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Bergkamp MI, Jacob MA, Cai M, Claassen JA, Kessels RPC, Esselink R, Tuladhar AM, De Leeuw FE. Long-Term Longitudinal Course of Cognitive and Motor Symptoms in Patients With Cerebral Small Vessel Disease. Neurology 2024; 102:e209148. [PMID: 38382000 DOI: 10.1212/wnl.0000000000209148] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/27/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with cerebral small vessel disease (SVD) show a heterogenous clinical course. The aim of the current study was to investigate the longitudinal course of cognitive and motor function in patients who developed parkinsonism, dementia, both, or none. METHODS Participants were from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort study, a prospective cohort of patients with SVD. Parkinsonism and dementia were, respectively, diagnosed according to the UK Parkinson's Disease Society brain bank criteria and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for major neurocognitive disorder. Linear and generalized linear mixed-effect analyses were used to study the longitudinal course of motor and cognitive tasks. RESULTS After a median follow-up of 12.8 years (interquartile range 10.2-15.3), 132 of 501 (26.3%) participants developed parkinsonism, dementia, or both. Years before diagnosis of these disorders, participants showed distinct clinical trajectories from those who developed none: Participant who developed parkinsonism had an annual percentage of 22% (95% CI 18%-27%) increase in motor part of the Unified Parkinson's Disease Rating Scale score. This was significantly higher than the 16% (95% CI 14%-18%) of controls, mainly because of a steep increase in bradykinesia and posture and gait disturbances. When they developed dementia as well, the increase in Timed Up and Go Test time of 0.73 seconds per year (95% CI 0.58-0.87) was significantly higher than the 0.20 seconds per year increase (95% CI 0.16-0.23) of controls. All groups, including the participants who developed parkinsonism without dementia, showed a faster decline in executive function compared with controls: Annual decline in Z-score was -0.07 (95% CI -0.10 to -0.05), -0.09 (95% CI -0.11 to -0.08), and -0.11 (95% CI -0.14 to -0.08) for participants who developed, respectively, parkinsonism, dementia, and both parkinsonism and dementia. These declines were all significantly faster than the annual decline in Z-score of 0.07 (95% CI -0.10 to -0.05) of controls. DISCUSSION A distinct pattern in deterioration of clinical markers is visible in patients with SVD, years before the diagnosis of parkinsonism and dementia. This knowledge aids early identification of patients with a high risk of developing these disorders.
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Affiliation(s)
- Mayra I Bergkamp
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Mina A Jacob
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Mengfei Cai
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Jurgen A Claassen
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Roy P C Kessels
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Rianne Esselink
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Anil Man Tuladhar
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Frank-Erik De Leeuw
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
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Tay J, Düring M, van Leijsen EMC, Bergkamp MI, Norris DG, de Leeuw FE, Markus HS, Tuladhar AM. Network structure-function coupling and neurocognition in cerebral small vessel disease. Neuroimage Clin 2023; 38:103421. [PMID: 37141644 PMCID: PMC10176072 DOI: 10.1016/j.nicl.2023.103421] [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: 11/03/2022] [Revised: 03/23/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Cerebral small vessel disease is a leading cause of cognitive decline and vascular dementia. Small vessel disease pathology changes structural brain networks, but its impact on functional networks remains poorly understood. Structural and functional networks are closely coupled in healthy individuals, and decoupling is associated with clinical symptoms in other neurological conditions. We tested the hypothesis that structural-functional network coupling is related to neurocognitive outcomes in 262 small vessel disease patients. METHODS Participants underwent multimodal magnetic resonance imaging and cognitive assessment in 2011 and 2015. Structural connectivity networks were reconstructed using probabilistic diffusion tractography, while functional connectivity networks were estimated from resting-state functional magnetic resonance imaging. Structural and functional networks were then correlated to calculate a measure of structural-functional network coupling for each participant. RESULTS Lower whole-brain coupling was associated with reduced processing speed and greater apathy both cross-sectionally and longitudinally. In addition, coupling within the cognitive control network was associated with all cognitive outcomes, suggesting that neurocognitive outcomes in small vessel disease may be related to the functioning of this intrinsic connectivity network. CONCLUSIONS Our work demonstrates the influence of structural-functional connectivity network decoupling in small vessel disease symptomatology. Cognitive control network function may be investigated in future studies.
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Affiliation(s)
- Jonathan Tay
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marco Düring
- Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | | | - Mayra I Bergkamp
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - David G Norris
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anil M Tuladhar
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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Boot EM, Mc van Leijsen E, Bergkamp MI, Kessels RPC, Norris DG, de Leeuw FE, Tuladhar AM. Structural network efficiency predicts cognitive decline in cerebral small vessel disease. Neuroimage Clin 2020; 27:102325. [PMID: 32622317 PMCID: PMC7334365 DOI: 10.1016/j.nicl.2020.102325] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/15/2020] [Accepted: 06/21/2020] [Indexed: 01/23/2023]
Abstract
Cerebral small vessel disease (SVD) is a common disease in older adults and a major contributor to vascular cognitive impairment and dementia. White matter network damage is a potentially important mechanism by which SVD causes cognitive impairment. Earlier studies showed that a higher degree of white matter network damage, indicated by lower global efficiency (a graph-theory measure assessing efficiency of network information transfer), was associated with lower scores on cognitive performance independent of MRI markers for SVD. However, it is unknown whether this global efficiency index is the strongest predictor for cognitive impairment, as there is a wide range of network measures. Here, we investigate which network measure is the most informative in explaining baseline cognitive performance and decline over a period of 8.7 years in SVD. We used data from the Radboud University Nijmegen Diffusion tensor and MRI Cohort (RUN DMC), which included 436 participants without dementia (65.2 ± 8.8 years) but with evidence of SVD on neuroimaging. Binarized and weighted structural brain networks were reconstructed using diffusion tensor imaging and deterministic streamlining. Using graph-theory, we calculated 21 global network measures and performed linear regression analyses, elastic net analysis and linear mixed effect models to compare these measures. All analyses were adjusted for potential confounders (age, sex, educational level, depressive symptoms and conventional SVD MRI-markers (e.g. white matter hyperintensities (WMH), lacunes of presumed vascular origin and microbleeds). The elastic net analyses showed that, at baseline, global efficiency had the strongest association with cognitive index (CI), while characteristic path length showed the strongest association with psychomotor speed (PMS) and memory. Binary local efficiency showed the strongest association with attention & executive function (A&EF). In addition, linear mixed-effect models demonstrated that baseline global efficiency predicts decline in CI (χ2(1) = 8.18, p = 0.004),PMS (χ2(1) = 7.75, p = 0.005), memory (χ2(1) = 27.28, p = 0.000) over time and that binary local efficiency predicts decline in A&EF (χ2(1) = 8.66, p = 0.003) over time. Our results suggest that among all network measures, network efficiency measures, i.e. global efficiency and local efficiency, are the strongest predictors for cognitive functions at cross-sectional level and also predict faster cognitive decline in SVD, which is in line with earlier findings. These findings suggests that in our study sample network efficiency measures are the most suitable surrogate markers for cognitive performance in patients with cerebral SVD among all network measures and MRI markers, and play a key role in the genesis of cognitive decline in SVD.
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Affiliation(s)
- Esther M Boot
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Esther Mc van Leijsen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Mayra I Bergkamp
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Radboud University Medical Center, Department of Medical Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany; Faculty of Science and Technology, Magnetic Detection and Imaging, University Twente, Enschede, the Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands.
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Bergkamp MI, Wissink JGJ, van Leijsen EMC, Ghafoorian M, Norris DG, van Dijk EJ, Platel B, Tuladhar AM, de Leeuw FE. Risk of Nursing Home Admission in Cerebral Small Vessel Disease. Stroke 2019; 49:2659-2665. [PMID: 30355195 DOI: 10.1161/strokeaha.118.021993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose- Since cerebral small vessel disease (SVD) is associated with cognitive and motor impairment and both might ultimately lead to nursing home admission, our objective was to investigate the association of SVD markers with nursing home admission. Methods- The RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort) is a prospective cohort of 503 independent living individuals with SVD. Date of nursing home admission was retrieved from the Dutch municipal personal records database. Risk of nursing home admission was calculated using a competing risk analysis, with mortality as a competing risk. Results- During follow-up (median 8.7 years, interquartile range 8.5-8.9), 31 participants moved to a nursing home. Before nursing home admission, 19 participants were diagnosed with dementia, 6 with parkinsonism, and 10 with stroke. Participants with the lowest white matter volume had an 8-year risk of nursing home admission of 13.3% (95% CI, 8.6-18.9), which was significantly different from participants with middle or highest white matter volume (respectively, 4.8% [95% CI, 2.3-8.8] and 0%; P<0.001). After adjusting for baseline age and living condition, the association of white matter volume and total brain volume with nursing home admission was significant, with, respectively, hazard ratios of 0.88 [95% CI, 0.84-0.95] ( P value 0.025) and 0.92 [95% CI, 0.85-0.98] ( P<0.001) per 10 mL. The association of white matter hyperintensities and lacunes with nursing home admission was not significant. Conclusions- This study demonstrates that in SVD patients, independent from age and living condition, a lower white matter volume and a lower total brain volume is associated with an increased risk of nursing home admission. Nursing home admission is a relevant outcome in SVD research since it might be able to combine both cognitive and functional consequences of SVD in 1 outcome.
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Affiliation(s)
- Mayra I Bergkamp
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Joost G J Wissink
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Esther M C van Leijsen
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mohsen Ghafoorian
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Centre, Nijmegen, the Netherlands.,Institute for Computing and Information Sciences, (M.G.), Radboud University, Nijmegen, the Netherlands
| | - David G Norris
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour (D.G.N.), Radboud University, Nijmegen, the Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany (D.G.N.)
| | - Ewoud J van Dijk
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Bram Platel
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
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Wiegertjes K, Ter Telgte A, Oliveira PB, van Leijsen EMC, Bergkamp MI, van Uden IWM, Ghafoorian M, van der Holst HM, Norris DG, Platel B, Klijn CJM, Tuladhar AM, de Leeuw FE. The role of small diffusion-weighted imaging lesions in cerebral small vessel disease. Neurology 2019; 93:e1627-e1634. [PMID: 31530710 DOI: 10.1212/wnl.0000000000008364] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/22/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of asymptomatic diffusion-weighted imaging-positive (DWI+) lesions in individuals with cerebral small vessel disease (SVD) and identify their role in the origin of SVD markers on MRI. METHODS We included 503 individuals with SVD from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) study (mean age 65.6 years [SD 8.8], 56.5% male) with 1.5T MRI in 2006 and, if available, follow-up MRI in 2011 and 2015. We screened DWI scans (n = 1,152) for DWI+ lesions, assessed lesion evolution on follow-up fluid-attenuated inversion recovery, T1 and T2* images, and examined the association between DWI+ lesions and annual SVD progression (white matter hyperintensities [WMH], lacunes, microbleeds). RESULTS We found 50 DWI+ lesions in 39 individuals on 1,152 DWI (3.4%). Individuals with DWI+ lesions were older (p = 0.025), more frequently had a history of hypertension (p = 0.021), and had a larger burden of preexisting SVD MRI markers (WMH, lacunes, microbleeds: all p < 0.001) compared to individuals without DWI+ lesions. Of the 23 DWI+ lesions with available follow-up MRI, 14 (61%) evolved into a WMH, 8 (35%) resulted in a cavity, and 1 (4%) was no longer visible. Presence of DWI+ lesions was significantly associated with annual WMH volume increase and yearly incidence of lacunes and microbleeds (all p < 0.001). CONCLUSION Over 3% of individuals with SVD have DWI+ lesions. Although DWI+ lesions play a role in the progression of SVD, they may not fully explain progression of SVD markers on MRI, suggesting that other factors than acute ischemia are at play.
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Affiliation(s)
- Kim Wiegertjes
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Annemieke Ter Telgte
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Pedro B Oliveira
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Esther M C van Leijsen
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Mayra I Bergkamp
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Ingeborg W M van Uden
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Mohsen Ghafoorian
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Helena M van der Holst
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - David G Norris
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Bram Platel
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Catharina J M Klijn
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands.
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van Leijsen EM, Bergkamp MI, van Uden IW, Cooijmans S, Ghafoorian M, van der Holst HM, Norris DG, Kessels RP, Platel B, Tuladhar AM, de Leeuw FE. Cognitive consequences of regression of cerebral small vessel disease. Eur Stroke J 2018; 4:85-89. [PMID: 31165098 DOI: 10.1177/2396987318820790] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/18/2018] [Indexed: 01/25/2023] Open
Abstract
Introduction Recent studies have shown that neuroimaging markers of cerebral small vessel disease can also regress over time. We investigated the cognitive consequences of regression of small vessel disease markers. Patients and methods Two hundred and seventy-six participants of the RUNDMC study underwent neuroimaging and cognitive assessments at three time-points over 8.7 years. We semi-automatically assessed white matter hyperintensities volumes and manually rated lacunes and microbleeds. We analysed differences in cognitive decline and accompanying brain atrophy between participants with regression, progression and stable small vessel disease by analysis of variance. Results Fifty-six participants (20.3%) showed regression of small vessel disease markers: 31 (11.2%) white matter hyperintensities regression, 10 (3.6%) vanishing lacunes and 27 (9.8%) vanishing microbleeds. Participants with regression showed a decline in overall cognition, memory, psychomotor speed and executive function similar to stable small vessel disease. Participants with small vessel disease progression showed more cognitive decline compared with stable small vessel disease (p < 0.001 for cognitive index and memory; p < 0.01 for executive function), although significance disappeared after adjusting for age and sex. Loss of total brain, gray matter and white matter volume did not differ between participants with small vessel disease regression and stable small vessel disease, while participants with small vessel disease progression showed more volume loss of total brain and gray matter compared to those with stable small vessel disease (p < 0.05), although significance disappeared after adjustments. Discussion Regression of small vessel disease markers was associated with similar cognitive decline compared to stable small vessel disease and did not accompany brain atrophy, suggesting that small vessel disease regression follows a relatively benign clinical course. Future studies are required to validate these findings and to assess the role of vascular risk factor control on small vessel disease regression and possible recovery of clinical symptoms. Conclusion Our findings of comparable cognitive decline between participants with regression and stable small vessel disease might suggest that small vessel disease regression has a relative benign cognitive outcome.
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Affiliation(s)
- Esther Mc van Leijsen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands
| | - Mayra I Bergkamp
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands
| | - Ingeborg Wm van Uden
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands
| | - Sjacky Cooijmans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands
| | - Mohsen Ghafoorian
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group, Radboudumc, Nijmegen, The Netherlands.,Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | | | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Roy Pc Kessels
- Department of Medical Psychology, Radboud Alzheimer Centre, Radboudumc, Nijmegen, The Netherlands.,Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Nijmegen, The Netherlands
| | - Bram Platel
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group, Radboudumc, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands
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7
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van Leijsen EMC, Tay J, van Uden IWM, Kooijmans ECM, Bergkamp MI, van der Holst HM, Ghafoorian M, Platel B, Norris DG, Kessels RPC, Markus HS, Tuladhar AM, de Leeuw FE. Memory decline in elderly with cerebral small vessel disease explained by temporal interactions between white matter hyperintensities and hippocampal atrophy. Hippocampus 2018; 29:500-510. [PMID: 30307080 DOI: 10.1002/hipo.23039] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/07/2018] [Accepted: 09/29/2018] [Indexed: 11/11/2022]
Abstract
White matter hyperintensities (WMH) constitute the visible spectrum of cerebral small vessel disease (SVD) markers and are associated with cognitive decline, although they do not fully account for memory decline observed in individuals with SVD. We hypothesize that WMH might exert their effect on memory decline indirectly by affecting remote brain structures such as the hippocampus. We investigated the temporal interactions between WMH, hippocampal atrophy and memory decline in older adults with SVD. Five hundred and three participants of the RUNDMC study underwent neuroimaging and cognitive assessments up to 3 times over 8.7 years. We assessed WMH volumes semi-automatically and calculated hippocampal volumes (HV) using FreeSurfer. We used linear mixed effects models and causal mediation analyses to assess both interaction and mediation effects of hippocampal atrophy in the associations between WMH and memory decline, separately for working memory (WM) and episodic memory (EM). Linear mixed effect models revealed that the interaction between WMH and hippocampal volumes explained memory decline (WM: β = .067; 95%CI[.024-0.111]; p < .01; EM: β = .061; 95%CI[.025-.098]; p < .01), with better model fit when the WMH*HV interaction term was added to the model, for both WM (likelihood ratio test, χ2 [1] = 9.3, p < .01) and for EM (likelihood ratio test, χ2 [1] = 10.7, p < .01). Mediation models showed that both baseline WMH volume (β = -.170; p = .001) and hippocampal atrophy (β = 0.126; p = .009) were independently related to EM decline, but the effect of baseline WMH on EM decline was not mediated by hippocampal atrophy (p value indirect effect: 0.572). Memory decline in elderly with SVD was best explained by the interaction of WMH and hippocampal volumes. The relationship between WMH and memory was not causally mediated by hippocampal atrophy, suggesting that memory decline during aging is a heterogeneous condition in which different pathologies contribute to the memory decline observed in elderly with SVD.
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Affiliation(s)
- Esther M C van Leijsen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jonathan Tay
- Department of Clinical Neurosciences, Neurology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ingeborg W M van Uden
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Eline C M Kooijmans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mayra I Bergkamp
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Mohsen Ghafoorian
- Radboud University Medical Centre, Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands.,Radboud University, Institute for Computing and Information Sciences, Nijmegen, The Netherlands
| | - Bram Platel
- Radboud University Medical Centre, Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands
| | - David G Norris
- Radboud University, Donders Institute for Brain Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Centre, Radboud Alzheimer Centre, Nijmegen, The Netherlands.,Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Nijmegen, The Netherlands
| | - Hugh S Markus
- Department of Clinical Neurosciences, Neurology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
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8
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van Leijsen EMC, Bergkamp MI, van Uden IWM, Ghafoorian M, van der Holst HM, Norris DG, Platel B, Tuladhar AM, de Leeuw FE. Progression of White Matter Hyperintensities Preceded by Heterogeneous Decline of Microstructural Integrity. Stroke 2018; 49:1386-1393. [PMID: 29724890 DOI: 10.1161/strokeaha.118.020980] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities (WMH) are frequently seen on neuroimaging of elderly and are associated with cognitive decline and the development of dementia. Yet, the temporal dynamics of conversion of normal-appearing white matter (NAWM) into WMH remains unknown. We examined whether and when progression of WMH was preceded by changes in fluid-attenuated inversion recovery and diffusion tensor imaging values, thereby taking into account differences between participants with mild versus severe baseline WMH. METHODS From 266 participants of the RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort), we semiautomatically segmented WMH at 3 time points for 9 years. Images were registered to standard space through a subject template. We analyzed differences in baseline fluid-attenuated inversion recovery, fractional anisotropy, and mean diffusivity (MD) values and changes in MD values over time between 4 regions: (1) remaining NAWM, (2) NAWM converting into WMH in the second follow-up period, (3) NAWM converting into WMH in the first follow-up period, and (4) WMH. RESULTS NAWM converting into WMH in the first or second time interval showed higher fluid-attenuated inversion recovery and MD values than remaining NAWM. MD values in NAWM converting into WMH in the first time interval were similar to MD values in WMH. When stratified by baseline WMH severity, participants with severe WMH had higher fluid-attenuated inversion recovery and MD and lower fractional anisotropy values than participants with mild WMH, in all areas including the NAWM. MD values in WMH and in NAWM that converted into WMH continuously increased over time. CONCLUSIONS Impaired microstructural integrity preceded conversion into WMH and continuously declined over time, suggesting a continuous disease process of white matter integrity loss that can be detected using diffusion tensor imaging even years before WMH become visible on conventional neuroimaging. Differences in microstructural integrity between participants with mild versus severe WMH suggest heterogeneity of both NAWM and WMH, which might explain the clinical variability observed in patients with similar small vessel disease severity.
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Affiliation(s)
- Esther M C van Leijsen
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Mayra I Bergkamp
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Ingeborg W M van Uden
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Mohsen Ghafoorian
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Center, Nijmegen, the Netherlands.,Institute for Computing and Information Sciences (M.G.)
| | - Helena M van der Holst
- Department of Neurology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands (H.M.v.d.H.)
| | - David G Norris
- Donders Institute for Brain, Cognition, and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany (D.G.N.)
| | - Bram Platel
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
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ten Harmsen BL, van Rumund A, Aerts MB, Bergkamp MI, Esselink RA, Richard E, Meijer FJ, Bloem BR, van Wamelen DJ. Clinical correlates of cerebral white matter abnormalities in patients with Parkinson's disease. Parkinsonism Relat Disord 2018; 49:28-33. [DOI: 10.1016/j.parkreldis.2017.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/12/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
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van Leijsen EMC, Kuiperij HB, Kersten I, Bergkamp MI, van Uden IWM, Vanderstichele H, Stoops E, Claassen JAHR, van Dijk EJ, de Leeuw FE, Verbeek MM. Plasma Aβ (Amyloid-β) Levels and Severity and Progression of Small Vessel Disease. Stroke 2018. [PMID: 29540613 DOI: 10.1161/strokeaha.117.019810] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (SVD) is a frequent pathology in aging and contributor to the development of dementia. Plasma Aβ (amyloid β) levels may be useful as early biomarker, but the role of plasma Aβ in SVD remains to be elucidated. We investigated the association of plasma Aβ levels with severity and progression of SVD markers. METHODS We studied 487 participants from the RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort) of whom 258 participants underwent 3 MRI assessments during 9 years. We determined baseline plasma Aβ38, Aβ40, and Aβ42 levels using ELISAs. We longitudinally assessed volume of white matter hyperintensities semiautomatically and manually rated lacunes and microbleeds. We analyzed associations between plasma Aβ and SVD markers by ANCOVA adjusted for age, sex, and hypertension. RESULTS Cross-sectionally, plasma Aβ40 levels were elevated in participants with microbleeds (mean, 205.4 versus 186.4 pg/mL; P<0.01) and lacunes (mean, 194.8 versus 181.2 pg/mL; P<0.05). Both Aβ38 and Aβ40 were elevated in participants with severe white matter hyperintensities (Aβ38, 25.3 versus 22.7 pg/mL; P<0.01; Aβ40, 201.8 versus 183.3 pg/mL; P<0.05). Longitudinally, plasma Aβ40 levels were elevated in participants with white matter hyperintensity progression (mean, 194.6 versus 182.9 pg/mL; P<0.05). Both Aβ38 and Aβ40 were elevated in participants with incident lacunes (Aβ38, 24.5 versus 22.5 pg/mL; P<0.05; Aβ40, 194.9 versus 181.2 pg/mL; P<0.01) and Aβ42 in participants with incident microbleeds (62.8 versus 60.4 pg/mL; P<0.05). CONCLUSIONS Plasma Aβ levels are associated with both presence and progression of SVD markers, suggesting that Aβ pathology might contribute to the development and progression of SVD. Plasma Aβ levels might thereby serve as inexpensive and noninvasive measure for identifying individuals with increased risk for progression of SVD.
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Affiliation(s)
- Esther M C van Leijsen
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - H Bea Kuiperij
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Iris Kersten
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Mayra I Bergkamp
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Ingeborg W M van Uden
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Hugo Vanderstichele
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Erik Stoops
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Jurgen A H R Claassen
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Ewoud J van Dijk
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Marcel M Verbeek
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.).
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11
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van der Holst HM, Tuladhar AM, Zerbi V, van Uden IWM, de Laat KF, van Leijsen EMC, Ghafoorian M, Platel B, Bergkamp MI, van Norden AGW, Norris DG, van Dijk EJ, Kiliaan AJ, de Leeuw FE. White matter changes and gait decline in cerebral small vessel disease. Neuroimage Clin 2017; 17:731-738. [PMID: 29270357 PMCID: PMC5730123 DOI: 10.1016/j.nicl.2017.12.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/09/2017] [Accepted: 12/04/2017] [Indexed: 12/23/2022]
Abstract
The relation between progression of cerebral small vessel disease (SVD) and gait decline is uncertain, and diffusion tensor imaging (DTI) studies on gait decline are lacking. We therefore investigated the longitudinal associations between (micro) structural brain changes and gait decline in SVD using DTI. 275 participants were included from the Radboud University Nijmegen Diffusion tensor and Magnetic resonance imaging Cohort (RUN DMC), a prospective cohort of participants with cerebral small vessel disease aged 50-85 years. Gait (using GAITRite) and magnetic resonance imaging measures were assessed during baseline (2006-2007) and follow-up (2011 - 2012). Linear regression analysis was used to investigate the association between changes in conventional magnetic resonance and diffusion tensor imaging measures and gait decline. Tract-based spatial statistics analysis was used to investigate region-specific associations between changes in white matter integrity and gait decline. 56.2% were male, mean age was 62.9 years (SD8.2), mean follow-up duration was 5.4 years (SD0.2) and mean gait speed decline was 0.2 m/s (SD0.2). Stride length decline was associated with white matter atrophy (β = 0.16, p = 0.007), and increase in mean white matter radial diffusivity and mean diffusivity, and decrease in mean fractional anisotropy (respectively, β = - 0.14, p = 0.009; β = - 0.12, p = 0.018; β = 0.10, p = 0.049), independent of age, sex, height, follow-up duration and baseline stride length. Tract-based spatial statistics analysis showed significant associations between stride length decline and fractional anisotropy decrease and mean diffusivity increase (primarily explained by radial diffusivity increase) in multiple white matter tracts, with the strongest associations found in the corpus callosum and corona radiata, independent of traditional small vessel disease markers. White matter atrophy and loss of white matter integrity are associated with gait decline in older adults with small vessel disease after 5 years of follow-up. These findings suggest that progression of SVD might play an important role in gait decline.
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Affiliation(s)
- H M van der Holst
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - A M Tuladhar
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - V Zerbi
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Anatomy, 6521 EZ Nijmegen, The Netherlands; Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zürich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - I W M van Uden
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - K F de Laat
- HagaZiekenhuis Den Haag, Department of Neurology, Leyweg 275, 2545 CH Den Haag, The Netherlands
| | - E M C van Leijsen
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - M Ghafoorian
- Radboud University Medical Centre, Department of radiology and nuclear medicine, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - B Platel
- Radboud University Medical Centre, Department of radiology and nuclear medicine, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - M I Bergkamp
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - A G W van Norden
- Amphia ziekenhuis Breda, Department of Neurology, Molengracht 21, 4818 CK Breda, The Netherlands
| | - D G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging, UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Arendahls Wiese 199, D-45141 Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, 7500 AE Enschede, The Netherlands
| | - E J van Dijk
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - A J Kiliaan
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Anatomy, 6521 EZ Nijmegen, The Netherlands
| | - F-E de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands.
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van Leijsen EMC, van Uden IWM, Ghafoorian M, Bergkamp MI, Lohner V, Kooijmans ECM, van der Holst HM, Tuladhar AM, Norris DG, van Dijk EJ, Rutten-Jacobs LCA, Platel B, Klijn CJM, de Leeuw FE. Nonlinear temporal dynamics of cerebral small vessel disease: The RUN DMC study. Neurology 2017; 89:1569-1577. [PMID: 28878046 PMCID: PMC5634663 DOI: 10.1212/wnl.0000000000004490] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/10/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the temporal dynamics of cerebral small vessel disease (SVD) by 3 consecutive assessments over a period of 9 years, distinguishing progression from regression. METHODS Changes in SVD markers of 276 participants of the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) cohort were assessed at 3 time points over 9 years. We assessed white matter hyperintensities (WMH) volume by semiautomatic segmentation and rated lacunes and microbleeds manually. We categorized baseline WMH severity as mild, moderate, or severe according to the modified Fazekas scale. We performed mixed-effects regression analysis including a quadratic term for increasing age. RESULTS Mean WMH progression over 9 years was 4.7 mL (0.54 mL/y; interquartile range 0.95-5.5 mL), 20.3% of patients had incident lacunes (2.3%/y), and 18.9% had incident microbleeds (2.2%/y). WMH volume declined in 9.4% of the participants during the first follow-up interval, but only for 1 participant (0.4%) throughout the whole follow-up. Lacunes disappeared in 3.6% and microbleeds in 5.7% of the participants. WMH progression accelerated over time: including a quadratic term for increasing age during follow-up significantly improved the model (p < 0.001). SVD progression was predominantly seen in participants with moderate to severe WMH at baseline compared to those with mild WMH (odds ratio [OR] 35.5, 95% confidence interval [CI] 15.8-80.0, p < 0.001 for WMH progression; OR 5.7, 95% CI 2.8-11.2, p < 0.001 for incident lacunes; and OR 2.9, 95% CI 1.4-5.9, p = 0.003 for incident microbleeds). CONCLUSIONS SVD progression is nonlinear, accelerating over time, and a highly dynamic process, with progression interrupted by reduction in some, in a population that on average shows progression.
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Affiliation(s)
- Esther M C van Leijsen
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Ingeborg W M van Uden
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Mohsen Ghafoorian
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Mayra I Bergkamp
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Valerie Lohner
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Eline C M Kooijmans
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Helena M van der Holst
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Anil M Tuladhar
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - David G Norris
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Ewoud J van Dijk
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Loes C A Rutten-Jacobs
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Bram Platel
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Catharina J M Klijn
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Frank-Erik de Leeuw
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany.
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