory deficits are frequent in mild subcortical vascular pathology and in the early stage of Alzheimer's disease. AIM To study the memory deficits in patients with subcortical vascular cognitive impairment (SVCI) vs. mild stage Alzheimer's disease patients (AD), using the Weschler Memory Scale-III (WMS-III) word lists test, to examine the adequacy of this test to show the different memory patterns in this population, that could contribute to early differential diagnosis. PATIENTS AND METHODS Three groups of patients were compared: AD (n = 25), SVCI-leukoaraiosis (n = 17) and SVCI-multi infarct (n = 16). The three groups did not differ in age, education or severity of illness. RESULTS Patients with SVCI showed a memory impairment in free recall with an improvement in their performance on the recognition task. The AD group, however, showed low scores in free recall as in recognition tasks, with a major number of false positive errors. Significant differences were also found between the SVCI-leukoaraiosis and SVCI-multi infarct groups, with the latter showing the best performance in long term retention and a minor trend to respond with false positive errors. CONCLUSIONS The WMS-III word lists test is a good instrument to differentiate the memory profile between SVCI and AD, with the recognition task being the most discriminative one. The worst impairment in leukoaraiosis patients in comparison to the multi infarct group, suggests that white matter diffuse lesion could affect more directly the recall processes mediatised by the frontal lobe.
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Affiliation(s)
- E Suades-González
- Servicio de Neurología, Corporació Sanitària Parc Taulí, E-08208Sabadell (Barcelona), Espana
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Birns J, Morris R, Jarosz J, Markus HS, Kalra L. Hypertension-related cognitive decline: is the time right for intervention studies? Minerva Cardioangiol 2009; 57:813-830. [PMID: 19942849] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The importance of lowering blood pressure in hypertensive subjects is well known but the relationship between hypertension and cognitive function has been a subject of considerable controversy. Cross-sectional studies investigating the relationship between blood pressure and cognition have shown conflicting relationships whilst the majority of longitudinal studies have demonstrated elevated blood pressure to be associated with cognitive decline. Randomised studies have demonstrated heterogeneous and sometimes conflicting effects of blood pressure lowering on cognitive function and suggested reasons include multiple mechanisms by which hypertension affects the brain, the variety of cognitive instruments used for assessment and differences in antihypertensive treatments. Chronic hypertension accelerates arteriosclerotic changes in the brain with a disproportionate effect on subcortical circuits associated with cerebral small vessel disease. Randomised clinical trials assessing the cognitive consequences of blood pressure reduction in people with small vessel disease are lacking and many of the existing controversies on the cognitive consequences of blood pressure lowering, especially in older people, arise from the design limitations of studies. This article describes the methodological issues in designing such a trial and the results of a pilot evaluation to see if careful selection of subjects and measurements would make undertaking intervention studies feasible. Given the predicted upswing in people with cognitive impairments, the time is right for randomised clinical trials with specific cognitive end-points to examine the relationship between cognitive function and hypertension and guide practice.
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Affiliation(s)
- J Birns
- Department of Ageing and Health, 9th Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK2.
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Luan P, Lu BX, Pan SY. [Correlation between diffusion anisotropy of the white matter fibers and cognitive function in patients with leukoaraiosis]. Nan Fang Yi Ke Da Xue Xue Bao 2009; 29:1106-1110. [PMID: 19726334] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the correlation between the diffusion anisotropy of the white matter fibers and the cognitive function in patients with leukoaraiosis (LA). METHODS Thirty-one LA patients were enrolled in this study, including 13 with grade LA-1 (mild), 12 with grade LA-2 (moderate) and 6 with grade LA-3 (severe) condition. The control group consisted of 18 subjects who were free of obvious clinical symptoms or had only mild dizziness and headache but with negative history for neural system diseases and in the absence of cognitive dysfunction, brain trauma, positive signs in neurological examinations, or abnormities in MRI examination. The Mini-mental State Examination (MMSE) was applied to evaluate the patients' cognitive function. The LA patients underwent examination with diffusion tensor MR imaging (DTI), and the FA and MD values in the normal-appearing white matter (NAWM) were measured. RESULTS The cognitive function of the LA patients tended to decline with the decrease of the MMSE scores, and their scores for time orientation, place orientation and calculation were significantly lower than those of the control group (P<0.05). No significant difference was found in memory, language and comprehensive abilities between the LA and control groups. In LA-1, LA-2 and total LA cases, the FA value in the NAWM was positively, and the MD value inversely, correlated to the cognitive function with correlation coefficients ranging from 0.5 to 0.8 (P<0.05). CONCLUSION The DTI parameters of NAWM region are correlated to the cognitive function of LA patients. DTI is far more sensitive than MRI in evaluating cognitive dysfunction in LA patients.
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Affiliation(s)
- Ping Luan
- Hospital of Guangzhou Economic and Technological Development District, Guangzhou, China.
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Koga H, Takashima Y, Murakawa R, Uchino A, Yuzuriha T, Yao H. Cognitive consequences of multiple lacunes and leukoaraiosis as vascular cognitive impairment in community-dwelling elderly individuals. J Stroke Cerebrovasc Dis 2008; 18:32-7. [PMID: 19110142 DOI: 10.1016/j.jstrokecerebrovasdis.2008.07.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 06/30/2008] [Accepted: 07/17/2008] [Indexed: 11/18/2022] Open
Abstract
The aim of our study was to investigate the effects of silent brain lesions on cognitive function of community-dwelling elderly individuals. Brain magnetic resonance imaging and other medical examinations were performed on 350 nondemented elderly individuals (121 male and 229 female, average age 72.4 years) who resided in the rural community of Sefuri Village, Saga, Japan. The mini mental state examination and modified Stroop test (MST) were used to identify cognitive impairment. White matter lesions (WMLs) and cerebral atrophy on magnetic resonance imaging were measured quantitatively. Multivariate analyses were done using a logistic regression model with a software package. Cognitive impairment defined by mini mental state examination score less than 24 was present in 55 individuals (15.7%). They had a lower educational level, significantly larger quantity of WMLs, and more remarkable cerebral atrophy. Frontal lobe dysfunction was detected in 52 individuals (14.9%) through prolonged MST score (>36 seconds). Impaired frontal lobe function was related to number of silent lacunar infarcts, larger WMLs, and more prominent cerebral atrophy. MST score in individuals with two or more infarcts was significantly more prolonged compared with MST score in those without infarction. These results suggest that WMLs may cause rather diffuse cognitive decline, whereas multiple lacunar infarcts are specifically involved in frontal lobe dysfunction. Silent ischemic lesions in apparently healthy elderly individuals seem to form a distinctive group of people with vascular cognitive impairment without dementia. This group should be the primary target of prevention of vascular dementia.
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Affiliation(s)
- Hiroshi Koga
- Center for Emotional and Behavioral Disorders, Hizen Psychiatric Center, Saga, Japan
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Jiménez I, Agulla J, Pouso M, Sabucedo M, Rodríguez-Yáñez M, Sobrino T, Brea D, Blanco M, Leira R, Castillo J. [Cognitive impairment associated to leukoaraiosis: its pathophysiology, clinical manifestations and treatment]. Rev Neurol 2008; 47:536-544. [PMID: 19012258] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION AND DEVELOPMENT Leukoaraiosis is a radiological term which refers to white matter disturbances observed as a hypodensity in computed tomography and hyperintensity in T2-weighted magnetic resonance image. The most accepted theory to explain the mechanism of production of leukoaraiosis is chronic ischemia, due to a damage in penetrating arteries. It is an entity with increasing interest, since it is associated with the presence of cognitive impairment. Clinical manifestations in relation with cognitive functions range from mild affectation to dementia, affecting the processing speed and executive functions. CONCLUSIONS It seems that the control of vascular risk factors slow the progression of leukoaraiosis and cognitive impairment, and although there are no really effective treatment, it seems that some drugs, such as acetylcholinesterase inhibitors or NMDA-receptor antagonists, exert a beneficial effect, although slight, in cognitive functions.
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Affiliation(s)
- I Jiménez
- Hospital Clinico Universitario, 15706 Santiago de Compostela, Espana
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Lee SJ, Kim JS, Lee KS, An JY, Kim W, Kim YI, Kim BS, Jung SL. The severity of leukoaraiosis correlates with the clinical phenotype of Parkinson's disease. Arch Gerontol Geriatr 2008; 49:255-259. [PMID: 18977043 DOI: 10.1016/j.archger.2008.09.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 09/07/2008] [Accepted: 09/11/2008] [Indexed: 11/19/2022]
Abstract
The impact of leukoaraiosis on Parkinson's disease (PD) has not been completely explained. We evaluated 141 patients with PD to assess the role of leukoaraiosis and determined its influence on the clinical phenotype of PD. Clinical assessments during off medication and leukoaraiosis grading were performed according to the atherosclerosis risk in communities (ARIC) study. Patients were grouped into two phenotypes, tremor or postural instability and gait difficulty (PIGD)-dominant groups. Associations between the age at onset, gender, disease duration, cardiovascular risk factors, leukoaraiosis grade and the disease phenotype were analyzed. In addition, the role of the leukoaraiosis grade in relationship to the parkinsonian motor handicaps was evaluated. The leukoaraiosis correlated with the severity of the clinical symptoms of PD as measured by the United Parkinson's disease rating scale (UPDRS) scores and the Hoehn and Yahr (H + Y) stage. There were significant correlations observed between the leukoaraiosis grade and specific motor handicaps especially those with axial symptoms. Multivariate logistic regression analysis showed that the leukoaraiosis grade was independently associated with the PIGD motor phenotype of PD. The leukoaraiosis grade was independently associated with the PIGD motor phenotype of PD; this might be explained by the affects on nondopaminergic subcortical pathways. These results have implications for clinical management of PD with regard to the control of vascular risk factors.
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Affiliation(s)
- Seung-Jae Lee
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Joong-Seok Kim
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea.
| | - Kwang-Soo Lee
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Jae-Young An
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Woojun Kim
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Yeong-In Kim
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Bum-Soo Kim
- Department of Radiology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - So-Lyung Jung
- Department of Radiology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
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Mandell DM, Han JS, Poublanc J, Crawley AP, Kassner A, Fisher JA, Mikulis DJ. Selective reduction of blood flow to white matter during hypercapnia corresponds with leukoaraiosis. Stroke 2008; 39:1993-8. [PMID: 18451357 DOI: 10.1161/strokeaha.107.501692] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Age-related white matter disease (leukoaraiosis) clusters in bands in the centrum semiovale, about the occipital and frontal horns of the lateral ventricles, in the corpus callosum, and internal capsule. Cerebrovascular anatomy suggests that some of these locations represent border zones between arterial supply territories. We hypothesized that there are zones of reduced cerebrovascular reserve (susceptible to selective reductions in blood flow, ie, steal phenomenon) in the white matter of young, healthy subjects, the physiological correlate of these anatomically defined border zones. Furthermore, we hypothesized that these zones spatially correspond with the regions where the elderly develop leukoaraiosis. METHODS Twenty-eight healthy volunteers underwent functional MR mapping of the cerebrovascular response to hypercapnia. We studied 18 subjects by blood oxygen level-dependent MRI and 10 subjects by arterial spin labeling MRI. We controlled both end-tidal pCO(2) and pO(2). All functional data was registered in Montreal Neurological Institute space and generated composite blood oxygen level-dependent MR and arterial spin labeling MR maps of cerebrovascular reserve. We compared these maps with frequency maps of leukoaraiosis published previously. RESULTS Composite maps demonstrated significant (90% CI excluding the value zero) steal phenomenon in the white matter. This steal was induced by relatively small changes in end-tidal pCO(2). It occurred precisely in those locations where elderly patients develop leukoaraiosis. CONCLUSIONS This steal phenomenon likely represents the physiological correlate of the previously anatomically defined internal border zones. Spatial concordance with white matter changes in the elderly raises the possibility that this steal phenomenon may have a pathogenetic role.
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Affiliation(s)
- Daniel M Mandell
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
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Della Nave R, Foresti S, Pratesi A, Ginestroni A, Inzitari M, Salvadori E, Giannelli M, Diciotti S, Inzitari D, Mascalchi M. Whole-brain histogram and voxel-based analyses of diffusion tensor imaging in patients with leukoaraiosis: correlation with motor and cognitive impairment. AJNR Am J Neuroradiol 2007; 28:1313-9. [PMID: 17698534 PMCID: PMC7977673 DOI: 10.3174/ajnr.a0555] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral white matter changes, termed leukoaraiosis (LA), appearing as areas of increased signal intensity in T2-weighted MR images, are common in elderly subjects, but the possible correlation of LA with cognitive or motor deficit has not been established. We hypothesized that histogram and voxel-based analyses of whole-brain mean diffusivity (MD) and fractional anisotropy (FA) maps calculated from diffusion tensor imaging (DTI) could be more sensitive tools than visual scales to investigate the clinical correlates of LA. MATERIALS AND METHODS Thirty-six patients of the Leukoaraiosis and Disability Study were evaluated with fluid-attenuated inversion recovery for LA extension, T1-weighted images for volume, and DTI for MD and FA. The extent of LA was rated visually. The normalized total, gray, and white matter brain volumes were computed, as well as the 25th percentile, 50th percentile, kurtosis, and skewness of the MD and FA maps of the whole brain. Finally, voxel-based analysis on the maps of gray and white matter volume, MD, and FA was performed with SPM2 software. Correlation analyses between visual or computerized data and motor or neuropsychologic scale scores were performed using the Spearman rank test and the SPM2 software. RESULTS The visual score correlated with some MD and FA histogram metrics (P<.01). However, only the 25th and 50th percentiles, kurtosis, and skewness of the MD and FA histograms correlated with motor or neuropsychologic deficits. Voxel-based analysis revealed a correlation (P<.05 corrected for multiple comparisons) between a large cluster of increased MD in the corpus callosum and pericallosal white matter and motor deficit. CONCLUSIONS These results are consistent with the hypothesis that histogram and voxel-based analyses of the whole-brain MD and FA maps are more sensitive tools than the visual evaluation for clinical correlation in patients with LA.
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Affiliation(s)
- R Della Nave
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, and Medical Physics, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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McMurtray AM, Liao A, Haider J, Licht E, Mendez MF. Cognitive Performance after Lacunar Stroke Correlates with Leukoaraiosis Severity. Cerebrovasc Dis 2007; 24:271-6. [PMID: 17646691 DOI: 10.1159/000105679] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 02/23/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study investigates the effect of leukoaraiosis on patients presenting with cognitive impairment after lacunar stroke. METHODS Fourty-six patients with cognitive impairment and newly discovered lacunar stroke detected by brain magnetic resonance imaging underwent neuropsychological testing. RESULTS Patients with both lacunar infarct and leukoaraiosis performed less well on cognitive measures, compared to those with lacunar infarcts alone. Additionally, leukoaraiosis severity inversely correlated with cognitive performance. CONCLUSIONS In patients with lacunar stroke, presence of leukoaraiosis is associated with worse performance in multiple cognitive domains. These findings suggest lacunar infarcts plus leukoaraiosis is a common etiology for vascular dementia.
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Affiliation(s)
- Aaron M McMurtray
- Department of Neurology, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA 90073, USA
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McMurtray A, Nakamoto B, Shikuma C, Valcour V. Small-Vessel Vascular Disease in Human Immunodeficiency Virus Infection: The Hawaii Aging with HIV Cohort Study. Cerebrovasc Dis 2007; 24:236-41. [PMID: 17630484 DOI: 10.1159/000104484] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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: 03/12/2007] [Accepted: 03/14/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study is designed to determine the relationship between age and occurrence of cerebral manifestations of small-vessel ischemic vascular disease in human immunodeficiency virus (HIV)-seropositive individuals. METHODS Periventricular leukoaraiosis severity and white matter lesion volume were determined by magnetic resonance imaging of the brain of 57 HIV-seropositive individuals. RESULTS Cerebral small-vessel ischemic vascular disease manifestations correlated with age and systolic blood pressure, but not with HIV infection-related parameters. CONCLUSIONS These findings suggest that, in the era of highly active antiretroviral therapy, leukoaraiosis severity and white matter lesion volume may be more indicative of small-vessel ischemic vascular disease than HIV-related CNS pathology, and support the need for aggressive treatment of vascular risk factors in HIV-seropositive individuals.
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Affiliation(s)
- Aaron McMurtray
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96816, USA.
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Park K, Yasuda N, Toyonaga S, Yamada SM, Nakabayashi H, Nakasato M, Nakagomi T, Tsubosaki E, Shimizu K. Significant association between leukoaraiosis and metabolic syndrome in healthy subjects. Neurology 2007; 69:974-8. [PMID: 17538033 DOI: 10.1212/01.wnl.0000266562.54684.bf] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship between leukoaraiosis (LA), which has been considered as an intermediate substitute of ischemic brain damages, and metabolic syndrome (MetS), which attracts attention as a risk factor for cerebrovascular diseases, in healthy subjects derived from various age groups. METHODS We studied 1,030 healthy persons at ages between 28 and 78 years (mean, 52.7 years) with no history of stroke who visited a health care facility for routine health checkups. MetS was defined using the criteria of the National Cholesterol Education Program Adult Treatment Panel III. LA was assessed using the rating scale of the Atherosclerosis Risk in Communities study on MRI. Logistic regression analysis was performed to examine associations between LA and MetS. RESULTS A total of 296 (28.8%) subjects had LA on MRI. MetS was significantly associated with the presence of LA (adjusted OR, 3.33; 95% CI, 2.30, 4.84). The association was constant across grades of LA; the adjusted OR was 3.41 (95% CI, 2.30, 5.06) for minimal LA and 3.07 (95% CI, 1.75, 5.38) for LA combining mild, moderate, and severe grades. As for MetS components, elevated blood pressure (adjusted OR, 2.16; 95% CI, 1.57, 2.99), impaired fasting glucose (adjusted OR, 1.64; 95% CI, 1.13, 2.39), and hypertriglyceridemia (adjusted OR, 1.56; 95% CI, 1.08, 2.28) were independently associated with all grades of LA. CONCLUSIONS Metabolic syndrome (MetS) was significantly associated with every grade of leukoaraiosis (LA), including the minimal LA. Impaired fasting glucose and hypertriglyceridemia were associated with LA independently of elevated blood pressure. MetS can play an important role in identifying healthy subjects who have an increased risk of LA.
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Affiliation(s)
- K Park
- Department of Neurosurgery, Medical School, Kochi University, Kohasu, Okohcho, Nankokushi, Kochi, Japan.
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Lin R, Svensson L, Gupta R, Lytle B, Krieger D. Chronic ischemic cerebral white matter disease is a risk factor for nonfocal neurologic injury after total aortic arch replacement. J Thorac Cardiovasc Surg 2007; 133:1059-65. [PMID: 17382653 DOI: 10.1016/j.jtcvs.2006.11.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 11/14/2006] [Accepted: 11/20/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Leukoaraiosis (chronic ischemic white matter changes) on preoperative brain magnetic resonance imaging is common in patients having aortic arch surgery. This study sought to determine whether it is associated with adverse neurologic outcome in the postoperative period. METHODS Data were collected from a retrospective chart review of 142 patients in whom total aortic arch replacement was planned at the Cleveland Clinic between April 2000 and December 2004. All patients had preoperative brain magnetic resonance imaging evaluation. Leukoaraiosis severity was rated semiquantitatively using the Schelten's scale. Postoperative neurologic injuries were investigated by clinical examination and appropriate neuroimaging. They were stratified as type 1 (focal ischemic stroke) and type 2 (nonfocal neurocognitive changes, generalized seizures) injuries. RESULTS The following were independent predictors of type 1 neurologic injury: age (odds ratio 1.06 [1.01-1.13], P = .02) and moderate to severe aortic atheroma (odds ratio 4.4 [1.4-9.7], P = .012). Total white matter scores (odds ratio 1.16 [1.06-1.27], P = .002) and higher preoperative hemoglobin A1c levels (odds ratio 1.8 [1.00-3.50], P = .05) were significantly associated with type 2 neurologic injuries. Survival was 96%, and 4.2% had persistent focal neurologic deficits at the time of hospital discharge. CONCLUSIONS Leukoaraiosis is a significant independent predictor of nonfocal postoperative neurologic morbidity following aortic arch replacement surgery. Preoperative evaluation with magnetic resonance imaging allows identification of a patient subgroup at risk and implementation of strategies aimed at improving neurologic outcome.
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Affiliation(s)
- Ridwan Lin
- Department of Neurology, Center for Aortic Surgery, Marfan Syndrome and Connective Tissue Disorder Clinic, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Abstract
OBJECTIVES To evaluate whether the presence of leukoaraiosis or multiple lacunes is associated with symptomatic intracerebral hemorrhage (ICH) and 90-day outcome after thrombolytic treatment with tissue plasminogen activator (tPA). METHODS Data were from a Canadian national registry of thrombolyzed patients with ischemic stroke. A total of 820 scans were assessed, blind to clinical features, for the presence of severe vs no/moderate leukoaraiosis, and of multiple (>2) vs no/single lacunar infarcts. Logistic regression was used to determine if an independent interaction existed between the presence and degree of leukoaraiosis/lacunes and risk of symptomatic ICH, and to evaluate the predictive role of leukoaraiosis and lacunes in relation to 90-day outcome. RESULTS An overall symptomatic ICH rate of 3.5% was observed. The rate of symptomatic ICH increased up to 10% in patients with severe leukoaraiosis and multiple lacunes. A significant association was observed between ICH risk and either severe leukoaraiosis (RR = 2.7 [95% CI 1.1 to 6.5]) or multiple lacunes (RR = 3.4 [95% CI 1.5 to 7.6]). Patients with multiple lacunes, but not leukoaraiosis, had higher mortality at 90 days compared to those with one or no lacunes (OR = 2.9, 95% CI 1.3 to 6.2, p = 0.008). No difference was observed in the good outcome rate among patients with and without leukoaraiosis or lacunes or both. CONCLUSION The presence of small vessel disease on CT scan does not affect overall clinical outcome at 3 months in routine community use of tPA for ischemic stroke. A significant increase in the risk of symptomatic ICH is observed.
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Affiliation(s)
- V Palumbo
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy.
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Abstract
OBJECTIVE To use an audiovestibular test battery to evaluate patients with leukoaraiosis in order to investigate the relationship between vertigo and dizziness and leukoaraiosis. DESIGN Retrospective study. SETTING Tertiary university hospital. Patients A total of 18 elderly patients with vertigo and dizziness and with leukoaraiosis confirmed by magnetic resonance imaging (hereafter, leukoaraiosis group), and another 18 age- and sex-matched patients with vertigo and dizziness but without leukoaraiosis (hereafter, nonleukoaraiosis group) were enrolled in this study. MAIN OUTCOME MEASURES Each patient underwent a battery of audiovestibular tests, including audiometry and electronystagmography (ENG). RESULTS In the leukoaraiosis group, ENG examination showed slow pursuit movements in 72% of patients, slowing of saccadic eye movements in 28%, abnormal optokinetic nystagmus test results in 44%, and canal paresis or caloric areflexia in 56% of cases. Compared with the nonleukoaraiosis group, 50%, 17%, 44%, and 61% of cases exhibited nonsignificant differences in slow pursuit movements, slowing of saccadic eye movements, abnormal optokinetic nystagmus test results, and abnormal caloric test results, respectively. However, saccadic oscillation had an occurrence rate of 72% in the leukoaraiosis group in contrast with a 22% rate in the nonleukoaraiosis group, revealing a significant statistical difference. CONCLUSIONS Saccadic oscillations in the ENG examination indicated leukoaraiosis on the magnetic resonance imaging scan, with a sensitivity of 72% and a specificity of 78%. We therefore recommend using ENG examination to screen elderly individuals with leukoaraiosis.
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Affiliation(s)
- Chun-Ching Wu
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
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Pantoni L, Poggesi A, Basile AM, Pracucci G, Barkhof F, Chabriat H, Erkinjuntti T, Ferro JM, Hennerici M, O'Brien J, Schmidt R, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D. Leukoaraiosis Predicts Hidden Global Functioning Impairment in Nondisabled Older People: The LADIS (Leukoaraiosis and Disability in the Elderly) Study. J Am Geriatr Soc 2006; 54:1095-101. [PMID: 16866681 DOI: 10.1111/j.1532-5415.2006.00798.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether leukoaraiosis severity is independently associated with differences in global functioning in nondisabled elderly patients. DESIGN Cross-sectional data analysis from an ongoing longitudinal multicenter and multinational study. SETTING The Leukoaraiosis and Disability Study, a collaboration aimed at assessing leukoaraiosis as an independent predictor of the transition to disability in older people. PARTICIPANTS Six hundred thirty-nine nondisabled subjects (288 men, 351 women, mean age+/-standard deviation 74.1+/-5.0) with magnetic resonance imaging-detected leukoaraiosis of different severity and presenting with one of the following: mild cognitive or motor disturbances, minor cerebrovascular events, or mood alterations or in whom leukoaraiosis was incidentally identified. MEASUREMENTS Centralized assessment of leukoaraiosis severity according to the three severity degrees of the Fazekas scale; Disability Assessment for Dementia (DAD) Scale for measurement of global functioning. RESULTS At baseline, 44% of participants had a mild, 31% a moderate, and 25% a severe degree of leukoaraiosis. A significant trend toward declining performance on the DAD Scale was apparent with increasing leukoaraiosis score severity (total score=98.8, 98.6, 97.5, respectively, in the three leukoaraiosis categories, analysis of variance P=.002). Similar trends were obtained for basic (P=.01) and instrumental (P<.001) function items. The statistical significance of these differences was confirmed in a multiple linear regression analysis correcting for numerous factors known to influence disability in older people. Executive function test performance declined along with increasing leukoaraiosis severity and was significantly related to DAD total score. CONCLUSION Even in nondisabled elderly patients, levels of functional ability are related to white matter lesion severity. Executive dysfunction may mediate this relationship.
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Affiliation(s)
- Leonardo Pantoni
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy.
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Naka H, Nomura E, Takahashi T, Wakabayashi S, Kajikawa H, Kohriyama T, Mimori Y, Matsumoto M. Plasma total homocysteine levels are associated with advanced leukoaraiosis but not with asymptomatic microbleeds on T2*-weighted MRI in patients with stroke. Eur J Neurol 2006; 13:261-5. [PMID: 16618343 DOI: 10.1111/j.1468-1331.2006.01205.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Both leukoaraiosis and asymptomatic microbleeds are associated with small-artery diseases. Although an association between hyperhomocysteinemia and leukoaraiosis has been reported, no studies have evaluated the association between total homocysteine (tHcy) level and presence of microbleeds in stroke patients. We evaluated the association between tHcy level and leukoaraiosis or microbleeds in stroke patients. In 102 patients with stroke (69.5 +/- 10.3 years old, 54 men and 48 women), microbleeds on T2*-weighted MR images were counted, leukoaraiosis on T2-weighted images was graded and fasting plasma tHcy concentrations were measured. Plasma tHcy level was significantly higher in patients with advanced leukoaraiosis than in those without advanced leukoaraiosis (13.9 +/- 4.6 micromol/l vs. 10.2 +/- 3.4 micromol/l, P < 0.0001). Plasma tHcy level was not significantly different in patients with microbleeds and those without microbleeds (11.3 +/- 4.1 micromol/l vs. 11.4 +/- 4.3 micromol/l, P = 0.9441). Elevated tHcy level is significantly and independently associated with advanced leukoaraiosis [odds ratio (OR), 1.330; 95% CI, 1.130-1.565] but not with the presence of microbleeds. Elevated tHcy level appears to be associated with ischemic small-artery disease rather than with bleeding-prone small-artery disease.
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Affiliation(s)
- H Naka
- Department of Neurology, Suiseikai Kajikawa Hospital, Showamachi, Hiroshima, Japan.
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Maia LF, Vasconcelos C, Seixas S, Magalhães R, Correia M. Lobar brain hemorrhages and white matter changes: Clinical, radiological and laboratorial profiles. Cerebrovasc Dis 2006; 22:155-61. [PMID: 16691025 DOI: 10.1159/000093245] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Accepted: 02/09/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND White matter changes have several histopathologic correlates including cerebral amyloid angiopathy (CAA). The aim of this study was to characterize the clinical, laboratorial and neuroradiological profile of a CAA-related lobar hemorrhages case series. METHODS A cohort of 50 consecutive patients with cerebral lobar hemorrhages was studied and clinical, radiological data and ApoE polymorphisms were analyzed. White matter changes were graded and microbleeds were characterized according to number and location using T2* MRI. RESULTS A statistically significant association was found between the prestroke cognitive performance and poststroke dementia and between hemorrhage volume and mortality. More severe white matter changes were found in probable CAA when comparing to possible CAA. The most prominent white matter lesions are associated with the presence and the number of microbleeds. The frequency of APOE epsilon 2 and epsilon 4 alleles was higher in this cohort when compared to a Northern Portuguese population. CONCLUSION White matter changes are frequent in lobar hemorrhage patients and are associated with cortical microbleeds, the radiological hallmark of CAA. Therefore, white matter changes may be the sole phenotype of CAA and, potentially, involved in the pre-stroke cognitive impairment presented by the patients, which are genetically distinct from the population in general.
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Affiliation(s)
- Luís F Maia
- Department of Neurology, Hospital Geral Santo António, Porto, Portugal
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47
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Pantoni L. [New evidence in the field of white matter changes]. No To Shinkei 2006; 58:298-302. [PMID: 16681258] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Leonardo Pantoni
- Department of Neurological and Psychiatric Sciences, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
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48
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Abstract
Ischaemic and haemorrhagic strokes may have a common pathogenesis
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49
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Ble A, Ranzini M, Zurlo A, Menozzi L, Atti AR, Munari MR, Volpato S, Scaramelli G, Fellin R, Zuliani G. Leukoaraiosis is associated with functional impairment in older patients with Alzheimer's disease but not vascular dementia. J Nutr Health Aging 2006; 10:31-5. [PMID: 16453055] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Leukoaraiosis (LA) is a common finding in older persons, and might be associated with reduced cognitive performance, gait abnormalities, and functional impairment. Although LA is more frequent in persons affected by dementia, scant data are available about its clinical consequences in this group of patients. OBJECTIVE To study the association between presence of LA and functional performance in basic activities of daily living in a sample of older persons affected by dementia. DESIGN We conducted a cross-sectional study on 214 patients; 77 affected by late onset Alzheimer's disease (LOAD), and 137 by vascular dementia (VD). Functional status was assessed using Barthel Index (BI). LA was assessed using computed tomography. RESULTS In LOAD patients, LA (OR: 7.87; 1.26-48.94), and MMSE score (OR: 0.83; 0.71-0.98) were associated with the risk of severe disability, independent of age, gender, diabetes, hypertension, coronary heart disease, left ventricular hypertrophy, atrial fibrillation, and brain atrophy. In VD patients, MMSE score (OR: 0.77; 0.64-0.93), and CHD (OR: 7.41; 1.09-50.21), but not LA (OR: 2.07; 0.45-9.45) were associated with a severe functional impairment after multivariate adjustment. CONCLUSIONS Our study suggests that LA might be associated with a worse functional status in basic activities of daily living in patients affected by LOAD but not VD. LA might act synergistically with cognitive and behavioural disturbances to the onset and progression of disability of these patients.
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Affiliation(s)
- A Ble
- Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology and Geriatrics; University of Ferrara, Via Savonarola no. 9, 44100 Ferrara, ITALY
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50
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Smith EE, Gurol ME, Eng JA, Engel CR, Nguyen TN, Rosand J, Greenberg SM. White matter lesions, cognition, and recurrent hemorrhage in lobar intracerebral hemorrhage. Neurology 2005; 63:1606-12. [PMID: 15534243 DOI: 10.1212/01.wnl.0000142966.22886.20] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Accumulating evidence suggests that white matter lesions are associated with vascular cognitive impairment. The authors investigated the relationships between white matter lesions, cognitive impairment, and risk of recurrent hemorrhage in a prospectively identified cohort of patients with lobar intracerebral hemorrhage (ICH). METHODS The authors collected clinical and genetic information on 182 consecutive patients age > or = 55 who had CT scan at admission for lobar ICH. White matter disease was graded on CT in all subjects and on MRI in a subset of 82 patients. All scans were interpreted blinded to clinical information. Survivors were followed for recurrent ICH by telephone interview. RESULTS White matter damage was common (present on CT in 77%) and severe (advanced CT grade in 32%). White matter damage was correlated with the total number of hemorrhages on gradient-echo MRI and with risk of recurrent ICH. Subjects with cognitive impairment prior to their index ICH were more likely to have severe white matter damage on CT (OR 3.6, 95% CI 1.6 to 8.1, p = 0.003) and more likely to have advanced periventricular hyperintensities on MRI. The relationships between white matter damage and cognitive impairment were similar in the subset of 88 subjects meeting criteria for probable or definite cerebral amyloid angiopathy and remained independent after adjustment for age, cortical atrophy, and APOE genotype. CONCLUSIONS White matter damage in lobar ICH is common and is associated with cognitive impairment. These data support the possibility that an underlying vasculopathy in lobar ICH patients, possibly cerebral amyloid angiopathy, can cause clinically important vascular dysfunction.
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Affiliation(s)
- E E Smith
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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