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Röhrig L, Sperber C, Bonilha L, Rorden C, Karnath HO. Right hemispheric white matter hyperintensities improve the prediction of spatial neglect severity in acute stroke. Neuroimage Clin 2022; 36:103265. [PMID: 36451368 PMCID: PMC9723300 DOI: 10.1016/j.nicl.2022.103265] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/12/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
White matter hyperintensities (WMH) are frequently observed in brain scans of elderly people. They are associated with an increased risk of stroke, cognitive decline, and dementia. However, it is unknown yet if measures of WMH provide information that improve the understanding of poststroke outcome compared to only state-of-the-art stereotaxic structural lesion data. We implemented high-dimensional machine learning models, based on support vector regression, to predict the severity of spatial neglect in 103 acute right hemispheric stroke patients. We found that (1) the additional information of right hemispheric or bilateral voxel-based topographic WMH extent indeed yielded a significant improvement in predicting acute neglect severity (compared to the voxel-based stroke lesion map alone). (2) Periventricular WMH appeared more relevant for prediction than deep subcortical WMH. (3) Among different measures of WMH, voxel-based maps as measures of topographic extent allowed more accurate predictions compared to the use of traditional ordinally assessed visual rating scales (Fazekas-scale, Cardiovascular Health Study-scale). In summary, topographic WMH appear to be a valuable clinical imaging biomarker for predicting the severity of cognitive deficits and bears great potential for rehabilitation guidance of acute stroke patients.
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Affiliation(s)
- Lisa Röhrig
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen 72076, Germany
| | - Christoph Sperber
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen 72076, Germany
| | - Leonardo Bonilha
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
| | - Christopher Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Hans-Otto Karnath
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen 72076, Germany; Department of Psychology, University of South Carolina, Columbia, SC 29208, USA.
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2
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Huo Y, Wang Y, Guo C, Liu Q, Shan L, Liu M, Wu H, Li G, Lv H, Lu L, Zhou Y, Feng J, Han Y. Deep white matter hyperintensity is spatially correlated to MRI-visible perivascular spaces in cerebral small vessel disease on 7 Tesla MRI. Stroke Vasc Neurol 2022; 8:144-150. [PMID: 36170993 PMCID: PMC10176991 DOI: 10.1136/svn-2022-001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/14/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The association between perivascular space (PVS) and white matter hyperintensity (WMH) has been unclear. Normal-appearing white matter (NAWM) around WMH is also found correlated with the development of focal WMH. This study aims to investigate the topological connections among PVS, deep WMH (dWMH) and NAWM around WMH using 7 Tesla (7T) MRI. METHODS Thirty-two patients with non-confluent WMHs and 16 subjects without WMHs were recruited from our department and clinic. We compared the PVS burden between patients with and without WMHs using a 5-point scale. Then, the dilatation and the number of PVS within a radius of 1 cm around each dWMH were compared with those of a reference site (without WMH) in the contralateral hemisphere. In this study, we define NAWM as an area within the radius of 1 cm around each dWMH. Furthermore, we assessed the spatial relationship between dWMH and PVS. RESULTS Higher PVS scores in the centrum semiovale were found in patients with >5 dWMHs (median 3) than subjects without dWMH (median 2, p = 0.014). We found there was a greater dilatation and a higher number of PVS in NAWM around dWMH than at the reference sites (p<0.001, p<0.001). In addition, 79.59% of the dWMHs were spatially connected with PVS. CONCLUSION dWMH, NAWM surrounding WMH and MRI-visible PVS are spatially correlated in the early stage of cerebral small vessel disease. Future study of WMH and NAWM should not overlook MRI-visible PVS.
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Affiliation(s)
- Yajing Huo
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yilin Wang
- Georgetown Preparatory School, North Bethesda, Maryland, USA
| | - Cen Guo
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qianyun Liu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lili Shan
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mingyuan Liu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haibo Wu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guanwu Li
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huihui Lv
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingdan Lu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yintin Zhou
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Yan Han
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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3
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Roseborough AD, Rasheed B, Jung Y, Nishimura K, Pinsky W, Langdon KD, Hammond R, Pasternak SH, Khan AR, Whitehead SN. Microvessel stenosis, enlarged perivascular spaces, and fibrinogen deposition are associated with ischemic periventricular white matter hyperintensities. Brain Pathol 2021; 32:e13017. [PMID: 34538024 PMCID: PMC8713528 DOI: 10.1111/bpa.13017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/24/2021] [Accepted: 08/13/2021] [Indexed: 12/31/2022] Open
Abstract
Periventricular white matter hyperintensities (pvWMH) are neuroimaging abnormalities surrounding the lateral ventricles that are apparent on magnetic resonance imaging (MRI). They are associated with age, neurodegenerative disease, and cerebrovascular risk factors. While pvWMH ultimately represent a loss of white matter structural integrity, the pathological causes are heterogeneous in nature, and currently, cannot be distinguished using neuroimaging alone. pvWMH could occur because of a combination of small vessel disease (SVD), ependymal loss, blood–brain barrier dysfunction, and microgliosis. In this study we aimed to characterize microvascular stenosis, fibrinogen extravasation, and microgliosis within pvWMH with and without imaging evidence of periventricular infarction. Using postmortem neuroimaging of human brains (n = 20), we identified pvWMH with and without periventricular infarcts (PVI). We performed histological analysis of microvessel stenosis, perivascular spaces, microgliosis, and immunohistochemistry against fibrinogen as a measure of serum protein extravasation. Herein, we report distinctions between pvWMH with and without periventricular infarcts based on associations with microvessel stenosis, enlarged perivascular spaces, and fibrinogen IHC. Microvessel stenosis was significantly associated with PVI and with cellular deposition of fibrinogen in the white matter. The presence of fibrinogen was associated with PVI and increased number of microglia. These findings suggest that neuroimaging‐based detection of infarction within pvWMH may help distinguish more severe lesions, associated with underlying microvascular disease and BBB dysfunction, from milder pvWMH that are a highly frequent finding on MRI.
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Affiliation(s)
- Austyn D Roseborough
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Berk Rasheed
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Youngkyung Jung
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Nishimura
- Department of Physiology and Pharmacology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - William Pinsky
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kristopher D Langdon
- Department of Pathology and Laboratory Medicine, The Cumming School of Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Stephen H Pasternak
- Department of Clinical Neurological Sciences, Robarts Research Institute, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Ali R Khan
- Department of Medical Biophysics, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shawn N Whitehead
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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Humphreys CA, Smith C, Wardlaw JM. Correlations in post-mortem imaging-histopathology studies of sporadic human cerebral small vessel disease: A systematic review. Neuropathol Appl Neurobiol 2021; 47:910-930. [PMID: 34037264 DOI: 10.1111/nan.12737] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/29/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
AIMS Sporadic human cerebral small vessel disease (SVD) commonly causes stroke and dementia but its pathogenesis is poorly understood. There are recognised neuroimaging and histopathological features. However, relatively few studies have examined the relationship between the radiological and pathological correlates of SVD; better correlation would promote greater insight into the underlying biological changes. METHODS We performed a systematic review to collate and appraise the information derived from studies that correlated histological with neuroimaging-defined SVD lesions. We searched for studies describing post-mortem imaging and histological tissue examination in adults, extracted data from published studies, categorised the information and compiled this narrative. RESULTS We identified 38 relevant studies, including at least 1146 subjects, 342 of these with SVD: 29 studies focussed on neuroradiological white matter lesions (WML), six on microinfarcts and three on dilated perivascular spaces (PVS) and lacunes. The histopathology terminology was diverse with few robust definitions. Reporting and methodology varied widely between studies, precluding formal meta-analysis. PVS and 'oedema' were frequent findings in WML, being described in at least 94 and 18 radiological WML, respectively, in addition to myelin pallor. Histopathological changes extended beyond the radiological lesion margins in at least 33 radiological WML. At least 43 radiological lesions not seen pathologically and at least 178 histological lesions were not identified on imaging. CONCLUSIONS Histopathological assessment of human SVD is hindered by inconsistent methodological approaches and unstandardised definitions. The data from this systematic review will help to develop standardised definitions to promote consistency in human SVD research.
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Affiliation(s)
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute at The University of Edinburgh, Edinburgh, UK.,Row Fogo Centre for Research into Ageing and the Brain, Edinburgh, UK
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5
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Lee YH, Lee WJ, Chung SJ, Yoo HS, Jung JH, Baik K, Sohn YH, Seong JK, Lee PH. Microstructural Connectivity is More Related to Cognition than Conventional MRI in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:239-249. [PMID: 33074193 DOI: 10.3233/jpd-202312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The different effects of white matter hyperintensity (WMH) severity and WMH-associated microstructural connectivity on cognition in the early stages of Parkinson's disease (PD) have not been investigated. OBJECTIVE To investigate the differential effect of WMH severity and WMH-associated microstructural connectivity on cognition in early stages of PD. METHODS A total of 136 de novo PD patients were enrolled and divided into groups based on total WMH visual rating scores as follows: mild, moderate, and severe. Microstructural connectivity was measured using graph theoretical analysis according to WMH severity. Additionally, correlation coefficients between WMH-associated microstructural connectivity or WMH scores and cognitive performance were assessed. RESULTS Patients with severe WMHs demonstrated poorer performance in language function than those with moderate WMHs, and in frontal/executive and visual memory function than those with mild WMHs. Areas of microstructural connectivity were more extensive in patients with severe WMHs compared to those with mild and moderate WMHs, involving frontal and parieto-temporal regions. WMH-associated right fronto-temporo-parietal microstructural disintegration was correlated with cognitive dysfunction in attention, frontal/executive, and memory domains, whereas there was no correlation between WMH scores and any cognitive domains. CONCLUSION These data suggest that disruption of microstructural networks by WMHs, rather than WMH burden itself, contributed more to cognitive impairment in PD.
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Affiliation(s)
- Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Wha Jin Lee
- School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, South Korea.,Department of Artificial Intelligence, Korea University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Roseborough AD, Langdon KD, Hammond R, Cipriano LE, Pasternak SH, Whitehead SN, Khan AR. Post-mortem 7 Tesla MRI detection of white matter hyperintensities: A multidisciplinary voxel-wise comparison of imaging and histological correlates. Neuroimage Clin 2020; 27:102340. [PMID: 32679554 PMCID: PMC7364158 DOI: 10.1016/j.nicl.2020.102340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/31/2022]
Abstract
White matter hyperintensities (WMH) occur in normal aging and across diagnostic categories of neurodegeneration. Ultra-high field imaging (UHF) MRI machines offer the potential to improve our understanding of WMH. Post-mortem imaging using UHF magnetic resonance imaging (MRI) is a useful way of assessing WMH, however, the responsiveness of UHF-MRI to pathological changes within the white matter has not been characterized. In this study we report post-mortem MRI sequences of white matter hyperintensities in normal aging, Alzheimer's disease, and cerebrovascular disease. Seven Tesla post-mortem MRI reliably detected periventricular WMH using both FLAIR and T2 sequences and reflects underlying pathology of myelin and axon density despite prolonged fixation time. Co-registration of histological images to MRI allowed for direct voxel- wise comparison of imaging findings and pathological changes. Myelin content and cerebrovascular pathology were the most significant predictors of MRI white matter intensity as revealed by linear mixed models. Future work investigating the utility of UHF- MRI in studying cell-specific changes within WMH is required to better understand radio-pathologic correlations.
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Affiliation(s)
- Austyn D Roseborough
- Department of Anatomy and Cell Biology, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kristopher D Langdon
- Department of Pathology and Laboratory Medicine, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lauren E Cipriano
- Ivey Business School and Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
| | - Stephen H Pasternak
- Department of Clinical Neurological Sciences, Robarts Research Institute, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shawn N Whitehead
- Department of Anatomy and Cell Biology, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Ali R Khan
- Department of Medical Biophysics, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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7
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Chabriat H, Jouvent E. Imaging of the aging brain and development of MRI signal abnormalities. Rev Neurol (Paris) 2020; 176:661-669. [PMID: 32229042 DOI: 10.1016/j.neurol.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 02/04/2023]
Abstract
Major changes occur at the cerebral level with aging. Cerebral atrophy develops progressively. Multiple lesions related to small-vessel diseases are detected in association with cerebral atrophy including white-matter hyperintensities, lacunes, microbleeds, dilated perivascular spaces and cerebral, including cortex, atrophy. The clinical impact and predictive value of these Imaging makers were examined.
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Affiliation(s)
- H Chabriat
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France.
| | - E Jouvent
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France
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8
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Brown CA, Schmitt FA, Smith CD, Gold BT. Distinct patterns of default mode and executive control network circuitry contribute to present and future executive function in older adults. Neuroimage 2019; 195:320-332. [PMID: 30953834 PMCID: PMC6536351 DOI: 10.1016/j.neuroimage.2019.03.073] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/16/2019] [Accepted: 03/30/2019] [Indexed: 11/26/2022] Open
Abstract
Executive function (EF) performance in older adults has been linked with functional and structural profiles within the executive control network (ECN) and default mode network (DMN), white matter hyperintensities (WMH) burden and levels of Alzheimer's disease (AD) pathology. Here, we simultaneously explored the unique contributions of these factors to baseline and longitudinal EF performance in older adults. Thirty-two cognitively normal (CN) older adults underwent neuropsychological testing at baseline and annually for three years. Neuroimaging and AD pathology measures were collected at baseline. Separate linear regression models were used to determine which of these variables predicted composite EF scores at baseline and/or average annual change in composite ΔEF scores over the three-year follow-up period. Results demonstrated that low DMN deactivation, high ECN activation and WMH burden were the main predictors of EF scores at baseline. In contrast, poor DMN and ECN WM microstructure and higher AD pathology predicted greater annual decline in EF scores. Subsequent mediation analysis demonstrated that DMN WM microstructure uniquely mediated the relationship between AD pathology and ΔEF. These results suggest that functional activation patterns within the DMN and ECN and WMHs contribute to baseline EF while structural connectivity within these networks impact longitudinal EF performance in older adults.
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Affiliation(s)
- Christopher A Brown
- Department of Neuroscience, University of Kentucky, Lexington, KY, 40536, USA
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA; Department of Neurology, University of Kentucky, Lexington, KY, 40536, USA; Department of Psychiatry, University of Kentucky, Lexington, KY, 40536, USA
| | - Charles D Smith
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA; Department of Neurology, University of Kentucky, Lexington, KY, 40536, USA; Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, KY, 40536, USA
| | - Brian T Gold
- Department of Neuroscience, University of Kentucky, Lexington, KY, 40536, USA; Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA; Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, KY, 40536, USA.
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9
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Haga Y, Hata J, Uematsu A, Seki F, Komaki Y, Mizumura M, Nishio M, Kaneko T, Kishi N, Okano H, Furukawa A. MR Imaging Properties of ex vivo Common Marmoset Brain after Formaldehyde Fixation. Magn Reson Med Sci 2019; 18:253-259. [PMID: 30726800 PMCID: PMC6883083 DOI: 10.2463/mrms.mp.2018-0086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Ex vivo brains have different MRI properties than in vivo brains because of chemical changes caused by fixative solutions, which change the signal intensity and/or tissue contrast on MR images. In this study, we investigated and compared the MRI properties of in vivo and ex vivo brains. Methods: Using a Bruker 9.4T experimental scanner unit for animals (Biospin GmbH, Ettlingen, Germany), we performed this study on the common marmoset. We measured the relaxation and diffusion values in the white matter and cortex of common marmosets and compared these values between in vivo brains (n = 20) and ex vivo brains (n = 20). Additionally, we observed the relationship between the tissue fixation duration and MRI properties by imaging a brain that underwent long-term fixation in a preliminary examination (n = 1). Results: The T1 values of ex vivo brains were decreased compared with those of in vivo brains; however, there were no significant difference in the T2 and T2* values of in vivo and ex vivo brains. Axial, radial, and mean diffusivity values of ex vivo brains decreased to approximately 65% and 52% of those of in vivo brains in the cortex and white matter, respectively. Conversely, fractional anisotropy values were not significantly different between in vivo and ex vivo brains. Conclusion: The T1 values and diffusion coefficient values of the ex vivo brains were strikingly different than those of the in vivo brains. Conversely, there were no significant changes in the T2, T2* or fractional anisotropy values. Altogether, the dehydration caused by tissue fixation and the reduction in brain temperature were involved in changing the relaxation and diffusion coefficient values. Here, it was difficult to specify all factors causing these changes. Further detailed study is needed to examine changes in MRI properties.
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Affiliation(s)
- Yawara Haga
- Department of Radiological Sciences, Human Health Sciences, Tokyo Metropolitan University Graduate School.,Department of Physiology, Keio University School of Medicine.,Laboratory for Marmoset Neural Architecture, Center for Brain Science, RIKEN
| | - Junichi Hata
- Department of Physiology, Keio University School of Medicine.,Laboratory for Marmoset Neural Architecture, Center for Brain Science, RIKEN.,Live Imaging Center, Central Institute for Experimental Animals
| | - Akiko Uematsu
- Department of Physiology, Keio University School of Medicine.,Laboratory for Marmoset Neural Architecture, Center for Brain Science, RIKEN.,Live Imaging Center, Central Institute for Experimental Animals
| | - Fumiko Seki
- Department of Physiology, Keio University School of Medicine.,Laboratory for Marmoset Neural Architecture, Center for Brain Science, RIKEN.,Live Imaging Center, Central Institute for Experimental Animals
| | - Yuji Komaki
- Department of Physiology, Keio University School of Medicine.,Live Imaging Center, Central Institute for Experimental Animals
| | - Mai Mizumura
- Department of Radiological Sciences, Human Health Sciences, Tokyo Metropolitan University Graduate School.,Laboratory for Marmoset Neural Architecture, Center for Brain Science, RIKEN
| | - Marin Nishio
- Department of Radiological Sciences, Human Health Sciences, Tokyo Metropolitan University Graduate School.,Live Imaging Center, Central Institute for Experimental Animals
| | - Takaaki Kaneko
- Department of Physiology, Keio University School of Medicine.,Laboratory for Marmoset Neural Architecture, Center for Brain Science, RIKEN
| | - Noriyuki Kishi
- Department of Physiology, Keio University School of Medicine.,Laboratory for Marmoset Neural Architecture, Center for Brain Science, RIKEN
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine.,Laboratory for Marmoset Neural Architecture, Center for Brain Science, RIKEN
| | - Akira Furukawa
- Department of Radiological Sciences, Human Health Sciences, Tokyo Metropolitan University Graduate School
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10
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Liu Y, Zhang M, Bao H, Zhang Z, Mei Y, Yun W, Zhou X. The efficacy of intravenous thrombolysis in acute ischemic stroke patients with white matter hyperintensity. Brain Behav 2018; 8:e01149. [PMID: 30378299 PMCID: PMC6305931 DOI: 10.1002/brb3.1149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/03/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We aimed to investigate effects of deep white matter hyperintensity (DWMH) and periventricular hyperintensity (PVH) on the efficacy of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). METHODS A total of 113 AIS patients with WMH were categorized into the PVH group and the DWMH group according to the lesion location, with the division of two subgroups based on whether or not they received IVT treatment: the thrombolysis group and the control group. Kaplan-Meier analysis was used for proportional hazards of recurrent stroke. Further, multivariate Cox regression analysis was employed. RESULTS Of total patients, there were 62 PVH patients and 51 DWMH patients: 27 of PVH patients and 22 of DWMH patients received IVT, and the remaining patients only received routine treatment. DWMH patients had a higher risk of END (36.4% vs. 11.1%; p = 0.034) and HT (22.7% vs. 3.7%; p = 0.038) than PVH patients in the thrombolysis group. Moreover, DWMH patients undergoing IVT also had a higher risk of END (36.4% vs. 10.3%; x2 = 5.050; p = 0.025) and HT (22.7% vs. 3.4%; x2 = 4.664; p = 0.031) than DWMH patients without IVT. Again, PVH patients had a higher rate of recurrent stroke (20.0% vs. 3.4%; p = 0.034) than DWMH patients in the control group after 90-day follow-up. Kaplan-Meier analysis showed a significant difference in cumulative probability of no major endpoint events (p = 0.039). Further, multivariate Cox regression revealed that PVH is an independent risk factor for stroke recurrence in AIS patients after adjusting confounding factors. CONCLUSIONS The location of WMH is closely associated with the efficacy of IVT in AIS patients.
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Affiliation(s)
- Yanyan Liu
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China.,The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Min Zhang
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Hanmo Bao
- Emergency Center of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhixiang Zhang
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Yuqing Mei
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Wenwei Yun
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Xianju Zhou
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
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Drepper C, Geißler J, Pastura G, Yilmaz R, Berg D, Romanos M, Gerlach M. Transcranial sonography in psychiatry as a potential tool in diagnosis and research. World J Biol Psychiatry 2018; 19:484-496. [PMID: 28971725 DOI: 10.1080/15622975.2017.1386325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES During the last two decades transcranial sonography (TCS) of the brain parenchyma evolved from a pure research tool to a clinical relevant neuroimaging method especially in Parkinson's disease and related movement disorders. The aim of this systematic review is to update and summarise the published TCS findings in psychiatric disorders and critically address the question whether TCS may be a valuable tool for the diagnosis or differential diagnosis of psychiatric disorders similarly to the field of movement disorders. METHODS This paper provides detailed information about the perspectives and limitations of TCS, including guidelines for the scanning procedures, assessment of midbrain structures and discusses the potential causes of the ultrasound abnormalities in psychiatric disorders. RESULTS Changes in the echogenicity of subcortical brain structures were detected in different disorders, such as obsessive-compulsive disorder, autism spectrum disorder, schizophrenia, panic disorder, attention-deficit/hyperactivity (ADHD), bipolar disorder and depressive disorder. Although the physical properties of brain tissue underlying the echogenic features in TCS are largely unknown, no alternative technique provides the same insight into the specific central nervous structural characteristics. CONCLUSIONS Urgent research questions to further clarify the underlying pathophysiological and structural alterations are further outlined to bring this promising technique to the clinic.
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Affiliation(s)
- Carsten Drepper
- a Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Würzburg , Germany
| | - Julia Geißler
- a Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Würzburg , Germany
| | - Giuseppe Pastura
- b Department of Pediatrics , The Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Rezzak Yilmaz
- c Department of Neurology , Christian-Albrecht-University , Kiel , Germany
| | - Daniela Berg
- c Department of Neurology , Christian-Albrecht-University , Kiel , Germany.,d Department of Neurodegeneration , University of Tübingen , Tübingen , Germany
| | - Marcel Romanos
- a Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Würzburg , Germany
| | - Manfred Gerlach
- a Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Würzburg , Germany
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13
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Polyakova TA, Arablinsky AV. [Neuroimaging and molecular biomarkers of dementia]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:16-22. [PMID: 28980608 DOI: 10.17116/jnevro20171176216-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Development of laboratory diagnosis and neuroimaging revealed a number of biomarkers for in vivo diagnosis of the most common forms of dementia (Alzheimer's disease, Lewy body dementia and vascular dementia). Currently, the highest diagnostic sensitivity and specificity of molecular biomarkers in the cerebrospinal fluid are detected for Alzheimer's disease. At the same time, the changes according to the magnetic resonance imaging are more prognostically significant for future cognitive decline than cerebrospinal fluid biomarkers. Cerebral microbleeds are an available adjuvant diagnostic marker, which increases the diagnostic value of leukoaraiosis that suggests the development of cerebral amyloid angiopathy or hypertensive microangiopathy, especially in cases of mixed pathology and severe cognitive deficits.
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Affiliation(s)
- T A Polyakova
- Russian Medical Academy for Continued Professional Education, Moscow, Russia
| | - A V Arablinsky
- Sechenov First Moscow Medical University, Moscow, Russia
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Adachi M, Sato T. Characterization of the Growth of Deep and Subcortical White Matter Hyperintensity on MR Imaging: A Retrospective Cohort Study. Magn Reson Med Sci 2017; 16:238-244. [PMID: 28090008 PMCID: PMC5600031 DOI: 10.2463/mrms.mp.2016-0063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose: In elderly patients, deep and subcortical white matter hyperintense lesions are frequently observed on MRI; however, the growth process of these lesions is unclear. The aims of this retrospective cohort study were to elucidate the growth characteristics of deep and subcortical white matter hyperintense lesions, and to insight their etiology. Materials and Methods: We enrolled 103 patients (1610 lesions) whose deep and subcortical white matter hyperintense lesions were monitored for 3 or more years by MRI examination. The area of each hyperintense lesion was measured using a tracing method in the first and last MRI examinations. The annual rate of increase in the area of each lesion was calculated, and using the Pearson product-moment correlation coefficient the correlation between the annual rate of increase in area and the interval between the first and last MRI examinations was determined. Results: The paired t-test showed a significant increase in the mean area of all the deep and subcortical white matter hyperintense lesions between the first and last MRI examinations (P < 0.001). However, hyperintense lesions had decreased in the area or disappeared in 227 (14.1%) lesions in the last MRI examination, particularly in patients with diabetes. The mean annual rate of increase in area of all hyperintense lesions was 0.013 ± 0.021 cm2 per year. The annual rate of increase in area and the interval between the first and last MRI examinations showed a weak negative correlation (r = −0.121; P < 0.01). Conclusion: Decrease in the area and the disappearance of the subcortical white matter hyperintense lesions, and a decline in the annual rate of increase in the lesion area with time suggest that the interstitial fluid accumulation associated with dysfunctional drainage around the vessels may be involved in the possible etiologies of deep and subcortical white matter hyperintense lesions.
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15
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Bonifacio G, Zamboni G. Brain imaging in dementia. Postgrad Med J 2016; 92:333-40. [PMID: 26933232 DOI: 10.1136/postgradmedj-2015-133759] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/04/2016] [Indexed: 12/16/2022]
Abstract
The introduction of MRI and positron emission tomography (PET) brain imaging has contributed significantly to the understanding of different dementia syndromes. Over the past 20 years these imaging techniques have been increasingly used for clinical characterisation and differential diagnosis, and to provide insight into the effects on functional capacity of the brain, patterns of spatial distribution of different dementia syndromes and their natural history and evolution over time. Brain imaging is also increasingly used in clinical trials, as part of inclusion criteria and/or as a surrogate outcome measure. Here we review all the relatively specific findings that can be identified with different MRI and PET techniques in each of the most frequent dementing disorders.
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Affiliation(s)
- Guendalina Bonifacio
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Giovanna Zamboni
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Italy
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Fisher M, Zawadzki MB, Ameriso S, Quismorio F, Wong V, Bernard J, Zee CS, Paganini-Hill A. Subcortical Magnetic Resonance Imaging Changes in a Healthy Elderly Population; Stroke Risk Factors, Ultrasound, and Hemostasis Findings. J Neuroimaging 2016; 3:28-32. [DOI: 10.1111/jon19933128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/1991] [Revised: 06/02/1992] [Accepted: 06/04/1992] [Indexed: 10/22/2022] Open
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17
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Tuladhar AM, van Norden AGW, de Laat KF, Zwiers MP, van Dijk EJ, Norris DG, de Leeuw FE. White matter integrity in small vessel disease is related to cognition. NEUROIMAGE-CLINICAL 2015; 7:518-24. [PMID: 25737960 PMCID: PMC4338206 DOI: 10.1016/j.nicl.2015.02.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 01/21/2023]
Abstract
Cerebral small vessel disease, including white matter hyperintensities (WMH) and lacunes of presumed vascular origin, is common in elderly people and is related to cognitive impairment and dementia. One possible mechanism could be the disruption of white matter tracts (both within WMH and normal-appearing white matter) that connect distributed brain regions involved in cognitive functions. Here, we investigated the relation between microstructural integrity of the white matter and cognitive functions in patients with small vessel disease. The Radboud University Nijmegen Diffusion tensor and Magnetic resonance Cohort study is a prospective cohort study among 444 independently living, non-demented elderly with cerebral small vessel disease, aged between 5500 and 85 years. All subjects underwent magnetic resonance imaging and diffusion tensor imaging scanning and an extensive neuropsychological assessment. We showed that loss of microstructural integrity of the white matter at specific locations was related to specific cognitive disturbances, which was mainly located in the normal-appearing white matter (p < 0.05, FWE-corrected for multiple comparisons). The microstructural integrity in the genu and splenium showed the highest significant relation with global cognitive function and executive functions, in the cingulum bundle with verbal memory performance. Associations between diffusion tensor imaging parameters and most cognitive domains remained present after adjustment for WMH and lacunes. In conclusion, cognitive disturbances in subjects with cerebral small vessel disease are related to microstructural integrity of multiple white matter fibers (within WMH and normal-appearing white matter) connecting different cortical and subcortical regions. White matter integrity in small vessel disease (SVD) was assessed with DTI. White matter integrity was related to cognition independent of SVD-markers. This relation was seen in multiple fibers within white matter hyperintensities. But also in normal-appearing white matter connecting different (sub)cortical regions
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Affiliation(s)
- Anil M Tuladhar
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboudumc, PO Box 9101, Nijmegen 6500 HB, The Netherlands ; Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | | | | | - Marcel P Zwiers
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Ewoud J van Dijk
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboudumc, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, PO Box 9101, Nijmegen 6500 HB, The Netherlands ; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany ; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboudumc, PO Box 9101, Nijmegen 6500 HB, The Netherlands ; Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands
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18
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Age-related changes in the central auditory system. Cell Tissue Res 2015; 361:337-58. [DOI: 10.1007/s00441-014-2107-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/22/2014] [Indexed: 12/19/2022]
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Zeifman LE, Eddy WF, Lopez OL, Kuller LH, Raji C, Thompson PM, Becker JT. Voxel Level Survival Analysis of Grey Matter Volume and Incident Mild Cognitive Impairment or Alzheimer's Disease. J Alzheimers Dis 2015; 46:167-78. [PMID: 25720412 PMCID: PMC4550581 DOI: 10.3233/jad-150047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to identify, at the voxel level, brain regions associated with the time to develop mild cognitive impairment (MCI) or Alzheimer's disease (AD) from normal cognition. We analyzed incident MCI (n = 58) or AD (n = 151) in 292 cognitively normal participants in the Cardiovascular Health Study-Cognition Study (mean age = 79.2 ± 3.6 years). We used segmented, modulated grey matter maps from 3D (spoiled gradient echo) MRI scans obtained in 1998/99 (with clinical follow-up through 2012) that were smoothed with a 3-D 4 mm Gaussian filter. We fit approximately 1.92 million voxel-level Cox proportional hazard models to examine the grey matter volume effect on time to event, adjusting for age, sex, and diabetes. We used the significance threshold of p < 0.005 with contiguity threshold of at least 68 voxels (false detection probability <2.5×10 -8). Areas within the mesial temporal lobe (MTL), anterior temporal lobe, hippocampus, and posterior cingulate gyrus were associated with time to MCI or AD. The presence of white matter lesions (a marker of small vessel disease in the brain) was associated with the volumes of the MTL and precuneus; MRI-identified infarcts also predicted MTL volume. These findings are important because we identified critical brain regions that predict a person's increased likelihood of developing MCI or AD over a decade prior to the onset of clinical symptoms; these critical brain regions were themselves affected by the presence of vascular disease.
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Affiliation(s)
- Lubov E Zeifman
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA
| | - William F Eddy
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Machine Learning, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cyrus Raji
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
- Departments of Neurology, Psychiatry, Radiology, Pediatrics, Engineering, & Ophthalmology, Keck USC School of Medicine, Los Angeles, CA, USA
| | - James T Becker
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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20
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Nutt JG. Higher-level gait disorders: an open frontier. Mov Disord 2014; 28:1560-5. [PMID: 24132844 DOI: 10.1002/mds.25673] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/26/2013] [Accepted: 08/13/2013] [Indexed: 11/10/2022] Open
Abstract
The term higher-level gait disorders (HLGD) defines a category of balance and gait disorders that are not explained by deficits in strength, tone, sensation, or coordination. HLGD are characterized by various combinations of disequilibrium and impaired locomotion. A plethora of new imaging techniques are beginning to determine the neural circuits that are the basis of these disorders. Although a variety of neurodegenerative and other pathologies can produce HLGD, the most common cause appears to be microvascular disease that causes white-matter lesions and thereby disrupts balance/locomotor circuits.
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Affiliation(s)
- John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
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21
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McAleese KE, Firbank M, Hunter D, Sun L, Hall R, Neal JW, Mann DMA, Esiri M, Jellinger KA, O'Brien JT, Attems J. Magnetic resonance imaging of fixed post mortem brains reliably reflects subcortical vascular pathology of frontal, parietal and occipital white matter. Neuropathol Appl Neurobiol 2014; 39:485-97. [PMID: 23075072 DOI: 10.1111/j.1365-2990.2012.01310.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/12/2012] [Indexed: 11/28/2022]
Abstract
AIMS Subcortical vascular pathology of the white and deep grey matter (WM and DGM) is associated with cognitive impairment. Routine neuropathological assessment of subcortical vascular pathology is based on semiquantitative scoring of characteristic lesions in a limited number of histological slides from selected WM and DGM areas. Clinically, WM and DGM lesions are visualized as hyper-intensities on magnetic resonance imaging (MRI). The aim of this study was to evaluate the feasibility of MRI on fixed post mortem brain hemispheres to complement routine neuropathological assessment of subcortical vascular pathology. METHODS We assessed subcortical vascular pathology in 40 post mortem brain hemispheres from demented (n = 26) and nondemented (n = 14) individuals (mean age 83.2 ± 14.8 years; 62.5% female) using (i) routine histological assessment; (ii) extensive histological assessment of the entire hemisphere at 7-mm intervals; and (iii) full T2-weighted MRI performed on fixed post mortem brain hemispheres. RESULTS In both WM and DGM routine histological scores for subcortical vascular pathology were significantly lower (P < 0.01) than the corresponding scores obtained by extensive histological assessment. In contrast, no significant differences were seen between scores obtained by MRI and extensive histological assessment in frontal, parietal and occipital lobes while MRI scores were significantly lower in the temporal WM and DGM (P < 0.01). CONCLUSIONS The results of our study indicate that routine histological assessment underrates subcortical vascular pathology and we conclude that MRI could be used in addition to complement neuropathological post mortem assessment of subcortical vascular pathology of the WM.
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Affiliation(s)
- K E McAleese
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Mavrogiorgou P, Nalato F, Meves S, Luksnat S, Norra C, Gold R, Juckel G, Krogias C. Transcranial sonography in obsessive-compulsive disorder. J Psychiatr Res 2013; 47:1642-8. [PMID: 23932243 DOI: 10.1016/j.jpsychires.2013.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/07/2013] [Accepted: 07/16/2013] [Indexed: 01/04/2023]
Abstract
There is convergent evidence that basal ganglia structures are involved in the pathogenesis of obsessive-compulsive disorder (OCD). It has been also assumed that OCD is caused by a central serotonergic dysfunction. Transcranial sonography (TCS) has become a reliable, sensitive and non-invasive diagnostic tool concerning the evaluation of extrapyramidal movement disorders. This study used TCS to examine the alterations in different parenchymal regions, especially concerning serotonergic brainstem raphe nuclei as well as basal ganglia in OCD. Thirty-one OCD patients were compared with 31 matched healthy controls. Echogenecities were investigated according to the examination protocol for extrapyramidal disorders using a Siemens Sonoline(®) Elegra system. Obsessive-compulsive disorder patients showed reduced echogenity of the serotonergic brainstem raphe nuclei (32.3%) compared with healthy controls (16.1%). In nine OCD-patients (31%), but only in 2 control subjects (6.2%), a hyperechogenicity of the caudate nucleus was found. Patients with OCD significantly more often reveal a hypoechogenic brainstem raphe possibly reflecting altered serotonergic neurons there and a hyperechogenicity of caudate nucleus indicating structural or molecular cell changes. Further research is warranted to examine, whether TCS is useful in order to classify OCD and its subtypes.
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Affiliation(s)
- Paraskevi Mavrogiorgou
- Dept. of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Alexandrinenstr. 1, 44791 Bochum, Germany
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Haller S, Garibotto V, Kövari E, Bouras C, Xekardaki A, Rodriguez C, Lazarczyk MJ, Giannakopoulos P, Lovblad KO. Neuroimaging of dementia in 2013: what radiologists need to know. Eur Radiol 2013; 23:3393-404. [DOI: 10.1007/s00330-013-2957-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 05/29/2013] [Accepted: 06/10/2013] [Indexed: 11/28/2022]
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Haller S, Kövari E, Herrmann FR, Cuvinciuc V, Tomm AM, Zulian GB, Lovblad KO, Giannakopoulos P, Bouras C. Do brain T2/FLAIR white matter hyperintensities correspond to myelin loss in normal aging? A radiologic-neuropathologic correlation study. Acta Neuropathol Commun 2013; 1:14. [PMID: 24252608 PMCID: PMC3893472 DOI: 10.1186/2051-5960-1-14] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/12/2013] [Indexed: 11/20/2022] Open
Abstract
Background White matter hyperintensities (WMH) lesions on T2/FLAIR brain MRI are frequently seen in healthy elderly people. Whether these radiological lesions correspond to irreversible histological changes is still a matter of debate. We report the radiologic-histopathologic concordance between T2/FLAIR WMHs and neuropathologically confirmed demyelination in the periventricular, perivascular and deep white matter (WM) areas. Results Inter-rater reliability was substantial-almost perfect between neuropathologists (kappa 0.71 - 0.79) and fair-moderate between radiologists (kappa 0.34 - 0.42). Discriminating low versus high lesion scores, radiologic compared to neuropathologic evaluation had sensitivity / specificity of 0.83 / 0.47 for periventricular and 0.44 / 0.88 for deep white matter lesions. T2/FLAIR WMHs overestimate neuropathologically confirmed demyelination in the periventricular (p < 0.001) areas but underestimates it in the deep WM (0 < 0.05). In a subset of 14 cases with prominent perivascular WMH, no corresponding demyelination was found in 12 cases. Conclusions MRI T2/FLAIR overestimates periventricular and perivascular lesions compared to histopathologically confirmed demyelination. The relatively high concentration of interstitial water in the periventricular / perivascular regions due to increasing blood–brain-barrier permeability and plasma leakage in brain aging may evoke T2/FLAIR WMH despite relatively mild demyelination.
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White matter hyperintensity burden and disability in older adults: is chronic pain a contributor? PM R 2013; 5:471-80; quiz 480. [PMID: 23474209 DOI: 10.1016/j.pmrj.2013.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To primarily explore differences in global and regional white matter hyperintensities (WMH) in older adults with self-reported disabling and nondisabling chronic low back pain (CLBP) and to examine the association of WMH with gait speed in all participants with CLBP. To secondarily compare WMH of the participants with CLBP with the pain-free controls. DESIGN A cross-sectional, case-control study. SETTING University of Pittsburgh. PARTICIPANTS Twenty-four community-dwelling older adults: 8 with self-reported disabling CLBP, 8 with nondisabling CLBP, and 8 were pain-free. Exclusions were psychiatric or neurologic disorders (either central or peripheral), substance abuse, opioid use, or diabetes mellitus. METHODS All participants underwent structural brain magnetic resonance imaging, and all participants with CLBP underwent the 4-m walk test. MAIN OUTCOME MEASUREMENTS All the participants were assessed for both global and regional WMH by using an automated localization and segmentation method, and gait speed of participants with CLBP. RESULTS The disabled group demonstrated statistically significant regional WMH in a number of left hemispheric tracts: anterior thalamic radiation (P = .0391), lower cingulate (P = .0336), inferior longitudinal fasciculus (P = .0367), superior longitudinal fasciculus (P = .0011), and the superior longitudinal fasciculus branch to the temporal lobe (P = .0072). Also, there was a statistically significant negative association (rs = -0.57; P = .0225) between the left lower cingulate WMH and the gait speed in all the participants with CLBP. There was a statistical difference in global WMH burden (P = .0014) and nearly all regional tracts (both left and right hemispheres) when comparing CLBP with pain-free participants. CONCLUSIONS Our findings suggest that WMH is associated with, and hence, may be accelerated by chronic pain manifesting as perceived disability, given the self-reported disabled CLBP patients had the greatest burden, and the pain free the least, and manifesting as measurable disability, given increasing WMH was associated with decreasing gait speed in all chronic pain participants.
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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 2012; 33:834.e7-16. [PMID: 21943959 PMCID: PMC3248984 DOI: 10.1016/j.neurobiolaging.2011.08.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [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 Medicine at UPMC Mercy Hospital in Pittsburgh, PA
- Department of Radiology, University of Pittsburgh in Pittsburgh, PA
| | - Oscar L. Lopez
- Department of Neurology, University of Pittsburgh in Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh in Pittsburgh, PA
| | - Lewis H. Kuller
- Department of Epidemiology, University of Pittsburgh in Pittsburgh, PA
| | | | - W. T. Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA
| | - H. Michael Gach
- Department of Radiology, University of Pittsburgh in Pittsburgh, PA
- Nevada Cancer Institute in Las Vegas, NV
| | - John Boardman
- Department of Radiology, University of Pittsburgh in Pittsburgh, PA
| | | | - Paul M. Thompson
- Laboratory of Neuro Imaging, Dept. of Neurology, UCLA School of Medicine, Los Angeles, CA
| | - James T. Becker
- Department of Radiology, University of Pittsburgh in Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh in Pittsburgh, PA
- Department of Psychology, University of Pittsburgh in Pittsburgh, PA
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Heterogeneity in age-related white matter changes. Acta Neuropathol 2011; 122:171-85. [PMID: 21706175 DOI: 10.1007/s00401-011-0851-x] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/15/2011] [Accepted: 06/16/2011] [Indexed: 10/18/2022]
Abstract
White matter changes occur endemically in routine magnetic resonance imaging (MRI) scans of elderly persons. MRI appearance and histopathological correlates of white matter changes are heterogeneous. Smooth periventricular hyperintensities, including caps around the ventricular horns, periventricular lining and halos are likely to be of non-vascular origin. They relate to a disruption of the ependymal lining with subependymal widening of the extracellular space and have to be differentiated from subcortical and deep white matter abnormalities. For the latter a distinction needs to be made between punctate, early confluent and confluent types. Although punctate white matter lesions often represent widened perivascular spaces without substantial ischemic tissue damage, early confluent and confluent lesions correspond to incomplete ischemic destruction. Punctate abnormalities on MRI show a low tendency for progression, while early confluent and confluent changes progress rapidly. The causative and modifying pathways involved in the occurrence of sporadic age-related white matter changes are still incompletely understood, but recent microarray and genome-wide association approaches increased the notion of pathways that might be considered as targets for therapeutic intervention. The majority of differentially regulated transcripts in white matter lesions encode genes associated with immune function, cell cycle, proteolysis, and ion transport. Genome-wide association studies identified six SNPs mapping to a locus on chromosome 17q25 to be related to white matter lesion load in the general population. We also report first and preliminary data that demonstrate apolipoprotein E (ApoE) immunoreactivity in white matter lesions and support epidemiological findings indicating that ApoE is another factor possibly related to white matter lesion occurrence. Further insights come from modern MRI techniques, such as diffusion tensor and magnetization transfer imaging, as they provide tools for the characterization of normal-appearing brain tissue beyond what can be expected from standard MRI scans. There is a need for additional pre- and postmortem studies in humans, including these new imaging techniques.
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Krogias C, Strassburger K, Eyding J, Gold R, Norra C, Juckel G, Saft C, Ninphius D. Depression in patients with Huntington disease correlates with alterations of the brain stem raphe depicted by transcranial sonography. J Psychiatry Neurosci 2011; 36:187-94. [PMID: 21138658 PMCID: PMC3080514 DOI: 10.1503/jpn.100067] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Transcranial sonography (TCS) has become a new diagnostic tool in the evaluation of extrapyramidal disorders. Studies of TCS report alterations of the mesencephalic raphe in patients with depression. The aim of this study was to evaluate TCS findings in patients with Huntington disease in correlation with their neurologic and psychiatric status. METHODS We recruited patients with genetically confirmed Huntington disease. The neurological and psychiatric status of participants was assessed by independent physicians. Echogenicities were investigated according to examination protocol for extrapyramidal disorders using a Siemens Sonoline Elegra system. The sonography examiner was blinded for clinical data. RESULTS We included 39 patients in our study; 21 patients (53.8%) showed symptoms of depression at the time of evaluation and, of those, 15 (71.4%) had hypoechogenic raphe structures. Thirty patients (76.9%) had a history of depressive episodes, 19 (63.3%) of them with hypoechogenic raphe structures. All 9 patients without a history of depressive episodes showed normal echogenicity of raphe structures (sensitivity 63.3%, specificity 100%). Twelve (70.6%) of the 17 patients with Huntington disease who showed psychiatric disturbances prior to the occurrence of motor symptoms exhibited pathological raphe echogenicity (sensitivity 70.6%, specificity 68.2%). LIMITATIONS Most of the patients were taking antichoreatic medication, which particularly influences neurologic status. Thus, a meaningful interpretation of the correlation between TCS findings and neurologic features was limited. CONCLUSION As a novel finding, a relation between mesencephalic raphe echogenicity and depressive state could be identified in patients with Huntington disease. An alteration of the serotonergic brain stem raphe might be involved in the pathogenesis of depression in these patients.
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Affiliation(s)
- Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany.
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Becker JT, Maruca V, Kingsley LA, Sanders JM, Alger JR, Barker PB, Goodkin K, Martin E, Miller EN, Ragin A, Sacktor N, Selnes O. Factors affecting brain structure in men with HIV disease in the post-HAART era. Neuroradiology 2011; 54:113-21. [PMID: 21424708 DOI: 10.1007/s00234-011-0854-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The purpose of this study was to characterize brain volumetric differences in HIV seropositive and seronegative men and to determine effects of age, cardiovascular risk, and HIV infection on structural integrity. METHODS Magnetic resonance imaging was used to acquire high-resolution neuroanatomic data in 160 men aged 50 years and over, including 84 HIV seropositive and 76 seronegative controls. Voxel-based morphometry was used to derive volumetric measurements at the level of the individual voxel. Data from a detailed neuropsychological test battery were recombined into four summary scores representing psychomotor speed, visual memory, verbal memory, and verbal fluency. RESULTS Both age and HIV status had a significant effect on both gray matter (GM) and white matter (WM) volume. The age-related GM atrophy was primarily in the superior temporal and inferior frontal regions; the HIV-related GM loss included the posterior and inferior temporal lobes, the parietal lobes, and the cerebellum. Among all subjects, the performance on neuropsychological tests, as indexed by a summary variable, was related to the volume of both the GM and WM. Contrary to our predictions, the CVD variables were not linked to brain volume in statistically adjusted models. CONCLUSION In the post-HAART era, having HIV infection is still linked to atrophy in both GM and WM. Secondly, advancing age, even in this relatively young cohort, is also linked to changes in GM and WM volume. Thirdly, CNS structural integrity is associated with overall cognitive functions, regardless of the HIV infection status of the study volunteers.
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Affiliation(s)
- James T Becker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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de Laat KF, van Norden AG, Gons RA, van Oudheusden LJ, van Uden IW, Norris DG, Zwiers MP, de Leeuw FE. Diffusion Tensor Imaging and Gait in Elderly Persons With Cerebral Small Vessel Disease. Stroke 2011; 42:373-9. [DOI: 10.1161/strokeaha.110.596502] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karlijn F. de Laat
- From the Department of Neurology (K.F.d.L., A.G.W.v.N., R.A.R.G., L.J.B.v.O., I.W.M.v.U., F.E.d.L.), Department of Psychiatry (M.P.Z.), and Centre for Cognitive Neuroimaging (D.G.N., M.P.Z.), Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Anouk G.W. van Norden
- From the Department of Neurology (K.F.d.L., A.G.W.v.N., R.A.R.G., L.J.B.v.O., I.W.M.v.U., F.E.d.L.), Department of Psychiatry (M.P.Z.), and Centre for Cognitive Neuroimaging (D.G.N., M.P.Z.), Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Rob A.R. Gons
- From the Department of Neurology (K.F.d.L., A.G.W.v.N., R.A.R.G., L.J.B.v.O., I.W.M.v.U., F.E.d.L.), Department of Psychiatry (M.P.Z.), and Centre for Cognitive Neuroimaging (D.G.N., M.P.Z.), Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Lucas J.B. van Oudheusden
- From the Department of Neurology (K.F.d.L., A.G.W.v.N., R.A.R.G., L.J.B.v.O., I.W.M.v.U., F.E.d.L.), Department of Psychiatry (M.P.Z.), and Centre for Cognitive Neuroimaging (D.G.N., M.P.Z.), Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Inge W.M. van Uden
- From the Department of Neurology (K.F.d.L., A.G.W.v.N., R.A.R.G., L.J.B.v.O., I.W.M.v.U., F.E.d.L.), Department of Psychiatry (M.P.Z.), and Centre for Cognitive Neuroimaging (D.G.N., M.P.Z.), Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - David G. Norris
- From the Department of Neurology (K.F.d.L., A.G.W.v.N., R.A.R.G., L.J.B.v.O., I.W.M.v.U., F.E.d.L.), Department of Psychiatry (M.P.Z.), and Centre for Cognitive Neuroimaging (D.G.N., M.P.Z.), Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Marcel P. Zwiers
- From the Department of Neurology (K.F.d.L., A.G.W.v.N., R.A.R.G., L.J.B.v.O., I.W.M.v.U., F.E.d.L.), Department of Psychiatry (M.P.Z.), and Centre for Cognitive Neuroimaging (D.G.N., M.P.Z.), Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- From the Department of Neurology (K.F.d.L., A.G.W.v.N., R.A.R.G., L.J.B.v.O., I.W.M.v.U., F.E.d.L.), Department of Psychiatry (M.P.Z.), and Centre for Cognitive Neuroimaging (D.G.N., M.P.Z.), Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Castillo J, Rodríguez JR, Corredera E, Alvarex JM, Purmar JM, Noya M. White matter high-signal areas on MRI associated with chronic hypoxia. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1996.tb00269.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Laat KF, Tuladhar AM, van Norden AGW, Norris DG, Zwiers MP, de Leeuw FE. Loss of white matter integrity is associated with gait disorders in cerebral small vessel disease. Brain 2010; 134:73-83. [PMID: 21156660 DOI: 10.1093/brain/awq343] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Gait disturbances are common in the elderly. Cerebral small vessel disease, including white matter lesions and lacunars infarcts, is thought to disrupt white matter tracts that connect important motor regions, hence resulting in gait disturbances. Pathological studies have demonstrated abnormalities in white matter that may appear normal on brain imaging. The loss of integrity in such normal-appearing white matter may partly be due to small vessel disease and may play a role in causing gait disturbances. The white matter regions involved in these gait disturbances, both in white matter lesions and normal-appearing white matter, remain unclear. We, therefore, aimed to investigate the relation between the location of white matter lesions and gait using voxel-based morphometry analysis, as well as between white matter integrity and gait by applying tract-based spatial statistics to diffusion tensor imaging parameters. Magnetic resonance imaging was carried out on 429 individuals in the age range of 50 and 85 years, with cerebral small vessel disease without dementia or parkinsonism. Gait was assessed quantitatively. White matter lesions, especially in the centrum semiovale and periventricular frontal lobe, were related to a lower gait velocity, shorter stride length and broader stride width. Loss of white matter integrity, as indicated by a lower fractional anisotropy and higher mean diffusivity, in numerous regions was related to a lower gait performance. Most of these regions were located in the normal-appearing white matter. The strongest significant association was found in the corpus callosum, particularly the genu. Most of the associations in the normal-appearing white matter disappeared after controlling for white matter lesions and lacunar infarcts, except for some in the corpus callosum. In conclusion, our study showed that using a combination of voxel-based morphometry analysis of the white matter lesions and diffusion tensor imaging is of added value in investigating the pathophysiology of gait disturbances in subjects with small vessel disease. Our data demonstrate that, in elderly subjects with small vessel disease, widespread disruption of white matter integrity, predominantly in the normal-appearing white matter, is involved in gait disturbances. In particular, loss of fibres interconnecting bilateral cortical regions, especially the prefrontal cortex that is involved in cognitive control on motor performance, may be important. The most important mechanisms underlying affected normal-appearing white matter are probably a direct effect of small vessel disease or, indirectly, remote effects of white matter lesions and lacunar infarcts.
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Affiliation(s)
- Karlijn F de Laat
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, The Netherlands
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Zhang Y, Du AT, Hayasaka S, Jahng GH, Hlavin J, Zhan W, Weiner MW, Schuff N. Patterns of age-related water diffusion changes in human brain by concordance and discordance analysis. Neurobiol Aging 2010; 31:1991-2001. [PMID: 19036473 PMCID: PMC2888604 DOI: 10.1016/j.neurobiolaging.2008.10.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 09/30/2008] [Accepted: 10/06/2008] [Indexed: 01/23/2023]
Abstract
In diffusion tensor imaging (DTI), interpreting changes in terms of fractional anisotropy (FA) and mean diffusivity or axial (D(||)) and radial (D(⊥)) diffusivity can be ambiguous. The main objective of this study was to gain insight into the heterogeneity of age-related diffusion changes in human brain white matter by analyzing relationships between the diffusion measures in terms of concordance and discordance instead of evaluating them separately, which is difficult to interpret. Fifty-one cognitively normal subjects (22-79 years old) were studied with DTI at 4 Tesla. Age was associated with widespread concordant changes of decreased FA and increased MD but in some regions significant FA reductions occurred discordant to MD changes. Prominent age-related FA reductions were primarily related to greater radial (D(⊥)) than axial (D(||)) diffusivity changes, potentially reflecting processes of demyelination. In conclusion, concordant/discordant changes of DTI indices provide additional characterization of white matter alterations that accompany normal aging.
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Affiliation(s)
- Yu Zhang
- Center for Imaging of Neurodegenerative Diseases, VA Medical Center, San Francisco, CA, United States.
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Lloyd AJ, Moore PB, Cousins DA, Thompson JM, McAllister VL, Hughes JH, Ferrier IN, Young AH. White matter lesions in euthymic patients with bipolar disorder. Acta Psychiatr Scand 2009; 120:481-91. [PMID: 19489745 DOI: 10.1111/j.1600-0447.2009.01416.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to quantify both load and regional distributions of hyperintensities on magnetic resonance imaging (MRI) in prospectively verified euthymic bipolar patients and matched controls. METHOD Cerebral hyperintensities on T2, proton density and fluid-attenuated inversion recovery (FLAIR) MRI were compared between 48 bipolar and 47 control subjects using semi-quantitative rating scales. RESULTS Bipolar subjects had more severe frontal deep white matter lesions (DWML). Hyperintensity load was independent of age in bipolar patients but increased with age in controls. Global prevalence and severity of hyperintensities did not differ between groups. Exploratory analysis showed DWML in excess in the left hemisphere in bipolar subjects but not in controls. CONCLUSION Findings are consistent with clinical, particularly some neurocognitive, features of bipolar disorder and implicate fronto-subcortical circuits in its neurobiology. They more probably reflect a trait abnormality or illness scar rather than a mood state-dependent finding. Processes other than ageing and vascular factors may underlie their development.
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Affiliation(s)
- A J Lloyd
- Psychobiology Group and Stanley Research Centre, Institute of Neuroscience, University of Newcastle upon Tyne NE1 4LP, Newcastle upon Tyne, UK.
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Choi HS, Cho YM, Kang JH, Shin CS, Park KS, Lee HK. Cerebral white matter hyperintensity is mainly associated with hypertension among the components of metabolic syndrome in Koreans. Clin Endocrinol (Oxf) 2009; 71:184-8. [PMID: 19178513 DOI: 10.1111/j.1365-2265.2008.03444.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cerebral white matter hyperintensity (WMH) is a common abnormality in brain magnetic resonance imaging (MRI) and is known to be associated with ischaemic stroke. Previous studies revealed that the risk factors for cerebral WMH were age, female gender, hypertension and diabetes. In this study we examined the association between cerebral WMH and metabolic syndrome, a cluster of hypertension, glucose intolerance, abdominal obesity and dyslipidaemia. METHODS AND RESULTS We reviewed the results of brain MRI of 5498 subjects who underwent routine check-ups including laboratory tests at the Seoul National University Health Care System. Among the subjects who met the inclusion criteria (n = 5104), 1693 (33.2%) had cerebral WMH. They were characterized by old age, female predominance, higher body mass index (BMI), larger waist circumference, higher blood pressure, higher fasting plasma glucose level, and higher haemoglobin A1c (HbA1c). In multivariate analyses, age, female gender and hypertension were the independent risk factors for cerebral WMH. Metabolic syndrome was associated with cerebral WMH after adjusting for age and gender [odds ratio (OR) 1.20, 95% confidence interval (CI) 1.04-1.39, P = 0.014]. Among the components of metabolic syndrome, hypertension was independently associated with cerebral WMH (OR 1.20, 95% CI 1.05-1.38, P = 0.007). CONCLUSION Age, female gender and hypertension were risk factors for cerebral WMH in the Korean population. Cerebral WMH was also associated with metabolic syndrome; however, metabolic syndrome offered no advantage over hypertension alone in predicting cerebral WMH.
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Affiliation(s)
- Hoon Sung Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Chongno-gu, Seoul, South Korea
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Improved detection of incipient vascular changes by a biotechnological platform combining post mortem MRI in situ with neuropathology. J Neurol Sci 2009; 283:2-8. [PMID: 19289241 DOI: 10.1016/j.jns.2009.02.327] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The histopathological counterpart of white matter hyperintensities is a matter of debate. Methodological and ethical limitations have prevented this question to be elucidated. We want to introduce a protocol applying state-of-the-art methods in order to solve fundamental questions regarding the neuroimaging-neuropathological uncertainties comprising the most common white matter hyperintensities [WMHs] seen in aging. By this protocol, the correlation between signal features in in situ, post mortem MRI-derived methods, including DTI and MTR and quantitative and qualitative histopathology can be investigated. We are mainly interested in determining the precise neuroanatomical substrate of incipient WMHs. A major issue in this protocol is the exact co-registration of small lesion in a tridimensional coordinate system that compensates tissue deformations after histological processing. The protocol is based on four principles: post mortem MRI in situ performed in a short post mortem interval, minimal brain deformation during processing, thick serial histological sections and computer-assisted 3D reconstruction of the histological sections. This protocol will greatly facilitate a systematic study of the location, pathogenesis, clinical impact, prognosis and prevention of WMHs.
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Kim KW, MacFall JR, Payne ME. Classification of white matter lesions on magnetic resonance imaging in elderly persons. Biol Psychiatry 2008; 64:273-80. [PMID: 18471801 PMCID: PMC2593803 DOI: 10.1016/j.biopsych.2008.03.024] [Citation(s) in RCA: 331] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 03/06/2008] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
Abstract
White matter lesions, commonly seen on MRIs of elderly people, are related to various geriatric disorders, including cerebrovascular diseases, cardiovascular diseases, dementia, and psychiatric disorders. Currently, white matter lesions are divided into periventricular white matter lesions and deep white matter lesions. Although the meaning of these terms varies by study and this dichotomization itself is still in debate, a possible dissimilarity in pathogenic mechanisms between periventricular white matter lesions and deep white matter lesions are providing some clues for understanding pathophysiology of many geriatric syndromes associated with white matter lesions. We have reviewed the distinctions between periventricular white matter lesions and deep white matter lesions in terms of etiology, histopathology, functional correlates, and imaging methodologies. We suggest a new subclassification of white matter lesions that might have better etiological and functional relevance than the current simple dichotomization. The new categories are juxtaventricular, periventricular, deep white, and juxtacortical. This new classification scheme might contribute to reducing the heterogeneity of white matter lesion findings in future research.
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Affiliation(s)
- Ki Woong Kim
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA,Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham, NC 27705 USA,Department of Neuropsychiatry, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Gyeonggido, Korea
| | - James R. MacFall
- Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham, NC 27705 USA,Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA,Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA,Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham, NC 27705 USA,CORRESPONDENCE: Martha E. Payne, PhD, RD, MPH, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham, NC 27705, USA, Tel.: (919) 416-7543 Fax: (919) 416-7547
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Grinberg LT, Amaro E, Teipel S, dos Santos DD, Pasqualucci CA, Leite REP, Camargo CR, Gonçalves JA, Sanches AG, Santana M, Ferretti REL, Jacob-Filho W, Nitrini R, Heinsen H. Assessment of factors that confound MRI and neuropathological correlation of human postmortem brain tissue. Cell Tissue Bank 2008; 9:195-203. [PMID: 18548334 DOI: 10.1007/s10561-008-9080-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 05/21/2008] [Indexed: 11/27/2022]
Abstract
In spite of considerable technical advance in MRI techniques, the optical resolution of these methods are still limited. Consequently, the delineation of cytoarchitectonic fields based on probabilistic maps and brain volume changes, as well as small-scale changes seen in MRI scans need to be verified by neuronanatomical/neuropathological diagnostic tools. To attend the current interdisciplinary needs of the scientific community, brain banks have to broaden their scope in order to provide high quality tissue suitable for neuroimaging- neuropathology/anatomy correlation studies. The Brain Bank of the Brazilian Aging Brain Research Group (BBBABSG) of the University of Sao Paulo Medical School (USPMS) collaborates with researchers interested in neuroimaging-neuropathological correlation studies providing brains submitted to postmortem MRI in-situ. In this paper we describe and discuss the parameters established by the BBBABSG to select and to handle brains for fine-scale neuroimaging-neuropathological correlation studies, and to exclude inappropriate/unsuitable autopsy brains. We tried to assess the impact of the postmortem time and storage of the corpse on the quality of the MRI scans and to establish fixation protocols that are the most appropriate to these correlation studies. After investigation of a total of 36 brains, postmortem interval and low body temperature proved to be the main factors determining the quality of routine MRI protocols. Perfusion fixation of the brains after autopsy by mannitol 20% followed by formalin 20% was the best method for preserving the original brain shape and volume, and for allowing further routine and immunohistochemical staining. Taken to together, these parameters offer a methodological progress in screening and processing of human postmortem tissue in order to guarantee high quality material for unbiased correlation studies and to avoid expenditures by post-imaging analyses and histological processing of brain tissue.
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Affiliation(s)
- Lea T Grinberg
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
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Matsusue E, Sugihara S, Fujii S, Ohama E, Kinoshita T, Ogawa T. White matter changes in elderly people: MR-pathologic correlations. Magn Reson Med Sci 2007; 5:99-104. [PMID: 17008766 DOI: 10.2463/mrms.5.99] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Magnetic resonance (MR) imaging features of white matter lesions, often seen in the elderly, are correlated with histologic findings. Dilatation of perivascular spaces is seen, especially in the frontal and/or parietal subcortical white matter; the spaces are less than 3 mm in diameter and have sharp margins with no perifocal abnormality. Old lacunar infarcts are larger than 3 mm in diameter and are irregularly shaped and accompanied by perifocal myelin pallor and gliosis. Periventricular hyperintensity, including cap and rim, histologically shows myelin pallor, dilatation of perivascular spaces, discontinuity of the ependymal lining, and subependymal gliosis. Deep and subcortical white matter hyperintensity reflects myelin pallor and dilatation of perivascular spaces. Diffuse white matter lesion, seen in Binswanger's disease, shows myelin pallor and tissue rarefaction associated with loss of myelin and axons. U-fibers are usually well preserved. Severe arteriosclerosis and arteriolosclerosis are usually seen in the white matter. Knowledge of the pathologic features of incidental changes in white matter helps in understanding MR imaging findings.
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Affiliation(s)
- Eiji Matsusue
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Tottori University, Japan.
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Jellinger KA. The enigma of vascular cognitive disorder and vascular dementia. Acta Neuropathol 2007; 113:349-88. [PMID: 17285295 DOI: 10.1007/s00401-006-0185-2] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 12/08/2006] [Accepted: 12/08/2006] [Indexed: 12/20/2022]
Abstract
The prevalence, morphology and pathogenesis of vascular dementia (VaD), recently termed vascular cognitive impairment, are a matter of discussion, and currently used clinical diagnostic criteria show moderate sensitivity (average 50%) and variable specificity (range 64-98%). In Western clinic-based series, VaD is suggested in 8-10% of cognitively impaired aged subjects. Its prevalence in autopsy series varies from 0.03 to 58%, with reasonable values of 8-15%, while in Japan it is seen in 22-35%. Neuropathologic changes associated with cognitive impairment include multifocal and/or diffuse disease and focal lesions: multi-infarct encephalopathy, white matter lesions or arteriosclerotic subcortical (leuko)encephalopathy, multilacunar state, mixed cortico-subcortical type, borderline/watershed lesions, rare granular cortical atrophy, post-ischemic encephalopathy and hippocampal sclerosis. They result from systemic, cardiac and local large or small vessel disease. Recent data indicate that cognitive decline is commonly associated with widespread small ischemic/vascular lesions (microinfarcts, lacunes) throughout the brain with predominant involvement of subcortical and functionally important brain areas. Their pathogenesis is multifactorial, and their pathophysiology affects neuronal networks involved in cognition, memory, behavior and executive functioning. Vascular lesions often coexist with Alzheimer disease (AD) and other pathologies. Minor cerebrovascular lesions, except for severe amyloid angiopathy, appear not essential for cognitive decline in full-blown AD, while both mild Alzheimer pathology and small vessel disease may interact synergistically. The lesion pattern of "pure" VaD, related to arteriosclerosis and microangiopathies, differs from that in mixed-type dementia (AD with vascular encephalopathy), more often showing large infarcts, which suggests different pathogenesis of both types of lesions. Due to the high variability of cerebrovascular pathology and its causative factors, no validated neuropathologic criteria for VaD are available, and a large variability across laboratories still exists in the procedures for morphologic examination and histology techniques.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, 1070, Vienna, Austria.
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Hentschel F, Damian M, Krumm B, Froelich L. White matter lesions - age-adjusted values for cognitively healthy and demented subjects. Acta Neurol Scand 2007; 115:174-80. [PMID: 17295712 DOI: 10.1111/j.1600-0404.2006.00762.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop age-adjusted norms for white matter lesions (WML) and to differentiate dementia from mild cognitive impairment and normal aging. MATERIALS AND METHODS 240 patients underwent a comprehensive clinical, neuropsychological and MRI examination. A scale was developed quantify WML in anatomically defined regions by rating size and frequency. FLAIR sequences were used to determine a global and a frontal score. The scores were correlated with the psychometric test results and the final clinical diagnosis: cognitively normal (CN), mild cognitive impairment (MCI), Alzheimer's Disease (AD), vascular dementia (VD). Age-adjusted curves for WML scores were calculated by means of a non-parametic smoothing method. RESULTS WML scores of the whole cerebrum and the frontal lobe were significantly increased in vascular dementia as compared to CN, MCI and AD. Individual WML scores correlated significantly with age and neuropsychological test results. For the age range 55-72, the WML scores of VD were significantly different from those of CN, MCI and AD. CONCLUSIONS Age-corrected WML load was significantly higher in vascular dementia as compared to MCI, AD and cognitively normals over a wide age range.
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Affiliation(s)
- F Hentschel
- Department of Neuroradiology, Central Institute of Mental Health (CIMH), Mannheim, Germany
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Smith CD, Chebrolu H, Wekstein DR, Schmitt FA, Markesbery WR. Age and gender effects on human brain anatomy: a voxel-based morphometric study in healthy elderly. Neurobiol Aging 2006; 28:1075-87. [PMID: 16774798 DOI: 10.1016/j.neurobiolaging.2006.05.018] [Citation(s) in RCA: 244] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Revised: 04/19/2006] [Accepted: 05/03/2006] [Indexed: 10/24/2022]
Abstract
The adult human brain shrinks slowly with age, but the regional specificity and tissue class specificity of this loss is unclear. Subjects (n=122) were healthy aged participants in a longitudinal cohort who undergo periodic standardized cognitive and clinical examination. Multi-spectral segmentation of magnetic resonance images into grey matter (GM), white matter (WM) and CSF was performed on cross-sectional image data using a custom template and calculated prior probability maps. Global differences were evaluated by fitting a regression model for absolute and normalized subject GM, WM, and CSF values. Global and regional patterns of GM, WM and CSF differences were assessed using optimized voxel-based morphometry (VBM). GM volume decreased with age at a rate of 2.4 cm(3)/year (-0.18%/year); CSF increased by 2.5 cm(3)/year (0.20%/year). Regression analyses showed no significant decrease in WM volume, but a focal WM decrease with age was detected in the anterior corpus callosum using VBM. Diffuse reductions of GM volume were seen with age in the frontal, parietal, and temporal cortex, cerebellum and basal ganglia. Relative regional differences in cortical GM volume with age occurred in the frontal, parietal and temporal lobes, but not in medial temporal lobe or in posterior cingulate. We did not observe significant gender effects. These findings establish a baseline for comparison with pathologic changes in human brain volume between ages 58 and 95 years.
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Affiliation(s)
- Charles D Smith
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY 40536-0098, United States.
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Zarow C, Kim TS, Singh M, Chui HC. A standardized method for brain-cutting suitable for both stereology and MRI-brain co-registration. J Neurosci Methods 2005; 139:209-15. [PMID: 15488234 DOI: 10.1016/j.jneumeth.2004.04.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Revised: 04/29/2004] [Accepted: 04/29/2004] [Indexed: 10/26/2022]
Abstract
We have developed an agar-embedding method for brain-slicing that minimizes the geometrical distortions which arise from handling and slicing the fixed postmortem brain. To facilitate postmortem brain-magnetic resonance imaging (MRI) co-registration, each hemisphere is processed separately. We embed the fixed brain hemisphere with reference markers in agar. The block containing the brain and markers is sliced at a fixed interval using a rotary slicer. Each slice is photographed with a high-resolution digital camera. The digital images are realigned as a 3-dimensional volume via a control point-based registration method for multi-slice registration. The realigned multiple slices of the reconstructed postmortem hemisphere are then co-registered to corresponding slices of an in vivo reference MRI-volume. We illustrate these postmortem MRI-brain co-registration methods to correlate in vivo T2-weighted MRI hyperintensities in gray and white matter with underlying pathology. For design-based stereology, the volume of interest (VOI) is defined using reproducible anatomical boundaries. This method is suitable for stereologic measures of structures ranging from defined nuclei to whole brain.
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Affiliation(s)
- C Zarow
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, University of Southern California, Downey, CA 90242, USA.
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Salat DH, Tuch DS, Greve DN, van der Kouwe AJW, Hevelone ND, Zaleta AK, Rosen BR, Fischl B, Corkin S, Rosas HD, Dale AM. Age-related alterations in white matter microstructure measured by diffusion tensor imaging. Neurobiol Aging 2004; 26:1215-27. [PMID: 15917106 DOI: 10.1016/j.neurobiolaging.2004.09.017] [Citation(s) in RCA: 602] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Revised: 08/26/2004] [Accepted: 09/30/2004] [Indexed: 10/26/2022]
Abstract
Cerebral white matter (WM) undergoes various degenerative changes with normal aging, including decreases in myelin density and alterations in myelin structure. We acquired whole-head, high-resolution diffusion tensor images (DTI) in 38 participants across the adult age span. Maps of fractional anisotropy (FA), a measure of WM microstructure, were calculated for each participant to determine whether particular fiber systems of the brain are preferentially vulnerable to WM degeneration. Regional FA measures were estimated from nine regions of interest in each hemisphere and from the genu and splenium of the corpus callosum (CC). The results showed significant age-related decline in FA in frontal WM, the posterior limb of the internal capsule (PLIC), and the genu of the CC. In contrast, temporal and posterior WM was relatively preserved. These findings suggest that WM alterations are variable throughout the brain and that particular fiber populations within prefrontal region and PLIC are most vulnerable to age-related degeneration.
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Affiliation(s)
- D H Salat
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129-2060, USA.
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Fernando MS, Ince PG. Vascular pathologies and cognition in a population-based cohort of elderly people. J Neurol Sci 2004; 226:13-7. [PMID: 15537512 DOI: 10.1016/j.jns.2004.09.004] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The MRC Cognitive Function and Ageing Study (CFAS) is a prospective longitudinal study of a population-based cohort of elderly people in six UK sites, evaluated using psychometric instruments and questionnaires to elucidate physical and mental health. Data from the core study includes prevalence and incidence rates for dementia and longitudinal measures of cognitive decline together with data on genetic risk factors for dementia. A neuropathology study runs in collaboration with the core study based on premortem counselling of individual respondents or carers. Analysis of pathological data from the first 209 accumulated brain donations showed that both Alzheimer-type pathologies (ATP) and vascular pathologies (including congophilic amyloid angiopathy (CAA)) were common in both demented and non-demented respondents. Although many cases fulfil conventional diagnostic criteria for the pathological diagnosis of Alzheimer disease, the data differ from those published from conventional studies of hospital or memory clinic cohorts. In particular, there are individuals whose total burden of pathology is inappropriately high or low compared with their clinical dementia status, even when all pathologies are considered in a multivariable model of dementia risk factors (25% of respondents misdiagnosed from pathology findings). Vascular pathology is so common that few dementia cases lack a mixed component of both ATP and vascular lesions (pure AD cases, 21%). More recently, the study has examined white matter pathology in this cohort as a potential manifestation of small-vessel disease (SVD) in the ageing brain. Using an MRI strategy to image formalin-fixed brain slices, the study shows that white matter lesions (WMLs) are common (94% overall frequency) and are an independent risk factor for dementia using multivariable analysis.
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Affiliation(s)
- Malee S Fernando
- Neuropathology, Academic Unit of Pathology, Division of Genomic Medicine, University of Sheffield, 'E' Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
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Wen W, Sachdev P, Shnier R, Brodaty H. Effect of white matter hyperintensities on cortical cerebral blood volume using perfusion MRI. Neuroimage 2004; 21:1350-6. [PMID: 15050560 DOI: 10.1016/j.neuroimage.2003.11.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2003] [Revised: 09/28/2003] [Accepted: 11/03/2003] [Indexed: 11/19/2022] Open
Abstract
White matter hyperintensities (WMHs) are commonly seen on brain magnetic resonance imaging (MRI) scans of elderly individuals, but their functional significance remains controversial. We used perfusion-weighted MRI to determine the impact of WMHs on cortical regional cerebral blood volume (rCBV). We studied 24 elderly stroke patients and 27 control subjects with conventional MRI which included T2-weighted FLAIR coronal slices through whole brain and gadolinium-DTPA (0.2 mmol/kg)-based perfusion MRI (pMRI) with echo planar imaging. Volumes of WMHs, including deep WMHs and periventricular hyperintensities (PVHs), were computed by an automated method after excluding regions of infarction. Partial correlations between WMH and corresponding cortical rCBV were determined after correction for age and atrophy. The relative rCBV of gray matter was higher in control subjects and there was no significant hemispheric asymmetry. When both stroke and control groups were included, there were significant correlations among frontal cortical rCBV and frontal WMHs, temporal cortical rCBV with temporal WMHs, and cortical rCBV with both total deep WMHs and PVHs. Although the trends of correlation still existed when the two groups were analyzed separately, they were not significant. The correlations between cortical rCBV and WMHs in the same lobe were significant for subjects with more severe hyperintensities irrespective of the group. In conclusion, T2-weighted WMHs are associated with reduced rCBV in the cerebral cortex, particularly in individuals with extensive hyperintensities.
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Affiliation(s)
- Wei Wen
- Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, New South Wales 2031, Australia
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Lyoo IK, Streeter CC, Ahn KH, Lee HK, Pollack MH, Silveri MM, Nassar L, Levin JM, Sarid-Segal O, Ciraulo DA, Renshaw PF, Kaufman MJ. White matter hyperintensities in subjects with cocaine and opiate dependence and healthy comparison subjects. Psychiatry Res 2004; 131:135-45. [PMID: 15313520 DOI: 10.1016/j.pscychresns.2004.04.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2003] [Revised: 01/03/2004] [Accepted: 04/01/2004] [Indexed: 11/26/2022]
Abstract
The prevalence, severity, and location of white matter signal hyperintensities (WMH) on brain magnetic resonance images were compared in patients with cocaine or opiate dependence and healthy subjects. Patients with cocaine (n=32) and opiate dependence (n=32), whose diagnoses were confirmed with the Structured Clinical Interview for DSM-IV, and age- and sex-matched healthy subjects (n=32) were scanned using a 1.5 T whole body GE magnetic resonance scanner. Axial proton-density and T2-weighted images were obtained as well as fluid-attenuated inversion recovery axial images. The severity of WMH was assessed separately for deep (and insular) and periventricular WMH, using a modified composite version of the rating scales of Fazekas and Coffey. The cocaine-dependent group had greater severity of WMH than the opiate-dependent group, which in turn had greater severity of WMH than the healthy comparison group (odds ratios=2.54 and 2.90, respectively). The cocaine-dependent group had greater lesion severity of deep and insular WMH than the opiate-dependent group and the healthy comparison group (odds ratio>3.25 for deep WMH; odds ratio>4.38 for insular WMH). For periventricular WMH, there were no significant differences between the three groups. The frontal lobes were the predominant locations of WMH in both substance-dependent groups. The greater prevalence and severity of WMH in cocaine-dependent subjects than in opiate-dependent subjects may reflect the fact that cocaine induces more ischemia via vasoconstriction than opiates. Also, there was a trend for lower WMH severity in substance-dependent women relative to the healthy comparison group, possibly due to estrogen's protective effect against cerebrovascular accidents.
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Affiliation(s)
- In Kyoon Lyoo
- McLean Hospital Brain Imaging Center and Department of Psychiatry, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA.
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Wen W, Sachdev P. The topography of white matter hyperintensities on brain MRI in healthy 60- to 64-year-old individuals. Neuroimage 2004; 22:144-54. [PMID: 15110004 DOI: 10.1016/j.neuroimage.2003.12.027] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Revised: 12/06/2003] [Accepted: 12/08/2003] [Indexed: 11/18/2022] Open
Abstract
We report the topography of brain white matter hyperintensities (WMHs) on T2-weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging in 477 healthy subjects aged 60-64 years selected randomly from the community. WMHs were delineated by using a computer algorithm. We found that all subjects had periventricular WMHs and 96.6% subjects also had deep WMHs. The mean volume of WMHs was 4.9 ml, comprising 0.83% of the white matter, of which 1.2 ml was severe in intensity. The deep WMHs were distributed throughout the cerebral hemispheres, with the occipital and frontal white matter bearing the greatest burden. The territory of the lenticulostriate arteries had the greatest WMHs. A white matter region of 4 mm adjacent to the cortex was not affected by hyperintensities. The mean (SD) number of discrete WMHs was 19.6 (7.1) per subject, of which 6.1 (4.4) were severe in intensity. Nearly half (48.6%) of the subjects had at least one large WMH (>12 mm diameter) and one eighth (12.5%) of the subjects had at least one large WMH that appeared to be severe in MRI. The overall load of WMHs was similar in men and women, but the latter had a higher proportion of their white matter so affected. This study provides the first detailed topographic analysis of WMHs in a large representative middle-aged sample, emphasizes their high prevalence in mid-adult life and raises issues about their etiology and significance.
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Affiliation(s)
- Wei Wen
- Neuropsychiatric Institute, Prince of Wales Hospital, School of Psychiatry, University of New South Wales, Randwick 2031, Sydney, Australia.
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Atwood LD, Wolf PA, Heard-Costa NL, Massaro JM, Beiser A, D'Agostino RB, DeCarli C. Genetic variation in white matter hyperintensity volume in the Framingham Study. Stroke 2004; 35:1609-13. [PMID: 15143299 DOI: 10.1161/01.str.0000129643.77045.10] [Citation(s) in RCA: 174] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE In a previous study of normal elderly male twins, the heritability of quantitative white matter hyperintensity (WMH) volume has been estimated to be high (0.73). We investigated heritability of WMH in a family-based sample of the Framingham Heart Study for sex differences and the impact of age. METHODS Brain magnetic resonance scans were performed on 2012 individuals in the cohort and offspring of the Framingham study. This report was limited to 1330 stroke-free and dementia-free members (mean age 61.0 years) of the Framingham offspring. Individuals with a history of multiple sclerosis, stroke, dementia, or other neurological condition including traumatic brain injury were excluded from this analysis. WMH volume and total cranial volume (TCV) were quantified using a previously published algorithm. Because of extreme skewing, measures of WMH were log-transformed before analysis. Variance components methods were used to estimate heritability of WMH after adjusting for sex, age, age2, and TCV. RESULTS In the full dataset, WMH heritability was 0.55 (P<0.0001). Heritability among women was 0.78 (P<0.0001) whereas heritability among men was 0.52 (P<0.0003). Heritability varied as average age increased, with a peak of 0.68 (P<0.0001) in individuals aged 55 or older. CONCLUSIONS Using a family-based study design comprising generally healthy individuals, this study found high heritability of WMH overall and similar heritability for both men and women. In addition, the heritability of WMH remained high among individuals in whom the prevalence of cerebrovascular brain injury was generally low, suggesting that WMH is also likely to be an excellent genetic marker of brain aging.
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Affiliation(s)
- Larry D Atwood
- Department of Neurology, Boston University School of Medicine, 715 Albany Street, B-609, Boston, Mass 02118, USA.
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