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Okawa R, Hayashi N, Takahashi T, Atarashi R, Yasui G, Mihara B. Comparison of qualitative and fully automated quantitative tools for classifying severity of white matter hyperintensity. J Stroke Cerebrovasc Dis 2024; 33:107772. [PMID: 38761849 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107772] [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: 08/23/2023] [Accepted: 05/15/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVE In this study, we aimed to compare the Fazekas scoring system and quantitative white matter hyperintensity volume in the classification of white matter hyperintensity severity using a fully automated analysis software to investigate the reliability of quantitative evaluation. MATERIALS AND METHODS Patients with suspected cognitive impairment who underwent medical examinations at our institution between January 2010 and May 2021 were retrospectively examined. White matter hyperintensity volumes were analyzed using fully automated analysis software and Fazekas scoring (scores 0-3). Using one-way analysis of variance, white matter hyperintensity volume differences across Fazekas scores were assessed. We employed post-hoc pairwise comparisons to compare the differences in the mean white matter hyperintensity volume between each Fazekas score. Spearman's rank correlation test was used to investigate the association between Fazekas score and white matter hyperintensity volume. RESULTS Among the 839 patients included in this study, Fazekas scores 0, 1, 2, and 3 were assigned to 68, 198, 217, and 356 patients, respectively. White matter hyperintensity volumes significantly differed according to Fazekas score (F=623.5, p<0.001). Post-hoc pairwise comparisons revealed significant differences in mean white matter hyperintensity volume between all Fazekas scores (p<0.05). We observed a significantly positive correlation between the Fazekas scores and white matter hyperintensity volume (R=0.823, p<0.01). CONCLUSIONS Quantitative white matter hyperintensity volume and the Fazekas scores are highly correlated and may be used as indicators of white matter hyperintensity severity. In addition, quantitative analysis may be more effective in classifying advanced white matter hyperintensity lesions than the Fazekas classification.
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Affiliation(s)
- Ryuya Okawa
- Department of Diagnostic Imaging, Institute of Brain and Blood Vessels Mihara Memorial Hospital; Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences.
| | - Norio Hayashi
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences.
| | - Tetsuhiko Takahashi
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences.
| | - Ryo Atarashi
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences.
| | - Go Yasui
- Department of Diagnostic Imaging, Institute of Brain and Blood Vessels Mihara Memorial Hospital.
| | - Ban Mihara
- Department of Neurology, Institute of Brain and Blood Vessels Mihara Memorial Hospital.
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2
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Zhang Z, Ding Z, Chen F, Hua R, Wu J, Shen Z, Shi F, Xu X. Quantitative Analysis of Multimodal MRI Markers and Clinical Risk Factors for Cerebral Small Vessel Disease Based on Deep Learning. Int J Gen Med 2024; 17:739-750. [PMID: 38463439 PMCID: PMC10923240 DOI: 10.2147/ijgm.s446531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Cerebral small vessel disease lacks specific clinical manifestations, and extraction of valuable features from multimodal images is expected to improve its diagnostic accuracy. In this study, we used deep learning techniques to segment cerebral small vessel disease imaging markers in multimodal magnetic resonance images and analyze them with clinical risk factors. Methods and results We recruited 211 lacunar stroke patients and 83 control patients. The patients' cerebral small vessel disease markers were automatically segmented using a V-shaped bottleneck network, and the number and volume were calculated after manual correction. The segmentation results of the V-shaped bottleneck network for white matter hyperintensity and recent small subcortical infarction were in high agreement with the ground truth (DSC>0.90). In small lesion segmentation, cerebral microbleed (average recall=0.778; average precision=0.758) and perivascular spaces (average recall=0.953; average precision=0.923) were superior to lacunar infarct (average recall=0.339; average precision=0.432) in recall and precision. Binary logistic regression analysis showed that age, systolic blood pressure, and total cerebral small vessel disease load score were independent risk factors for lacunar stroke (P<0.05). Ordered logistic regression analysis showed age was positively correlated with cerebral small vessel disease load score and total cholesterol was negatively correlated with cerebral small vessel disease score (P<0.05). Conclusion Lacunar stroke patients exhibited higher cerebral small vessel disease imaging markers, and age, systolic blood pressure, and total cerebral small vessel disease score were independent risk factors for lacunar stroke patients. V-shaped bottleneck network segmentation network based on multimodal deep learning can segment and quantify various cerebral small vessel disease lesions to some extent.
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Affiliation(s)
- Zhiliang Zhang
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, People’s Republic of China
| | - Zhongxiang Ding
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, People’s Republic of China
| | - Fenyang Chen
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, People’s Republic of China
| | - Rui Hua
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd, Shanghai, People’s Republic of China
| | - Jiaojiao Wu
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd, Shanghai, People’s Republic of China
| | - Zhefan Shen
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, People’s Republic of China
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd, Shanghai, People’s Republic of China
| | - Xiufang Xu
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, People’s Republic of China
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3
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Wisniewski T, Masurkar AV. Gait dysfunction in Alzheimer disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:267-274. [PMID: 37620073 DOI: 10.1016/b978-0-323-98817-9.00013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Alzheimer's disease (AD) is the most common cause of age-associated dementia and will exponentially rise in prevalence in the coming decades, supporting the parallel development of the early stage detection and disease-modifying strategies. While primarily considered as a cognitive disorder, AD also features motor symptoms, primarily gait dysfunction. Such gait abnormalities can be phenotyped across classic clinical syndromes as well as by quantitative kinematic assessments to address subtle dysfunction at preclinical and prodromal stages. As such, certain measures of gait can predict the future cognitive and functional decline. Moreover, cross-sectional and longitudinal studies have associated gait abnormalities with imaging, biofluid, and genetic markers of AD across all stages. This suggests that gait assessment is an important tool in the clinical assessment of patients across the AD spectrum, especially to help identify at-risk individuals.
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Affiliation(s)
- Thomas Wisniewski
- Department of Neurology, NYU School of Medicine, New York, NY, United States; Department of Pathology, NYU School of Medicine, New York, NY, United States; Department of Psychiatry, NYU School of Medicine, New York, NY, United States; Division of Cognitive Neurology, Center for Cognitive Neurology, NYU School of Medicine, New York, NY, United States.
| | - Arjun V Masurkar
- Department of Neurology, NYU School of Medicine, New York, NY, United States; Division of Cognitive Neurology, Center for Cognitive Neurology, NYU School of Medicine, New York, NY, United States
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4
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Decreased cognitive function is associated with impaired spatiotemporal gait performance in community dwelling older adults with chronic musculoskeletal pain. Brain Cogn 2022; 159:105862. [DOI: 10.1016/j.bandc.2022.105862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/09/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
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5
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Zhu H, Lu H, Wang F, Liu S, Shi Z, Gan J, Du X, Yang Y, Li D, Wang L, Ji Y. Characteristics of Cortical Atrophy and White Matter Lesions Between Dementia With Lewy Bodies and Alzheimer's Disease: A Case-Control Study. Front Neurol 2022; 12:779344. [PMID: 35087466 PMCID: PMC8788384 DOI: 10.3389/fneur.2021.779344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Currently, there is still clinical overlap between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) patients, which may affect the accuracy of the early diagnosis of DLB. For better diagnosis and prognosis, further exploration of local cortical atrophy patterns and white matter lesions is needed. Methods: We reviewed the outpatient medical records of 97 DLB patients and 173 AD patients from January 2018 to September 2020 along with 30 matched outpatient clinic normal elderly people. MRI visual rating scales, including medial temporal lobe atrophy (MTA), global cortical atrophy-frontal subscale (GCA-F), posterior atrophy (PA), Fazekas scale, Evans Index and cerebral microbleeds were evaluated and analyzed in DLB and AD patients with different severities and normal controls. Results: Overall, patients with DLB had higher scores on all visual rating scales than the normal controls. Meanwhile, compared with AD, DLB had lower MTA scores in the mild to moderate groups (both p ≤ 0.001), but the GCA-F and PA scores were similar (all p > 0.05). The Fazekas scores in the moderate to severe DLB group were lower than those in the AD group (p = 0.024 and p = 0.027, respectively). In addition, the diagnostic performance and sensitivity of multiple imaging indicators for DLB were better than that of MTA alone (the combination of MTA, GCA-F, PA, Fazekas visual rating scales, AUC = 0.756, 95%CI: 0.700–0.813, sensitivity = 0.647, specificity = 0.804 and MTA visual rating scale, AUC = 0.726, 95%CI: 0.667–0.785, sensitivity = 0.497, specificity = 0.876, respectively). Conclusion: The medial temporal lobe of DLB patients was relatively preserved, the frontal and parietal lobes were similarly atrophied to AD patients, and the white matter hyperintensity was lighter than that in AD patients. Combined multiple visual rating scales may provide a novel idea for the diagnosis of early DLB.
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Affiliation(s)
- Han Zhu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Hao Lu
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Fei Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoshan Du
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Yaqi Yang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Daibin Li
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Lichen Wang
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yong Ji
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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6
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Hu Y, Yang Y, Hou X, Zhou Y, Nie S. The influence of white matter hyperintensities severity on functional brain activity in cerebral small vessel disease: An rs-fMRI study. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:1213-1227. [PMID: 36120754 DOI: 10.3233/xst-221218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate relationships between the severity of white matter hyperintensities (WMH), functional brain activity, and cognition in cerebral small vessel disease (CSVD) based on resting-state functional magnetic resonance imaging (rs-fMRI) data. METHODS A total of 103 subjects with CSVD were included. The amplitude of low frequency fluctuations (ALFF), regional homogeneity (ReHo), functional connectivity (FC) and their graph properties were applied to explore the influence of WMH burden on functional brain activity. We also investigated whether there are correlations between different functional brain characteristics and cognitive assessments. Finally, we selected disease-related rs-fMRI features in combination with ensemble learning to classify CSVD patients with low WMH load and with high WMH load. RESULTS The high WMH load group demonstrated significantly abnormal functional brain activity based on rs-MRI data, relative to the low WMH load group. ALFF and graph properties in specific brain regions were significantly correlated with patients' cognitive assessments in CSVD. Moreover, altered rs-fMRI signal can help predict the severity of WMH in CSVD patients with an overall accuracy of 92.23%. CONCLUSIONS This study provided a comprehensive analysis and evidence for a pattern of altered functional brain activity under different WMH load in CSVD based on rs-fMRI data, enabling accurately individual prediction of status of WMH.
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Affiliation(s)
- Ying Hu
- Institute of Medical Imaging Engineering, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yifeng Yang
- Institute of Medical Imaging Engineering, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Xuewen Hou
- Institute of Medical Imaging Engineering, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shengdong Nie
- Institute of Medical Imaging Engineering, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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7
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Hijazi Z, Yassi N, O'Brien JT, Watson R. The influence of cerebrovascular disease in dementia with Lewy bodies and Parkinson's disease dementia. Eur J Neurol 2021; 29:1254-1265. [PMID: 34923713 DOI: 10.1111/ene.15211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lewy body dementia (LBD), including dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is a common form of neurodegenerative dementia. The frequency and influence of comorbid cerebrovascular disease is not understood but has potentially important clinical management implications. METHODS A systematic literature search was conducted (Medline and Embase) for studies including participants with DLB and/or PDD assessing cerebrovascular lesions (imaging and pathological studies). They included white matter changes, cerebral amyloid angiopathy (CAA), cerebral microbleeds (CMB), macroscopic infarcts, micro-infarcts and intracerebral haemorrhage. RESULTS Of 4411 articles, 63 studies were included. Cerebrovascular lesions commonly studied included white matter changes (41 studies) and CMB (18 studies). There was an increased severity of white matter changes on magnetic resonance imaging (visualized as white matter hyperintensities, WMH), but not neuropathology, in LBD compared to PD without dementia and age-matched controls. CMB prevalence in DLB was highly variable but broadly similar to Alzheimer's disease (AD) (0-48%), with a lobar predominance. No relationship was found between large cortical or small subcortical infarcts or intracerebral haemorrhage and presence of LBD. CONCLUSION The underlying mechanisms of WMH in LBD require further exploration, as their increased severity in LBD was not supported by neuropathological examination of white matter. CMB in LBD had a similar prevalence as AD. There is a need for larger studies assessing the influence of cerebrovascular lesions on clinical symptoms, disease progression and outcomes.
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Affiliation(s)
- Zina Hijazi
- Monash University School of Rural Health, Bendigo Hospital, Bendigo, VIC, Australia.,Department of Medicine, Bendigo Hospital, Bendigo, VIC, Australia
| | - Nawaf Yassi
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Level E4, Box 189, Cambridge, CB2 0QC, UK
| | - Rosie Watson
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
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8
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Jansen MG, Geerligs L, Claassen JAHR, Overdorp EJ, Brazil IA, Kessels RPC, Oosterman JM. Positive Effects of Education on Cognitive Functioning Depend on Clinical Status and Neuropathological Severity. Front Hum Neurosci 2021; 15:723728. [PMID: 34566608 PMCID: PMC8459869 DOI: 10.3389/fnhum.2021.723728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Variability in cognitive functions in healthy and pathological aging is often explained by educational attainment. However, it remains unclear to which extent different disease states alter protective effects of education. We aimed to investigate whether protective effects of education on cognition depend on (1) clinical diagnosis severity, and (2) the neuropathological burden within a diagnosis in a memory clinic setting. Methods: In this cross-sectional study, we included 108 patients with subjective cognitive decline [SCD, median age 71, IQR (66-78), 43% men], 190 with mild cognitive impairment [MCI, median age 78, IQR (73-82), 44% men], and 245 with Alzheimer's disease dementia (AD) [median age 80, IQR (76-84), 35% men]. We combined visual ratings of hippocampal atrophy, global atrophy, and white matter hyperintensities on MRI into a single neuropathology score. To investigate whether the contribution of education to cognitive performance differed across SCD, MCI, and AD, we employed several multiple linear regression models, stratified by diagnosis and adjusted for age, sex, and neurodegeneration. We re-ran each model with an additional interaction term to investigate whether these effects were influenced by neuropathological burden for each diagnostic group separately. False discovery rate (FDR) corrections for multiple comparisons were applied. Results: We observed significant positive associations between education and performance for global cognition and executive functions (all adjusted p-values < 0.05). As diagnosis became more severe, however, the strength of these associations decreased (all adjusted p-values < 0.05). Education related to episodic memory only at relatively lower levels of neuropathology in SCD (β = -0.23, uncorrected p = 0.02), whereas education related to episodic memory in those with higher levels of neuropathology in MCI (β = 0.15, uncorrected p = 0.04). However, these interaction effects did not survive FDR-corrections. Conclusions: Altogether, our results demonstrated that positive effects of education on cognitive functioning reduce with diagnosis severity, but the role of neuropathological burden within a particular diagnosis was small and warrants further investigation. Future studies may further unravel the extent to which different dimensions of an individual's disease severity contribute to the waxing and waning of protective effects in cognitive aging.
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Affiliation(s)
- Michelle G. Jansen
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Linda Geerligs
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Jurgen A. H. R. Claassen
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, Netherlands
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Inti A. Brazil
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Roy P. C. Kessels
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, Netherlands
- Department of Medical Psychology, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, Netherlands
| | - Joukje M. Oosterman
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, Netherlands
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Huang Z, Tu X, Lin Q, Zhan Z, Tang L, Liu J. Increased internal cerebral vein diameter is associated with age. Clin Imaging 2021; 78:187-193. [PMID: 33962184 DOI: 10.1016/j.clinimag.2021.03.027] [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: 01/10/2021] [Revised: 02/21/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE A recent study described the relationship between cerebral venous diameter and white matter hyperintensity (WMH) volume. However, the adults were not further grouped; therefore, we aimed to compare across age groups and use susceptibility-weighted imaging (SWI) to explore whether there is also a relationship between a larger cerebral draining venous diameter and age, which could provide evidence of a temporal relationship. METHODS We retrospectively analysed data collected from 405 subjects (90 youths, 166 middle-aged participants, and 149 elderly subjects) and respectively used T2-weighted fluid-attenuated inversion recovery (FLAIR) and SWI to assess WMHs and venous diameter. RESULTS An increased internal cerebral vein (ICV) diameter was associated with age in different WMH groups (F = 3.453, 10.437, 11.746, and 21.723, respectively, all p < 0.001; multiple comparisons all p < 0.05), whereas the effect of the anterior septal vein (ASV) was opposite (F = 1.046, 1.210, 0.530, and 0.078, respectively, p > 0.05). There was a positive correlation between the ICV diameter and age with increasing WMH severity (R = 0.727, 0.709, 0.754, and 0.830, respectively, all p < 0.001). A statistically significant relationship between the thalamostriate vein (TSV) diameter and age was observed only in the moderate and severe WMH groups (F = 4.070 and 3.427, respectively, all p < 0.05; multiple comparisons all p < 0.05). CONCLUSIONS Our study demonstrates that increased TSV and ICV diameters are associated with age with increasing WMH severity, especially the ICV diameter using SWI.
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Affiliation(s)
- Zhenhuan Huang
- Department of Radiology, Longyan First Hospital, Fujian Medical University, No. 105 North 91 Road, Xinluo District, Fujian 364000, China.
| | - Xuezhao Tu
- Department of Orthopedics, Longyan First Hospital, Fujian Medical University, No. 105 North 91 Road, Xinluo District, Fujian 364000, China
| | - Qi Lin
- Department of Radiology, Longyan First Hospital, Fujian Medical University, No. 105 North 91 Road, Xinluo District, Fujian 364000, China
| | - Zejuan Zhan
- Department of Radiology, Longyan First Hospital, Fujian Medical University, No. 105 North 91 Road, Xinluo District, Fujian 364000, China
| | - Langlang Tang
- Department of Radiology, Longyan First Hospital, Fujian Medical University, No. 105 North 91 Road, Xinluo District, Fujian 364000, China
| | - Jinkai Liu
- Department of Radiology, Longyan First Hospital, Fujian Medical University, No. 105 North 91 Road, Xinluo District, Fujian 364000, China
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Zeng W, Chen Y, Zhu Z, Gao S, Xia J, Chen X, Jia J, Zhang Z. Severity of white matter hyperintensities: Lesion patterns, cognition, and microstructural changes. J Cereb Blood Flow Metab 2020; 40:2454-2463. [PMID: 31865841 PMCID: PMC7820685 DOI: 10.1177/0271678x19893600] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
White matter hyperintensity (WMH) is a common finding in aging population and considered to be a contributor to cognitive decline. Our study aimed to characterize the spatial patterns of WMH in different severities and explore its impact on cognition and brain microstructure in non-demented elderly. Lesions were both qualitatively (Fazekas scale) and quantitatively assessed among 321 community-dwelled individuals with MRI scanning. Voxel- and atlas-based analyses of the whole-brain white matter microstructure were performed. The WMH of the same severities was found to occur uniformly with a specific pattern of lesions. The severity of WMH had a significant negative association with the performance of working and episodic memory, beginning to appear in Fazekas 3 and 4. The white matter tracts presented significant impairments in Fazekas 3, which showed brain-wide changes above Fazekas 4. Lower FA in the superior cerebellar peduncle and left posterior thalamic radiation was mainly associated with episodic memory, and the middle cerebellar peduncle was significantly associated with working memory. These results support that memory is the primary domain to be affected by WMH, and the effect may potentially be influenced by tract-specific WM abnormalities. Fazekas scale 3 might be the critical stage predicting a future decline in cognition.
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Affiliation(s)
- Weiyi Zeng
- Medical School of Chinese PLA, Beijing, China.,Department of Geriatric Neurology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yaojing Chen
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,BABRI Centre, Beijing Normal University, Beijing, China
| | - Zhibao Zhu
- Department of Neurology, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Shudan Gao
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,BABRI Centre, Beijing Normal University, Beijing, China
| | - Jianan Xia
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,BABRI Centre, Beijing Normal University, Beijing, China.,School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Xiaochun Chen
- Department of Neurology, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jianjun Jia
- Medical School of Chinese PLA, Beijing, China.,Department of Geriatric Neurology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,BABRI Centre, Beijing Normal University, Beijing, China
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11
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Chan M, Ferguson D, Ni Mhurchu E, Yuan R, Gondara L, McKenzie M, Olson R, Thiessen B, Lalani N, Ma R, Nichol A. Patients with pretreatment leukoencephalopathy and older patients have more cognitive decline after whole brain radiotherapy. Radiat Oncol 2020; 15:271. [PMID: 33239056 PMCID: PMC7687765 DOI: 10.1186/s13014-020-01717-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/13/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To investigate predictors of cognitive decline after whole brain radiotherapy (WBRT) for brain metastases. Methods A secondary analysis of a phase 2 clinical trial was conducted in patients who received stereotactic radiosurgery for 1–10 brain metastases and WBRT (NCT01046123). The Montreal Cognitive Assessment (MoCA) was performed at baseline and every 3 months after WBRT. Baseline T2-weighted fluid attenuation inversion recovery magnetic resonance imaging was independently assessed by two neuroradiologists for the presence of white matter hyperintensities (WMH) using the Fazekas visual rating scale. WMH were also manually segmented for volumetric analysis. Univariable and multivariable logistic regression were used to test the association between baseline variables and MoCA score decline.
Results Forty-six patients survived ≥ 3 months after treatment. Age (OR 1.12 (1.04–1.21), p < 0.01), baseline WMH volume (OR 1.20, 95% CI 1.06–1.52, p = 0.02) and baseline Fazekas score ≥ 3/6 (OR 6.4, 95% CI 1.7–24.7, p < 0.01) were predictive of MoCA score decline. In multivariable analysis, age was the only significant predictor of MoCA decline. However, all three patients with pre-treatment leukoencephalopathy (Fazekas score = 6/6) had notable adverse outcomes due to cognitive impairment: one required full-time home nursing support and two were institutionalized. Conclusion A greater decline in cognition after WBRT was observed in older patients and patients with a higher baseline WMH burden. Although this study is small and hypothesis-generating, we propose that radiation oncologists should exercise caution in prescribing WBRT if leukoencephalopathy is present on pre-treatment imaging. Trial Registration: clinicaltrials.gov identifier NCT01046123. First posted January 11, 2010. https://clinicaltrials.gov/ct2/show/NCT01046123
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Affiliation(s)
- Matthew Chan
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Vancouver, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - David Ferguson
- Department of Radiology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Elaine Ni Mhurchu
- Department of Radiology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Ren Yuan
- Department of Radiology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Lovedeep Gondara
- Department of Population Oncology, BC Cancer - Vancouver Centre, Vancouver, BC, Canada
| | - Michael McKenzie
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Vancouver, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Robert Olson
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Prince George, Prince George, BC, Canada
| | - Brian Thiessen
- Department of Medical Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Nafisha Lalani
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Vancouver, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Roy Ma
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Vancouver, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Alan Nichol
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Department of Radiation Oncology, BC Cancer - Vancouver, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada.
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12
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Fruhwirth V, Enzinger C, Fandler-Höfler S, Kneihsl M, Eppinger S, Ropele S, Schmidt R, Gattringer T, Pinter D. Baseline white matter hyperintensities affect the course of cognitive function after small vessel disease-related stroke: a prospective observational study. Eur J Neurol 2020; 28:401-410. [PMID: 33065757 PMCID: PMC7839458 DOI: 10.1111/ene.14593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023]
Abstract
Background and purpose Cognitive impairment is a common sequel of recent small subcortical infarction (RSSI) and might be negatively affected by preexisting cerebral small vessel disease (SVD). We investigated whether the course of cognitive function in patients with RSSI is influenced by the severity of white matter hyperintensities (WMH), an important imaging feature of SVD. Methods Patients with magnetic resonance imaging (MRI)‐proven single RSSI were tested neuropsychologically concerning global cognition, processing speed, attention, and set‐shifting. Deep and periventricular WMH severity was assessed using the Fazekas scale, and total WMH lesion volume was calculated from T1‐weighted MRI images. We compared baseline function and course of cognition 15 months after the acute event in patients with absent, mild, and moderate‐to‐severe WMH. Results The study cohort comprised 82 RSSI patients (mean age: 61 ± 10 years, 23% female). At baseline, 40% had cognitive impairment (1.5 standard deviations below standardized mean), and deficits persisted in one‐third of the sample after 15 months. After age correction, there were no significant differences in set‐shifting between WMH groups at baseline. However, although patients without WMH (deep: p < 0.001, periventricular: p = 0.067) or only mild WMH (deep: p = 0.098, periventricular: p = 0.001) improved in set‐shifting after 15 months, there was no improvement in patients with moderate‐to‐severe WMH (deep: p = 0.980, periventricular: p = 0.816). Baseline total WMH volume (p = 0.002) was the only significant predictor for attention 15 months poststroke. Conclusions This longitudinal study demonstrates that preexisting moderate‐to‐severe WMH negatively affect the restoration of cognitive function after RSSI, suggesting limited functional reserve in patients with preexisting SVD.
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Affiliation(s)
- V Fruhwirth
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - S Fandler-Höfler
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - M Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Eppinger
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - R Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - D Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
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13
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García-Alberca JM, Mendoza S, Gris E, Royo JL, Cruz-Gamero JM, García-Casares N. White matter lesions and temporal atrophy are associated with cognitive and neuropsychiatric symptoms in patients with hypertension and Alzheimer's disease. Int J Geriatr Psychiatry 2020; 35:1292-1300. [PMID: 32584440 DOI: 10.1002/gps.5366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 06/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES An increasing evidence suggests hypertension (HTN) could be linked to cognitive impairment and incident Alzheimer's disease (AD). The precise mechanisms linking HTN and AD are not well-known. The aim of this study was to assess the putative association between HTN and AD. METHODS We assessed in patients with AD associations between HTN and demographic and clinical data, vascular risk factors, treatments, APOE genotypes, brain white matter hyperintensities (WMH), and medial temporal atrophy (MTA) in multivariate analysis of covariance. RESULTS We studied 92 patients with AD (mean ± SD age: 72.12 ± 6.91; women: 66.30%). Patients with HTN had significantly worse cognitive and functional status and higher frequency and severity of neuropsychiatric symptoms (P = .010). Magnetic resonance imaging analyzes showed significant increases in WMH (P = .018) and in MTA (P = .012) in patients with AD with HTN compared with those without HTN. CONCLUSIONS Neuroimaging burden (MTA and higher degree of severity of WMH) among patients with AD and HTN are associated with the impaired cognitive function and neuropsychiatric symptoms.
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Affiliation(s)
| | - Silvia Mendoza
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - Esther Gris
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - José Luis Royo
- Department of Surgery, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
| | - José Manuel Cruz-Gamero
- Department of Surgery, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
| | - Natalia García-Casares
- Department of Medicine, School of Medicine, University of Málaga, Research Medical Center of Málaga University, Biomedical Research Institute of Málaga, Málaga, Spain
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14
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de Leeuw FA, Karamujić-Čomić H, Tijms BM, Peeters CFW, Kester MI, Scheltens P, Ahmad S, Vojinovic D, Adams HHH, Hankemeier T, Bos D, van der Lugt A, Vernooij MW, Ikram MA, Amin N, Barkhof F, Teunissen CE, van Duijn CM, van der Flier WM. Circulating metabolites are associated with brain atrophy and white matter hyperintensities. Alzheimers Dement 2020; 17:205-214. [PMID: 32886448 PMCID: PMC7984157 DOI: 10.1002/alz.12180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 07/25/2020] [Accepted: 08/08/2020] [Indexed: 01/01/2023]
Abstract
Introduction Our aim was to study whether systemic metabolites are associated with magnetic resonance imaging (MRI) measures of brain and hippocampal atrophy and white matter hyperintensities (WMH). Methods We studied associations of 143 plasma‐based metabolites with MRI measures of brain and hippocampal atrophy and WMH in three independent cohorts (n = 3962). We meta‐analyzed the results of linear regression analyses to determine the association of metabolites with MRI measures. Results Higher glucose levels and lower levels of three small high density lipoprotein (HDL) particles were associated with brain atrophy. Higher glucose levels were associated with WMH. Discussion Glucose levels were associated with brain atrophy and WMH, and small HDL particle levels were associated with brain atrophy. Circulating metabolites may aid in developing future intervention trials.
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Affiliation(s)
- Francisca A de Leeuw
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Hata Karamujić-Čomić
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Betty M Tijms
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Carel F W Peeters
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maartje I Kester
- Department of Neurology, Flevoziekenhuis, Almere, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Shahzad Ahmad
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dina Vojinovic
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hieab H H Adams
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Thomas Hankemeier
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Division of Analytical Biosciences, Leiden Academic Centre for Drug Research, Faculty of Science, Leiden University, Leiden, The Netherlands.,Translational Epidemiology, Faculty Science, Leiden University, Leiden, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Najaf Amin
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Institutes of Neurology & Healthcare Engineering, UCL London, London, UK
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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15
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Verhaar BJ, de Leeuw FA, Doorduijn AS, Fieldhouse JL, van de Rest O, Teunissen CE, van Berckel BN, Barkhof F, Visser M, de van der Schueren MA, Scheltens P, Kester MI, Muller M, van der Flier WM. Nutritional status and structural brain changes in Alzheimer's disease: The NUDAD project. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12063. [PMID: 32793798 PMCID: PMC7418890 DOI: 10.1002/dad2.12063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Weight loss is associated with higher mortality and progression of cognitive decline, but its associations with magnetic resonance imaging (MRI) changes related to Alzheimer's disease (AD) are unknown. METHODS We included 412 patients from the NUDAD project, comprising 129 with AD dementia, 107 with mild cognitive impairment (MCI), and 176 controls. Associations between nutritional status and MRI measures were analyzed using linear regression, adjusted for age, sex, education, cognitive functioning, and cardiovascular risk factors. RESULTS Lower body mass index (BMI), fat mass (FM), and fat free mass index were associated with higher medial temporal atrophy (MTA) scores. Lower BMI, FM, and waist circumference were associated with more microbleeds. Stratification by diagnosis showed that the observed associations with microbleeds were only significant in MCI. DISCUSSION Lower indicators of nutritional status were associated with more MTA and microbleeds, with largest effect sizes in MCI.
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Affiliation(s)
- Barbara J.H. Verhaar
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Internal Medicine, Amsterdam Cardiovascular SciencesVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Francisca A. de Leeuw
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Clinical Chemistry, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Astrid S. Doorduijn
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Nutrition and Dietetics, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Jay L.P. Fieldhouse
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Ondine van de Rest
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenthe Netherlands
| | - Charlotte E. Teunissen
- Department of Clinical Chemistry, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Bart N.M. van Berckel
- Department of Radiology and Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Frederik Barkhof
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Radiology and Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- UCL Institutes of Neurology and Healthcare EngineeringLondonUnited Kingdom
| | - Marjolein Visser
- Department of Health Sciences, Faculty of ScienceVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Marian A.E. de van der Schueren
- Department of Nutrition and Dietetics, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Nutrition and HealthHAN University of Applied SciencesNijmegenthe Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Maartje I. Kester
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Majon Muller
- Department of Internal Medicine, Amsterdam Cardiovascular SciencesVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
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16
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Occurrence of Impaired Physical Performance in Memory Clinic Patients With Cerebral Small Vessel Disease. Alzheimer Dis Assoc Disord 2019; 32:214-219. [PMID: 29240562 DOI: 10.1097/wad.0000000000000233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cerebral small vessel disease (CSVD) occurs often in memory clinic patients. Apart from cognitive deficits, these patients can express physical decline, which predicts adverse health outcomes. In this study, we investigated the cooccurrence of clinically relevant impairments in physical performance and CSVD in memory clinic patients. We included 131 patients with vascular brain injury, mild cognitive impairment or Alzheimer disease with available 3T MRI and physical performance scores. CSVD was visually rated according to 3 subtypes and as a total burden score, composed of the presence of white matter hyperintensities (WMH), lacunar infarcts (LI), and cerebral microbleeds (MB). Physical performance was assessed with the Short Physical Performance Battery (SPPB), covering gait speed, balance, and chair stand performance. CSVD markers and impaired physical performance both occurred often. High total CSVD burdens cooccurred with impaired chair stand performances [odds ratio (OR) 2.67; 95% confidence interval (CI) (1.12-6.34)]. WMH cooccurred with impaired SPPB scores (OR, 3.76; 95% CI, 1.68-8.44), impaired gait speeds (OR, 4.11; 95% CI, 1.81-9.31) and impaired chair stand performances (OR, 5.62; 95% CI, 2.29-13.80). In memory clinic patients, high burdens of CSVD, particularly WMH, often cooccur with impairments in physical performance. The presence of WMH should alert clinicians to the presence of these, clinically relevant, physical impairments.
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17
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Pinter D, Gattringer T, Enzinger C, Seifert-Held T, Kneihsl M, Fandler S, Pichler A, Barro C, Eppinger S, Pirpamer L, Bachmaier G, Ropele S, Wardlaw JM, Kuhle J, Khalil M, Fazekas F. Longitudinal MRI dynamics of recent small subcortical infarcts and possible predictors. J Cereb Blood Flow Metab 2019; 39:1669-1677. [PMID: 29737904 PMCID: PMC6727145 DOI: 10.1177/0271678x18775215] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to explore the morphological evolution of recent small subcortical infarcts (RSSIs) over 15 months. Moreover, we hypothesized that quantitative lesion apparent diffusion coefficient (ADC) values and serum neurofilament light (NfL) levels predict subsequent lacunar cavitation. We prospectively studied 78 RSSI patients, who underwent pre-defined follow-up investigations three and 15 months poststroke using 3 T MRI including high-resolution T1 sequences. To identify potential predictors of cavitation, we determined RSSI size and quantitative ADC values, and serum NfL using the SIMOA technique. The majority of RSSIs showed cavitation at three months (n = 61, 78%) with only minimal changes regarding cavitation status thereafter. The maximum axial lacunar diameter decreased from 8 mm at three to 7 mm at 15 months (p < 0.05). RSSIs which cavitated had lower lesional ADC values and were associated with higher baseline NfL levels compared to those without cavitation, but did not differ regarding lesion size. In logistic regression analysis, only baseline NfL levels predicted cavitation (p = 0.017). In this prospective study using predefined high-resolution MRI protocols, the majority of RSSIs evolved into lacunes during the first three months poststroke with not much change thereafter. Serum NfL seems to be a promising biomarker for more advanced subsequent tissue destruction in RSSIs.
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Affiliation(s)
- Daniela Pinter
- 1 Department of Neurology, Medical University of Graz, Austria
| | | | - Christian Enzinger
- 1 Department of Neurology, Medical University of Graz, Austria.,2 Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Austria
| | | | - Markus Kneihsl
- 1 Department of Neurology, Medical University of Graz, Austria
| | - Simon Fandler
- 1 Department of Neurology, Medical University of Graz, Austria
| | | | - Christian Barro
- 3 Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Lukas Pirpamer
- 1 Department of Neurology, Medical University of Graz, Austria
| | - Gerhard Bachmaier
- 4 Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Stefan Ropele
- 1 Department of Neurology, Medical University of Graz, Austria
| | - Joanna M Wardlaw
- 5 Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,6 UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Jens Kuhle
- 3 Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Khalil
- 1 Department of Neurology, Medical University of Graz, Austria
| | - Franz Fazekas
- 1 Department of Neurology, Medical University of Graz, Austria
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18
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Morgello S, Gensler G, Sherman S, Ellis RJ, Gelman BB, Kolson DL, Letendre SL, Robinson-Papp J, Rubin LH, Singer E, Valdes-Sueiras M. Frailty in medically complex individuals with chronic HIV. AIDS 2019; 33:1603-1611. [PMID: 31305330 PMCID: PMC6760300 DOI: 10.1097/qad.0000000000002250] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort. DESIGN Analysis of a prospective, observational, longitudinal cohort. METHODS Three hundred and thirty-two participants in the medically advanced National NeuroAIDS Tissue Consortium (NNTC) study were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty. RESULTS The mean number of medical comorbidities per participant was 2.7, mean CD4 T-cell count was 530 cells/μl, and 77% had undetectable HIV RNA in blood. Twenty-two percent were frail, 55% prefrail, and 23% robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD. CONCLUSION Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIV-associated morbidity in aging populations.
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Affiliation(s)
- Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York
- Departments of Neuroscience and Pathology, ISMMS, New York, New York
| | | | | | - Ronald J Ellis
- Departments of Neurosciences and Psychiatry, University of California, San Diego, California
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Dennis L Kolson
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott L Letendre
- Departments of Psychiatry and Medicine, University of California, San Diego, California
| | - Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York
| | - Leah H Rubin
- Departments of Neurology and Epidemiology, Johns Hopkins Schools of Medicine and Public Health, Baltimore, Maryland
| | - Elyse Singer
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Miguel Valdes-Sueiras
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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19
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Zhang S, Luo Y, Dong Z, Chen X, Cheng X, Dong Q, Wu D. Impact of periventricular hyperintensities and cystatin C on different cognitive domains in the population of non-demented elderly Chinese. J Clin Neurosci 2019; 68:201-210. [PMID: 31307855 DOI: 10.1016/j.jocn.2019.05.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the impact of periventricular hyperintensities and serum cystatin C on mild cognitive impairment to provide a basis for the investigation of the pathogenesis. METHOD 286 patients enrolled the study and underwent an examination in Shanghai Fifth People's Hospital from June 2017 to June 2018. The participants' cognitive function was evaluated by different cognitive domains using of mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), auditory verbal learning test, Huashan version (AVLT-H), digit span test (DST), symbol digit modalities test (SDMT), trail making test (TMT) and verbal fluency test (VFT). We measured the levels of serum cystatin C at the department of clinical laboratory in Shanghai Fifth People's Hospital and each subject took an MRI examination in the Department of Radiology of Shanghai Fifth People's Hospital. Multivariate linear regression analyses were used to assess the relationship of cognitive score and the level of cystatin C and periventricular hyperintensities severity. All statistical analyses were performed using the SPSS system. RESULTS Among 286 eligible participants, 203 (71.0%) were enrolled to further analysis, including 69 male and 134 female (Mean age 67.93 ± 6.19 years). Significant predictors of severe periventricular hyperintensities (PVH) were older age and hypertension. Significant predictors of severe deep white matter hyperintensities (DWMH) were older age only. PVH severity was independently associated with mild cognitive impairment and that the primary impairment was executive function and processing speed. DWMH had no significant effect on cognitive function. Cystatin C only affected the overall cognitive level, and the relationship with WMH severity was not significant. CONCLUSIONS We demonstrated that in the chinese non-demented elderly, the severity of PVH was independent and significant associated with mild cognitive impairment and that the primary impairment was executive capacity and processing speed, while cystatin C may be an independent risk factor for overall cognitive impairment.
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Affiliation(s)
- Shufan Zhang
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Yufan Luo
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Zhiyuan Dong
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China.
| | - Xin Chen
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Xin Cheng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China.
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20
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Kaskikallio A, Karrasch M, Rinne JO, Tuokkola T, Parkkola R, Grönholm-Nyman P. Domain-specific cognitive effects of white matter pathology in old age, mild cognitive impairment and Alzheimer's disease. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:453-470. [PMID: 31198088 DOI: 10.1080/13825585.2019.1628916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Concomitant white matter (WM) brain pathology is often present in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Cognitive effects of WM pathology on cognition in normal and pathological aging have been studied, but very little is known about possible group-specific effects in old age, MCI and AD. The purpose of the current study was to examine the relationship between WM pathology and cognitive functioning in four cognitive domains in old age, MCI and AD. The study utilized multi-domain neuropsychological data and visually rated MRI imaging data from a sample of 56 healthy older adults, 40 patients with MCI and 52 patients with AD (n = 148). After controlling for age and education, main effects of frontal WM pathology (especially in the left hemisphere) were found for cognitive performances in two domains, whereas a main effect of parieto-occipital WM pathology was only found for processing speed. In addition, with regard to processing speed, an interaction between group and WM changes was found: Patients with AD that had moderate or severe left frontal WM pathology were considerably slower than patients with AD that had milder cerebrovascular pathology. Frontal WM pathology, especially in the left hemisphere, seems to affect cognitive functions in many domains in all three groups. The results of the study increase our knowledge of cognitive repercussions stemming from frontal and/or parieto-occipital WM pathology in AD. Clinicians should be aware that patients with AD with prominent frontal cerebrovascular pathology can have considerably slowed cognitive processing.
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Affiliation(s)
- Alar Kaskikallio
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Juha O Rinne
- Turku PET-Centre, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | | | - Riitta Parkkola
- Department of Radiology, University and University Hospital of Turku, Turku, Finland
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Grajauskas LA, Siu W, Medvedev G, Guo H, D’Arcy RC, Song X. MRI-based evaluation of structural degeneration in the ageing brain: Pathophysiology and assessment. Ageing Res Rev 2019; 49:67-82. [PMID: 30472216 DOI: 10.1016/j.arr.2018.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 11/08/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
Advances in MRI technology have significantly contributed to our ability to understand the process of brain ageing, allowing us to track and assess changes that occur during normal ageing and neurological conditions. This paper focuses on reviewing structural changes of the ageing brain that are commonly seen using MRI, summarizing the pathophysiology, prevalence, and neuroanatomical distribution of changes including atrophy, lacunes, white matter lesions, and dilated perivascular spaces. We also review the clinically accessible methodology for assessing these MRI-based changes, covering visual rating scales, as well computer-aided and fully automated methods. Subsequently, we consider novel assessment methods designed to evaluate changes across the whole brain, and finally discuss new directions in this field of research.
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22
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García-Alberca JM, Florido M, Cáceres M, Sánchez-Toro A, Lara JP, García-Casares N. Medial temporal lobe atrophy is independently associated with behavioural and psychological symptoms in Alzheimer's disease. Psychogeriatrics 2019; 19:46-54. [PMID: 30084177 DOI: 10.1111/psyg.12363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/31/2018] [Accepted: 06/29/2018] [Indexed: 01/10/2023]
Abstract
AIM Evidence describing the contribution of cerebral white matter disease and medial temporal atrophy (MTA) to behavioural and psychological symptoms of dementia (BPSD) has been conflicting. The aim of this study was to assess the relationship of white matter hyperintensities (WMH) and MTA observed on magnetic resonance imaging with BPSD among patients with Alzheimer's disease. METHODS In a cross-sectional study of a prospective cohort of patients attending a memory clinic, 46 patients with probable Alzheimer's disease (mean age: 72.38 ± 7.05 years) were studied. Sociodemographic, cognitive, and BPSD data were collected. BPSD were assessed using the Neuropsychiatric Inventory. Magnetic resonance imaging, WMH, and MTA were rated using the Scheltens scales for the assessment of signal hyperintensities and atrophy of medial temporal lobes. For multivariate analysis, two binary logistic regression analyses were carried out, with presence or absence of each BPSD as the dependent variable and with WMH or MTA as the predictor variable. Results of the logistic regression were analyzed to see if the significance of the WMH or MTA score was maintained in a model that factored in other possible confounding variables identified in univariate analysis. RESULTS The results of binary logistic regression analysis showed that in models that accounted for confounding variables, increased total MTA was significantly associated with apathy (odds ratio = 1.605, adjusted P = 0.042) and disinhibition (odds ratio = 0.607, adjusted P = 0.042). WMH measures did not significantly predict any BPSD item. CONCLUSIONS These findings indicate that MTA potentially contributes to the aetiology of BPSD, and they provide evidence to support the hypothesis that Alzheimer's disease pathology itself can contribute to BPSD.
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Affiliation(s)
| | - Mercedes Florido
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - Marta Cáceres
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - Alicia Sánchez-Toro
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - José Pablo Lara
- Unit of Cognitive Neurophysiology, Research Medical Center of Málaga University, Biomedical Research Institute of Málaga, Málaga, Spain
| | - Natalia García-Casares
- Department of Medicine, Faculty of Medicine, University of Málaga, Research Medical Center of Málaga University, Biomedical Research Institute of Málaga, Málaga, Spain
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23
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Jang M, Hong CH, Kim HC, Choi SH, Seo SW, Kim SY, Na DL, Lee Y, Chang KJ, Roh HW, Son SJ. Subcortical Ischemic Change as a Predictor of Driving Cessation in the Elderly. Psychiatry Investig 2018; 15:1162-1167. [PMID: 30466207 PMCID: PMC6318496 DOI: 10.30773/pi.2018.10.10.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Motor, perceptual, and cognitive functions are known to affect driving competence. Subcortical ischemic changes on brain magnetic resonance imaging (MRI) can reflect reduction in cognitive and motor performance. However, few studies have reported the relationship between subcortical ischemic changes and driving competence of the elderly. Thus, the objective of this study was to investigate the association between subcortical ischemic changes on MRI and driving abilities of the elderly. METHODS Participants (n=540) were drawn from a nationwide, multicenter, hospital-based, longitudinal cohort. Each participant underwent MRI scan and interview for driving capacity categorized into 'now driving' and 'driving cessation (driven before, not driving now)'. Participants were divided into three groups (mild, n=389; moderate, n=116; and severe, n=35) depending on the degree of white matter hyperintensity (WMH) on MRI at baseline. Driving status was evaluated at follow-up. Statistical analyses were conducted using χ2 test, analysis of variance (ANOVA), structured equation model (SEM), and generalized estimating equation (GEE). RESULTS In SEM, greater baseline degree of WMH was directly associated with driving cessation regardless of cognitive or motor dysfunction (β=-0.110, p<0.001). In GEE models after controlling for age, sex, education, cognitive, and motor dysfunction, more severe change in the degree of WMH was associated with faster change from 'now driving' state to 'driving cessation' state over time in the elderly (β=-0.508, p<0.001). CONCLUSION In both cross-sectional and longitudinal results, the degree of subcortical ischemic change on MRI might predict driving cessation in the elderly.
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Affiliation(s)
- Mi Jang
- Department of General Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun-Chung Kim
- Department of Psychiatry, National Medical Center of Korea, Seoul, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ki Jung Chang
- Department of Psychiatry, Ajou Good Hospital, Suwon, Republic of Korea
| | - Hyun Woong Roh
- Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
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Mascalchi M, Salvadori E, Toschi N, Giannelli M, Orsolini S, Ciulli S, Ginestroni A, Poggesi A, Giorgio A, Lorenzini F, Pasi M, De Stefano N, Pantoni L, Inzitari D, Diciotti S. DTI-derived indexes of brain WM correlate with cognitive performance in vascular MCI and small-vessel disease. A TBSS study. Brain Imaging Behav 2018; 13:594-602. [DOI: 10.1007/s11682-018-9873-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zerna C, Yu AYX, Modi J, Patel SK, Coulter JI, Smith EE, Coutts SB. Association of White Matter Hyperintensities With Short-Term Outcomes in Patients With Minor Cerebrovascular Events. Stroke 2018. [PMID: 29540612 DOI: 10.1161/strokeaha.117.017429] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE White matter lesions (WML) are associated with cognitive decline, increased stroke risk, and disability in old age. We hypothesized that superimposed acute cerebrovascular occlusion on chronic preexisting injury (leukoaraiosis) leads to worse outcome after minor cerebrovascular event, both using quantitative (volumetric) and qualitative (Fazekas scale) assessment, as well as relative total brain volume. METHODS WML volume assessment was performed in 425 patients with high-risk transient ischemic attack (TIA; motor/speech deficits >5 minutes) or minor strokes from the CATCH study (CT and MRI in the Triage of TIA and Minor Cerebrovascular Events to Identify High Risk Patients). Complete baseline characteristics and outcome assessment were available in 412 patients. Primary outcome was disability at 90 days, defined as modified Rankin Scale score of >1. Secondary outcomes were stroke progression, TIA recurrence, and stroke recurrence. Analysis was performed using descriptive statistics and regression models including interaction terms. RESULTS Median age was 69 years, 39.8% were female. Sixty-two patients (15%) had unfavorable outcome with disability at 90 days (modified Rankin Scale score >1). Higher Fazekas scores were strongly correlated with higher WML volume (r=0.79). Both higher Fazekas score and higher WMH volume were associated with disability at 90 days in univariate regression (odds ratio 1.22; 95% confidence interval, 1.04-1.43 and odds ratio, 1.25 per milliliter increase; 95% confidence interval, 1.02-1.54, respectively) but not with stroke progression, TIA recurrence, or stroke recurrence. In multivariable-adjusted analyses, additive interaction terms were associated with unfavorable outcome (adjusted odds ratio 3.99, 95% confidence interval, 1.87-8.49). CONCLUSIONS Our data suggest that quantitative and qualitative WML assessments are highly correlated and comparable in TIA/minor stroke patients. WML burden is associated with short-term outcome of patients with good prestroke function in the presence of intracranial stenosis/occlusion.
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Affiliation(s)
- Charlotte Zerna
- From the Department of Clinical Neurosciences (C.Z., A.Y.X.Y., S.K.P, J.I.C., E.E.S., S.B.C.) and the Hotchkiss Brain Institute (E.E.S., S.B.C.), University of Calgary, Alberta, Canada; and Medanta - The Medicity Hospital, Gurgaon, India (J.M.).
| | - Amy Y X Yu
- From the Department of Clinical Neurosciences (C.Z., A.Y.X.Y., S.K.P, J.I.C., E.E.S., S.B.C.) and the Hotchkiss Brain Institute (E.E.S., S.B.C.), University of Calgary, Alberta, Canada; and Medanta - The Medicity Hospital, Gurgaon, India (J.M.)
| | - Jayesh Modi
- From the Department of Clinical Neurosciences (C.Z., A.Y.X.Y., S.K.P, J.I.C., E.E.S., S.B.C.) and the Hotchkiss Brain Institute (E.E.S., S.B.C.), University of Calgary, Alberta, Canada; and Medanta - The Medicity Hospital, Gurgaon, India (J.M.)
| | - Shiel K Patel
- From the Department of Clinical Neurosciences (C.Z., A.Y.X.Y., S.K.P, J.I.C., E.E.S., S.B.C.) and the Hotchkiss Brain Institute (E.E.S., S.B.C.), University of Calgary, Alberta, Canada; and Medanta - The Medicity Hospital, Gurgaon, India (J.M.)
| | - Jonathan I Coulter
- From the Department of Clinical Neurosciences (C.Z., A.Y.X.Y., S.K.P, J.I.C., E.E.S., S.B.C.) and the Hotchkiss Brain Institute (E.E.S., S.B.C.), University of Calgary, Alberta, Canada; and Medanta - The Medicity Hospital, Gurgaon, India (J.M.)
| | - Eric E Smith
- From the Department of Clinical Neurosciences (C.Z., A.Y.X.Y., S.K.P, J.I.C., E.E.S., S.B.C.) and the Hotchkiss Brain Institute (E.E.S., S.B.C.), University of Calgary, Alberta, Canada; and Medanta - The Medicity Hospital, Gurgaon, India (J.M.)
| | - Shelagh B Coutts
- From the Department of Clinical Neurosciences (C.Z., A.Y.X.Y., S.K.P, J.I.C., E.E.S., S.B.C.) and the Hotchkiss Brain Institute (E.E.S., S.B.C.), University of Calgary, Alberta, Canada; and Medanta - The Medicity Hospital, Gurgaon, India (J.M.)
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26
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Moon SY, de Souto Barreto P, Rolland Y, Chupin M, Bouyahia A, Fillon L, Mangin JF, Andrieu S, Cesari M, Vellas B. Prospective associations between white matter hyperintensities and lower extremity function. Neurology 2018. [DOI: 10.1212/wnl.0000000000005289] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
ObjectiveTo evaluate the relationship of white matter hyperintensities (WMH) with decline in lower extremity function (LEF) over approximately 3 years in dementia-free older adults with memory complaints.MethodsWe obtained brain MRI data from 458 community-dwelling adults, aged 70 years or over, at baseline, and from 358 adults over an average follow-up of 963 days. We evaluated LEF using the Short Physical Performance Battery (SPPB). We related baseline WMH volumes and progression to SPPB scores over time, using mixed-effect linear regressions. For the secondary analyses, we categorized baseline WMH volume into quartiles, and dichotomized the WMH progression to compare fast and slow progression.ResultsBaseline WMH volume (β = −0.017, 95% confidence interval [CI] −0.025 to −0.009), as well as WMH progression (β = −0.002, 95% CI −0.003 to −0.001), significantly associated with a decline in SPPB performance in adjusted analyses. Compared with the lowest quartile of baseline WMH volume, the highest quartile associated with a decline in SPPB performance (β = −0.301, 95% CI −0.558 to −0.044). Fast progression also associated with a decline in SPPB performance. We found clinically meaningful differences in the SPPB, with higher scores in participants with slow progression of WMH, at both 24 and 36 months.ConclusionsBaseline level and WMH progression associated with longitudinal decline in SPPB performance among older adults. We detected clinically meaningful differences in SPPB performance on comparing fast with slow progression of WMH, suggesting that speed of WMH progression is an important determinant of LEF during aging.
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27
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Affiliation(s)
- Mooyeon Oh-Park
- Geriatric Rehabilitation, Kessler Institute for Rehabilitation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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28
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Pinter D, Ritchie SJ, Doubal F, Gattringer T, Morris Z, Bastin ME, del C. Valdés Hernández M, Royle NA, Corley J, Muñoz Maniega S, Pattie A, Dickie DA, Staals J, Gow AJ, Starr JM, Deary IJ, Enzinger C, Fazekas F, Wardlaw J. Impact of small vessel disease in the brain on gait and balance. Sci Rep 2017; 7:41637. [PMID: 28134332 PMCID: PMC5278543 DOI: 10.1038/srep41637] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/22/2016] [Indexed: 11/09/2022] Open
Abstract
Gait and balance impairment is highly prevalent in older people. We aimed to assess whether and how single markers of small vessel disease (SVD) or a combination thereof explain gait and balance function in the elderly. We analysed 678 community-dwelling healthy subjects from the Lothian Birth Cohort 1936 at the age of 71-74 years who had undergone comprehensive risk factor assessment, gait and balance assessment as well as brain MRI. We investigated the impact of individual SVD markers (white matter hyperintensity - WMH, microbleeds, lacunes, enlarged perivascular spaces, brain atrophy) as seen on structural brain MRI and of a global SVD score on the patients' performance. A regression model revealed that age, sex, and hypertension significantly explained gait speed. Among SVD markers white matter hyperintensity (WMH) score or volume were additional significant and independent predictors of gait speed in the regression model. A similar association was seen with the global SVD score. Our study confirms a negative impact of SVD-related morphologic brain changes on gait speed in addition to age, sex and hypertension independent from brain atrophy. The presence of WMH seems to be the major driving force for SVD on gait impairment in healthy elderly subjects.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, 8036, Austria
| | - Stuart J. Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Fergus Doubal
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, 8036, Austria
| | - Zoe Morris
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Mark E. Bastin
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Maria del C. Valdés Hernández
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Natalie A. Royle
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Janie Corley
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Susana Muñoz Maniega
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alison Pattie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - David A. Dickie
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Centre, Maastricht, 6211, Netherlands
| | - Alan J. Gow
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - John M. Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Alzheimer Scotland Dementia Research Centre, Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Ian J. Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, 8036, Austria
- Division of Neuroradiology, Vascular and Interventional Neuroradiology, Department of Radiology, Medical University of Graz, Graz, 8036, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, 8036, Austria
| | - Joanna Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
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Resende EDPF, Costa-Silva L, Carmona KC, Machado TH, Machado JCB, Guimarães HC, Barbosa MT, Teixeira AL, de Souza LC, Caramelli P. Ischemic cerebrovascular burden evaluated by magnetic resonance imaging in an elderly Brazilian community: The Pietà study. eNeurologicalSci 2016; 5:30-34. [PMID: 29430555 PMCID: PMC5803083 DOI: 10.1016/j.ensci.2016.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/08/2016] [Accepted: 11/28/2016] [Indexed: 01/18/2023] Open
Abstract
In developing countries, cardiovascular risk factors are poorly controlled, leading to high prevalence of cerebrovascular diseases. The aim of the study was to evaluate the burden of white matter lesions in magnetic resonance through the Fazekas scale in a population aged 75 + years living in the community, and to investigate possible associations between vascular lesions, cardiovascular risk factors and cognitive status. Subjects were selected from a community-based study on brain aging conducted in Caeté (Minas Gerais state), Brazil. Overall, 177 participants (112 cognitively healthy, 36 with cognitive impairment-no dementia and 29 with dementia), being 108 women, aged 79.3 ± 3.8 years, with 3.1 ± 2.9 years of educational level, underwent a 3 Tesla magnetic resonance scanner with fluid attenuated image recovery acquisition. Severity of white matter lesions was assessed through the Fazekas scale. Severe white matter lesions were present in 31.1% of the whole sample and in 25.0% of the cognitively healthy individuals. A significant association was found between severe white matter lesions and cognitive impairment (OR = 2.20, 95% CI 1.17–6.53; p = 0.021), as well as with hypertension (OR = 1.92, 95% CI 1.03–7.39; p = 0.043). In conclusion, a high prevalence of severe white matter lesions was observed in this elderly Brazilian population sample, and white matter lesions were associated with hypertension and cognitive status. Importantly, the prevalence of white matter lesions was also high in cognitively healthy subjects. The ischemic cerebrovascular burden assessed by MRI in an elderly Brazilian community is very high. MRI white matter lesions were associated with cognitive impairment and hypertension. Even in cognitively healthy individuals the prevalence of ischemic cerebrovascular lesions was high.
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Affiliation(s)
- Elisa de Paula França Resende
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Luciana Costa-Silva
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Karoline Carvalho Carmona
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Thais Helena Machado
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - João Carlos Barbosa Machado
- Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo Horizonte, MG 30130-110, Brazil
| | - Henrique Cerqueira Guimarães
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Maira Tonidandel Barbosa
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Antônio Lúcio Teixeira
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Leonardo Cruz de Souza
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
| | - Paulo Caramelli
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof Alfredo Balena, 190, room 246, Belo Horizonte, MG 30130-100, Brazil
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30
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Duan D, Li C, Shen L, Cui C, Shu T, Zheng J. Regional Gray Matter Atrophy Coexistent with Occipital Periventricular White Matter Hyper Intensities. Front Aging Neurosci 2016; 8:214. [PMID: 27656141 PMCID: PMC5013128 DOI: 10.3389/fnagi.2016.00214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/24/2016] [Indexed: 01/03/2023] Open
Abstract
White matter hyperintensities (WMHs) and brain atrophy often coexist in the elderly. Additionally, WMH is often observed as occipital periventricular hyperintensities (OPVHs) with low-grade periventricular (PV) white matter (WM) lesions and is usually confined within an anatomical structure. However, the effects of OPVHs on gray matter (GM) atrophy remain largely unknown. In this study, we investigated GM atrophy in OPVHs patients and explored the relationship between such atrophy and clinical risk factors. T1-weighted and T2-weighted Magnetic resonance imaging (MRI) were acquired, and voxel-based morphometry (VBM) analysis was applied. The clinical (demographic and cardiovascular) risk factors of the OPVHs patients and healthy controls were then compared. Lastly, scatter plots and correlation analysis were applied to explore the relationship between the MRI results and clinical risk factors in the OPVHs patients. OPVHs patients had significantly reduced GM in the right supramarginal gyrus, right angular gyrus, right middle temporal gyrus, right anterior cingulum and left insula compared to healthy controls. Additionally, OPVHs patients had GM atrophy in the left precentral gyrus and left insula cortex, and such atrophy is associated with a reduction in low-density lipoprotein cholesterol (LDL-C) and apolipoprotein-B (Apo-B).
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Affiliation(s)
- Dazhi Duan
- Department of Neurology, Xinqiao Hospital, Third Military Medical University Chongqing, China
| | - Congyang Li
- Department of Neurology, Chengdu Military General Hospital Chengdu, China
| | - Lin Shen
- Department of Neurology, Xinqiao Hospital, Third Military Medical University Chongqing, China
| | - Chun Cui
- Department of Radiology, Xinqiao Hospital, Third Military Medical University Chongqing, China
| | - Tongsheng Shu
- Department of Radiology, Xinqiao Hospital, Third Military Medical University Chongqing, China
| | - Jian Zheng
- Department of Neurology, Xinqiao Hospital, Third Military Medical University Chongqing, China
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Pini L, Pievani M, Bocchetta M, Altomare D, Bosco P, Cavedo E, Galluzzi S, Marizzoni M, Frisoni GB. Brain atrophy in Alzheimer's Disease and aging. Ageing Res Rev 2016; 30:25-48. [PMID: 26827786 DOI: 10.1016/j.arr.2016.01.002] [Citation(s) in RCA: 409] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/15/2016] [Accepted: 01/20/2016] [Indexed: 01/22/2023]
Abstract
Thanks to its safety and accessibility, magnetic resonance imaging (MRI) is extensively used in clinical routine and research field, largely contributing to our understanding of the pathophysiology of neurodegenerative disorders such as Alzheimer's disease (AD). This review aims to provide a comprehensive overview of the main findings in AD and normal aging over the past twenty years, focusing on the patterns of gray and white matter changes assessed in vivo using MRI. Major progresses in the field concern the segmentation of the hippocampus with novel manual and automatic segmentation approaches, which might soon enable to assess also hippocampal subfields. Advancements in quantification of hippocampal volumetry might pave the way to its broader use as outcome marker in AD clinical trials. Patterns of cortical atrophy have been shown to accurately track disease progression and seem promising in distinguishing among AD subtypes. Disease progression has also been associated with changes in white matter tracts. Recent studies have investigated two areas often overlooked in AD, such as the striatum and basal forebrain, reporting significant atrophy, although the impact of these changes on cognition is still unclear. Future integration of different MRI modalities may further advance the field by providing more powerful biomarkers of disease onset and progression.
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Affiliation(s)
- Lorenzo Pini
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Michela Pievani
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy
| | - Martina Bocchetta
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Daniele Altomare
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Paolo Bosco
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy
| | - Enrica Cavedo
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) Hôpital de la Pitié-Salpétrière & Institut du Cerveau et de la Moelle épinière (ICM), UMR S 1127, Hôpital de la Pitié-Salpétrière Paris & CATI Multicenter Neuroimaging Platform, France
| | - Samantha Galluzzi
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy
| | - Moira Marizzoni
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy
| | - Giovanni B Frisoni
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland.
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Duan D, Shen L, Li C, Cui C, Shu T, Zheng J. Memory impairment in occipital periventricular hyperintensity patients is associated with reduced functional responses in the insula and Heschl's gyrus. Int J Neurosci 2016; 127:493-500. [PMID: 27323873 DOI: 10.1080/00207454.2016.1198345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the cognitive impairments of occipital periventricular hyperintensity (OPVH) patients and their brain-wide functional alterations in large scale. METHODS The Mini-Mental State Examination (MMSE) was performed in 15 OPVH patients and 12 age-matched healthy controls to distinguish the cognitive impairment features of OPVH. Functional magnetic resonance imaging (fMRI) was applied with a delayed digital match memory task to identify the brain-wide functional alterations in OPVH patients. RESULTS The two groups were not statistically different in terms of demographic or cardiovascular risk factors. The OPVH group had significantly lower scores in global cognitive abilities, immediate memory and delayed memory as determined by the MMSE (p < 0.05). The fMRI results demonstrated that the insula, precentral gyrus and Heschl's gyrus of the OPVH group had decreased activation compared to the control group (p < 0.005, uncorrected). Multivariate analysis also showed that OPVH was negatively correlated with reduced activation in the insula, precentral gyrus and Heschl's gyrus (p < 0.005). CONCLUSION OPVH affects the immediate and delayed memory. These changes are accompanied with decreased functional responses in the insula and Heschl's gyrus.
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Affiliation(s)
- Dazhi Duan
- a Department of Neurology, Xinqiao Hospital , Third Military Medical University , Chongqing , China
| | - Lin Shen
- a Department of Neurology, Xinqiao Hospital , Third Military Medical University , Chongqing , China
| | - Congyang Li
- b Department of Neurology , Chengdu Military General Hospital , Chengdu , China
| | - Chun Cui
- c Department of Radiology, Xinqiao Hospital , Third Military Medical University , Chongqing , China
| | - Tongsheng Shu
- c Department of Radiology, Xinqiao Hospital , Third Military Medical University , Chongqing , China
| | - Jian Zheng
- a Department of Neurology, Xinqiao Hospital , Third Military Medical University , Chongqing , China
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Windham BG, Wilkening SR, Lirette ST, Kullo IJ, Turner ST, Griswold ME, Mosley TH. Associations Between Inflammation and Physical Function in African Americans and European Americans with Prevalent Cardiovascular Risk Factors. J Am Geriatr Soc 2016; 64:1448-55. [PMID: 27310030 DOI: 10.1111/jgs.14229] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine associations between inflammation and physical function and potential mediation by white matter hyperintensities (WMHs) in African Americans (AAs) and European Americans (EAs). DESIGN Cross-sectional analysis using linear and logistic models with generalized estimating equations to account for family clustering, reporting results as regression coefficients (β) and odds ratios (ORs) adjusted for education, alcohol, exercise, body mass index, hypertension, diabetes mellitus, heart disease, cognition, ankle-brachial index, race (site), and supported interactions. SETTING Genetic Epidemiology Network of Arteriopathy-Genetics of Microangiopathic Brain Injury Study cohort. PARTICIPANTS AA and EA sibships with two or more siblings with hypertension before age 60 (N = 1,960; 65% female, 51% AA, aged 26-91, 50% obese, 72% hypertensive). MEASUREMENTS Inflammation (C-reactive protein (CRP), interleukin-6 (IL6), soluble tumor necrosis factor receptors (sTNFRs) 1 and 2, WMH volume (cm(3) ) according to magnetic resonance imaging), walking speed (cm/s) over 25 feet, and mobility difficulty (any self-reported difficulty walking half a mile). RESULTS In separate models, inflammatory markers were associated with walking speed (sTNFR1: β = -2.74, P < .001; sTNFR2: β = -1.23, P = .03; CRP: β = -1.95, P = .001; IL6: β = -1.24, P = .03) and mobility difficulty (sTNFR1: OR = 1.36, P = .001; sTNFR2: OR = 1.25, P = .005; CRP: OR = 1.22, P = .005; IL6: OR = 1.18, P = .02); the association between WMH volume and sTNFR1 in AA (β = 0.07, P = .06) did not reach typical statistical thresholds. WMH volume was associated with walking speed in AA (β = -3.17, P = .02) but not with mobility difficulty (OR = 1.10, P = .54). Adjusting for WMH did not change associations. CONCLUSION In young, middle-aged, and older adults with prevalent cardiovascular risk factors, multiple inflammatory biomarkers were associated with slower walking speed independent of microvascular disease in the brain. There was little evidence of mediation by brain WMH volume. Inflammation may contribute to physical function impairments through pathways other than brain microvascular disease, particularly in AAs.
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Affiliation(s)
- B Gwen Windham
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Steven R Wilkening
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Seth T Lirette
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Michael E Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Thomas H Mosley
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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Smith CD, Johnson ES, Van Eldik LJ, Jicha GA, Schmitt FA, Nelson PT, Kryscio RJ, Murphy RR, Wellnitz CV. Peripheral (deep) but not periventricular MRI white matter hyperintensities are increased in clinical vascular dementia compared to Alzheimer's disease. Brain Behav 2016; 6:e00438. [PMID: 26925303 PMCID: PMC4754499 DOI: 10.1002/brb3.438] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Vascular dementia (VAD) is a complex diagnosis at times difficult to distinguish from Alzheimer's disease (AD). MRI scans often show white matter hyperintensities (WMH) in both conditions. WMH increase with age, and both VAD and AD are associated with aging, thus presenting an attribution conundrum. In this study, we sought to show whether the amount of WMH in deep white matter (dWMH), versus periventricular white matter (PVH), would aid in the distinction between VAD and AD, independent of age. METHODS Blinded semiquantitative ratings of WMH validated by objective quantitation of WMH volume from standardized MRI image acquisitions. PVH and dWMH were rated separately and independently by two different examiners using the Scheltens scale. Receiver operator characteristic (ROC) curves were generated using logistic regression to assess classification of VAD (13 patients) versus AD (129 patients). Clinical diagnoses were made in a specialty memory disorders clinic. RESULTS Using PVH rating alone, overall classification (area under the ROC curve, AUC) was 75%, due only to the difference in age between VAD and AD patients in our study and not PVH. In contrast, dWMH rating produced 86% classification accuracy with no independent contribution from age. A global Longstreth rating that combines dWMH and PVH gave an 88% AUC. CONCLUSIONS Increased dWMH indicate a higher likelihood of VAD versus AD. Assessment of dWMH on MRI scans using Scheltens and Longstreth scales may aid the clinician in distinguishing the two conditions.
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Affiliation(s)
- Charles D Smith
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Magnetic Resonance Imaging and Spectroscopy Center University of Kentucky Lexington Kentucky
| | - Eleanor S Johnson
- Magnetic Resonance Imaging and Spectroscopy Center University of Kentucky Lexington Kentucky
| | - Linda J Van Eldik
- Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Anatomy and Neurobiology University of Kentucky College of Medicine Lexington Kentucky
| | - Gregory A Jicha
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky
| | - Frederick A Schmitt
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky
| | - Peter T Nelson
- Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Pathology & Laboratory Medicine University of Kentucky College of Medicine Lexington Kentucky
| | - Richard J Kryscio
- Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Statistics University of Kentucky Lexington Kentucky
| | - Ronan R Murphy
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky
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Reijmer YD, Schultz AP, Leemans A, O'Sullivan MJ, Gurol ME, Sperling R, Greenberg SM, Viswanathan A, Hedden T. Decoupling of structural and functional brain connectivity in older adults with white matter hyperintensities. Neuroimage 2015; 117:222-9. [PMID: 26025290 DOI: 10.1016/j.neuroimage.2015.05.054] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/30/2015] [Accepted: 05/09/2015] [Indexed: 12/23/2022] Open
Abstract
Age-related impairments in the default network (DN) have been related to disruptions in connecting white matter tracts. We hypothesized that the local correlation between DN structural and functional connectivity is negatively affected in the presence of global white matter injury. In 125 clinically normal older adults, we tested whether the relationship between structural connectivity (via diffusion imaging tractography) and functional connectivity (via resting-state functional MRI) of the posterior cingulate cortex (PCC) and medial prefrontal frontal cortex (MPFC) of the DN was altered in the presence of white matter hyperintensities (WMH). A significant correlation was observed between microstructural properties of the cingulum bundle and MPFC-PCC functional connectivity in individuals with low WMH load, but not with high WMH load. No correlation was observed between PCC-MPFC functional connectivity and microstructure of the inferior longitudinal fasciculus, a tract not passing through the PCC or MPFC. Decoupling of connectivity, measured as the absolute difference between structural and functional connectivity, in the high WMH group was related to poorer executive functioning and memory performance. These results suggest that such decoupling may reflect reorganization of functional networks in response to global white matter pathology and may provide an early marker of clinically relevant network alterations.
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Affiliation(s)
- Y D Reijmer
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - A P Schultz
- Dept. of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - A Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M J O'Sullivan
- Dept. of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - M E Gurol
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Sperling
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Dept. of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Dept. of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S M Greenberg
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A Viswanathan
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - T Hedden
- Dept. of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
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36
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Cerebral small vessel disease, cognitive reserve and cognitive dysfunction. J Neurol 2015; 262:2411-9. [DOI: 10.1007/s00415-015-7776-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 11/25/2022]
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Muzar Z, Lozano R, Schneider A, Adams PE, Faradz SMH, Tassone F, Hagerman RJ. Methadone use in a male with the FMRI premutation and FXTAS. Am J Med Genet A 2015; 167:1354-9. [PMID: 25900641 DOI: 10.1002/ajmg.a.37030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/08/2015] [Indexed: 01/18/2023]
Abstract
The fragile X-associated tremor ataxia syndrome (FXTAS) is caused by the premutation in FMR1 gene. Recent reports of environmental toxins appear to worsen the progression of FXTAS. Here we present a case of male adult with FXTAS and a long history of methadone use. The patient shows a faster progression in both symptoms of disease and MRI changes compared to what is typically seen in FXTAS. There has been no research regarding the role of narcotics in onset, progression, and severity of FXTAS symptoms. However, research has shown that narcotics can have a negative impact on several neurodegenerative diseases, and we hypothesize that in this particular case, methadone may have contributed to a faster progression of FXTAS as well as exacerbating white matter disease through RNA toxicity seen in premutation carriers.
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Affiliation(s)
- Zukhrofi Muzar
- Center for Biomedical Research, Faculty of Medicine Diponegoro University Semarang, Central Java, Indonesia.,Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California
| | - Reymundo Lozano
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Patrick E Adams
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Sultana M H Faradz
- Center for Biomedical Research, Faculty of Medicine Diponegoro University Semarang, Central Java, Indonesia
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California at Davis, Davis, Califonia
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
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Yamawaki M, Wada-Isoe K, Yamamoto M, Nakashita S, Uemura Y, Takahashi Y, Nakayama T, Nakashima K. Association of cerebral white matter lesions with cognitive function and mood in Japanese elderly people: a population-based study. Brain Behav 2015; 5:e00315. [PMID: 25798332 PMCID: PMC4356848 DOI: 10.1002/brb3.315] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/21/2014] [Accepted: 12/22/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To determine the relationships between regional white matter lesions (WMLs), lifestyle factors, and cognitive, motor function and mood. METHODS A comprehensive evaluation, including brain MRI, blood tests, the Unified Parkinson's Disease Rating Scale, the Mini Mental State Examination, and the Geriatric Depression Scale, was performed for people aged 65 years or older living in Ama-cho on October 1, 2009. Participants were classified by severity of periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) using the Fazekas score. RESULTS Of 900 eligible participants, 688 (76.4%) were enrolled, including 303 men. Significant predictors of severe PVH were older age, lower low-density lipoprotein cholesterol (LDL-C) levels, elevated blood pressure (BP), cerebral infarction, and no current alcohol use. Significant predictors of severe DWMH were older age, lower 1,5-anhydroglucitol (1,5-AG) levels, elevated BP, cerebral infarction, and no current alcohol use. Higher cognitive function was associated with younger age, female sex, mild DWMH, more years of education, and higher high-density lipoprotein cholesterol levels. Depressive symptoms were associated with lower 1,5-AG levels, lower LDL-C levels, moderate to severe PVH, and no current alcohol use. CONCLUSIONS White matter lesions in elderly people were related to hypertension and impaired glucose tolerance. The severity of WMLs was associated with cognitive function and mood.
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Affiliation(s)
- Mika Yamawaki
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University Yonago, Japan
| | - Kenji Wada-Isoe
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University Yonago, Japan
| | - Mikie Yamamoto
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University Yonago, Japan
| | - Satoko Nakashita
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University Yonago, Japan
| | - Yusuke Uemura
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University Yonago, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health Kyoto, Japan
| | - Kenji Nakashima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University Yonago, Japan
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Prins ND, Scheltens P. White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol 2015; 11:157-65. [DOI: 10.1038/nrneurol.2015.10] [Citation(s) in RCA: 602] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Macfarlane MD, Looi JC, Walterfang M, Spulber G, Velakoulis D, Styner M, Crisby M, Örndahl E, Erkinjuntti T, Waldemar G, Hennerici MG, Bäzner H, Blahak C, Wallin A, Wahlund LO. Shape abnormalities of the caudate nucleus correlate with poorer gait and balance: results from a subset of the LADIS study. Am J Geriatr Psychiatry 2015; 23:59-71.e1. [PMID: 23916546 PMCID: PMC4234689 DOI: 10.1016/j.jagp.2013.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/18/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Functional deficits seen in several neurodegenerative disorders have been linked with dysfunction in frontostriatal circuits and with associated shape alterations in striatal structures. The severity of visible white matter hyperintensities (WMHs) on magnetic resonance imaging has been found to correlate with poorer performance on measures of gait and balance. This study aimed to determine whether striatal volume and shape changes were correlated with gait dysfunction. METHODS Magnetic resonance imaging scans and clinical gait/balance data (scores from the Short Physical Performance Battery [SPPB]) were sourced from 66 subjects in the previously published LADIS trial, performed in nondisabled individuals older than age 65 years with WMHs at study entry. Data were obtained at study entry and at 3-year follow-up. Caudate nuclei and putamina were manually traced using a previously published method and volumes calculated. The relationships between volume and physical performance on the SPPB were investigated with shape analysis using the spherical harmonic shape description toolkit. RESULTS There was no correlation between the severity of WMHs and striatal volumes. Caudate nuclei volume correlated with performance on the SPPB at baseline but not at follow-up, with subsequent shape analysis showing left caudate changes occurred in areas corresponding to inputs of the dorsolateral prefrontal, premotor, and motor cortex. There was no correlation between putamen volumes and performance on the SPPB. CONCLUSION Disruption in frontostriatal circuits may play a role in mediating poorer physical performance in individuals with WMHs. Striatal volume and shape changes may be suitable biomarkers for functional changes in this population.
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Affiliation(s)
- Matthew D. Macfarlane
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychological and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia
| | - Jeffrey C.L. Looi
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychological and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia, Karolinska Institute, Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Stockholm, Sweden
| | - Mark Walterfang
- Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Gabriela Spulber
- Karolinska Institute, Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Stockholm, Sweden
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Martin Styner
- Neuroimaging Research and Analysis Laboratories, Carolina Institute of Developmental Disabilities, Departments of Psychiatry and Computer Science, University of North Carolina, Chapel Hill, NC
| | - Milita Crisby
- Karolinska Institute, Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Stockholm, Sweden
| | - Eva Örndahl
- Department of Clinical Science, Intervention and Technology at Karolinska Institute, Division of Medical Imaging and Technology, Stockholm, Sweden and Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Timo Erkinjuntti
- Department of Neurological Sciences, University of Helsinki, Finland and Department of Neurology, Helsinki University Central Hospital, Finland
| | - Gunhild Waldemar
- Memory Disorders Research Group, Dept. of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Michael G. Hennerici
- Department of Neurology, Universitäts Medizin Mannheim UMM, University of Heidelberg, Mannheim, Germany
| | - Hansjörg Bäzner
- Department of Neurology, Universitäts Medizin Mannheim UMM, University of Heidelberg, Mannheim, Germany
| | - Christian Blahak
- Department of Neurology, Universitäts Medizin Mannheim UMM, University of Heidelberg, Mannheim, Germany
| | - Anders Wallin
- Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Olof Wahlund
- Karolinska Institute, Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Stockholm, Sweden
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Sudo FK, Alves GS, Ericeira-Valente L, Alves CEO, Tiel C, Moreira DM, Laks J, Engelhardt E. Executive testing predicts functional loss in subjects with white matter lesions. Neurocase 2015; 21:679-87. [PMID: 25350127 DOI: 10.1080/13554794.2014.973884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In order to assess ecological validity of executive function (EF) tests and the impact of EF dysfunction on functional status in elderly subjects with moderate and severe subcortical white matter hyperintensities (WMHs), we made a correlation analysis between EF scores and two measures of Instrumental Activities of Daily Living (IADL). Trail-making test and CLOX correlated with the ability to perform IADL in subjects with severe WMH. EF tests might present low ecological validity for those with WMH below severe stage.
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Affiliation(s)
- Felipe Kenji Sudo
- a Center for Subjects with Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Federal University of Rio de Janeiro (CDA/IPUB/UFRJ) , Rio de Janeiro , Brazil
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Burzynska AZ, Chaddock-Heyman L, Voss MW, Wong CN, Gothe NP, Olson EA, Knecht A, Lewis A, Monti JM, Cooke GE, Wojcicki TR, Fanning J, Chung HD, Awick E, McAuley E, Kramer AF. Physical activity and cardiorespiratory fitness are beneficial for white matter in low-fit older adults. PLoS One 2014; 9:e107413. [PMID: 25229455 PMCID: PMC4167864 DOI: 10.1371/journal.pone.0107413] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 08/12/2014] [Indexed: 01/12/2023] Open
Abstract
Physical activity (PA) and cardiorespiratory fitness (CRF) are associated with better cognitive function in late life, but the neural correlates for these relationships are unclear. To study these correlates, we examined the association of both PA and CRF with measures of white matter (WM) integrity in 88 healthy low-fit adults (age 60–78). Using accelerometry, we objectively measured sedentary behavior, light PA, and moderate to vigorous PA (MV-PA) over a week. We showed that greater MV-PA was related to lower volume of WM lesions. The association between PA and WM microstructural integrity (measured with diffusion tensor imaging) was region-specific: light PA was related to temporal WM, while sedentary behavior was associated with lower integrity in the parahippocampal WM. Our findings highlight that engaging in PA of various intensity in parallel with avoiding sedentariness are important in maintaining WM health in older age, supporting public health recommendations that emphasize the importance of active lifestyle.
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Affiliation(s)
- Agnieszka Zofia Burzynska
- The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois, United States of America
- * E-mail:
| | - Laura Chaddock-Heyman
- The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois, United States of America
| | - Michelle W. Voss
- Department of Psychology, University of Iowa, Iowa City, Iowa, United States of America
| | - Chelsea N. Wong
- The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois, United States of America
| | - Neha P. Gothe
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, United States of America
| | - Erin A. Olson
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, United States of America
| | - Anya Knecht
- The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois, United States of America
| | - Andrew Lewis
- The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois, United States of America
| | - Jim M. Monti
- The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois, United States of America
| | - Gillian E. Cooke
- The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois, United States of America
| | - Thomas R. Wojcicki
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, United States of America
| | - Jason Fanning
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, United States of America
| | - Hyondo David Chung
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, United States of America
| | - Elisabeth Awick
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, United States of America
| | - Edward McAuley
- The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois, United States of America
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, United States of America
| | - Arthur F. Kramer
- The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois, United States of America
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Bjerke M, Jonsson M, Nordlund A, Eckerström C, Blennow K, Zetterberg H, Pantoni L, Inzitari D, Schmidt R, Wallin A. Cerebrovascular Biomarker Profile Is Related to White Matter Disease and Ventricular Dilation in a LADIS Substudy. Dement Geriatr Cogn Dis Extra 2014; 4:385-94. [PMID: 25493088 PMCID: PMC4255994 DOI: 10.1159/000366119] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Small vessel disease (SVD) represents a common often progressive condition in elderly people contributing to cognitive disability. The relationship between cerebrospinal fluid (CSF) biomarkers and imaging correlates of SVD was investigated, and the findings were hypothesized to be associated with a neuropsychological profile of SVD. METHODS CSF SVD-related biomarkers [neurofilament light (NF-L), myelin basic protein (MBP), soluble amyloid precursor protein-β (sAPPβ), matrix metalloproteinases (MMPs), and tissue inhibitor of metalloproteinase (TIMP)] were analysed in 46 non-demented elderly with imaging findings of SVD. We assessed the relationship between the CSF biomarkers and white matter hyperintensity (WMH) volume, diffusion-weighted imaging and atrophy as well as their association with neuropsychological profiles. RESULTS The WMH volume correlated with ventricular dilation, which was associated with executive function and speed and attention. Increased WMH and ventricular dilation were related to increased CSF levels of TIMP-1, NF-L and MBP and to decreased sAPPβ. A positive correlation was found between the CSF biomarker MMP-9 and WMH progression. CONCLUSIONS The link between progressive WMH and MMP-9 suggests an involvement of the enzyme in white matter degeneration. CSF TIMP-1, NF-L, MBP and sAPPβ may function as biological markers of white matter damage.
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Affiliation(s)
- Maria Bjerke
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Michael Jonsson
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Arto Nordlund
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Carl Eckerström
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- UCL Institute of Neurology, London, UK
| | - Leonardo Pantoni
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Domenico Inzitari
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Reinhold Schmidt
- Department of Clinical Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Anders Wallin
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
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The relationship between specific cognitive domains, fear of falling, and falls in people with multiple sclerosis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:281760. [PMID: 25165694 PMCID: PMC4131562 DOI: 10.1155/2014/281760] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 11/18/2022]
Abstract
The primary aim was to examine the relationship between seven definite aspects of cognition measured by a computerized cognitive testing tool on the history falls in people with mild to moderate MS (PwMS). Secondary aims focused on whether cognition performance is correlated to fear of falling, walking velocity, and a patient-rated measure of walking ability. One hundred and one PwMS were included in the study analysis. Fifty-two had a history of at least one fall during the past year. Outcome measures included a computerized cognitive test battery designed to evaluate multiple cognitive domains, gait speed, and self-reported questionnaires; 12-item MS walking scale (MSWS-12); and Falls Efficacy Scale International. Significant differences between fallers and nonfallers were exhibited in attention and verbal function, scoring 7.5% (P = 0.013) and 6.2% (P = 0.05), respectively, below the parallel scores of the nonfallers. Attention was the only cognitive component significantly correlated with the MSWS-12 self-reported questionnaire. Fear of falling was significantly correlated with 6 (out of 7) definite cognitive variables. The present findings support the concept that when evaluating and attempting to reduce fall risk, emphasis should be placed not only on traditional fall risk factors like muscle strength and motor function, but also on cognitive function.
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45
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Overdorp EJ, Kessels RPC, Claassen JA, Oosterman JM. Cognitive impairments associated with medial temporal atrophy and white matter hyperintensities: an MRI study in memory clinic patients. Front Aging Neurosci 2014; 6:98. [PMID: 24904411 PMCID: PMC4034495 DOI: 10.3389/fnagi.2014.00098] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/06/2014] [Indexed: 11/13/2022] Open
Abstract
In this retrospective study, we investigated the independent effects of white matter hyperintensities (WMH) and hippocampal atrophy on cognitive functions in a broad sample of patients seen in a memory clinic. To ensure generalizability, these associations were examined irrespective of diagnosis and with minimal exclusion criteria. Next to these independent effects, interactions between WMH and hippocampal atrophy were examined. Between January 2006 and September 2011 a total of 500 patients visited the memory clinic, 397 of whom were included. Magnetic resonance images of 397 patients were visually analyzed for WMH, medial temporal atrophy (MTA), and global atrophy. We evaluated the association of WMH and MTA with the following cognitive domains: global cognition, episodic memory, working memory, executive function and psychomotor speed. Main effects and interaction effects were examined by means of correlation and regression analyses. In the regression analyses, we controlled for potential confounding effects of global atrophy. The correlational results revealed that WMH were associated with global cognition, executive function and psychomotor speed, whereas a trend was found for episodic memory. MTA was associated with all these four cognitive domains; an additional trend was observed for working memory. Hierarchical regression analyses revealed main independent effects of MTA for episodic memory, executive function, psychomotor speed and global cognition; WMH were only associated with global cognition. The interaction between MTA and WMH was significant for episodic memory only. This study demonstrates that predominantly MTA is an independent predictor not only for memory function, with which is it classically associated, but also for global cognition and executive function. Taken together, MTA may be an important correlate of cognitive deficits found in people attending the memory clinic.
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Affiliation(s)
- Eduard J Overdorp
- Department of Psychiatry, Gelre Medical Centre Zutphen, Netherlands ; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Nijmegen, Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Nijmegen, Netherlands ; Department of Medical Psychology, Radboud University Medical Center-Radboud Alzheimer Center Nijmegen, Netherlands
| | - Jurgen A Claassen
- Department of Medical Psychology, Radboud University Medical Center-Radboud Alzheimer Center Nijmegen, Netherlands ; Department of Geriatric Medicine, Radboud University Medical Center-Radboud Alzheimer Center Nijmegen, Netherlands
| | - Joukje M Oosterman
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Nijmegen, Netherlands
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46
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Amboni M, Barone P, Hausdorff JM. Cognitive contributions to gait and falls: evidence and implications. Mov Disord 2014; 28:1520-33. [PMID: 24132840 DOI: 10.1002/mds.25674] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/15/2013] [Accepted: 08/19/2013] [Indexed: 12/18/2022] Open
Abstract
Dementia and gait impairments often coexist in older adults and patients with neurodegenerative disease. Both conditions represent independent risk factors for falls. The relationship between cognitive function and gait has recently received increasing attention. Gait is no longer considered merely automated motor activity but rather an activity that requires executive function and attention as well as judgment of external and internal cues. In this review, we intend to: (1) summarize and synthesize the experimental, neuropsychological, and neuroimaging evidence that supports the role played by cognition in the control of gait; and (2) briefly discuss the implications deriving from the interplay between cognition and gait. In recent years, the dual task paradigm has been widely used as an experimental method to explore the interplay between gait and cognition. Several neuropsychological investigations have also demonstrated that walking relies on the use of several cognitive domains, including executive-attentional function, visuospatial abilities, and even memory resources. A number of morphological and functional neuroimaging studies have offered additional evidence supporting the relationship between gait and cognitive resources. Based on the findings from 3 lines of studies, it appears that a growing body of evidence indicates a pivotal role of cognition in gait control and fall prevention. The interplay between higher-order neural function and gait has a number of clinical implications, ranging from integrated assessment tools to possible innovative lines of interventions, including cognitive therapy for falls prevention on one hand and walking program for reducing dementia risk on the other.
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Affiliation(s)
- Marianna Amboni
- Isituto di Diagnosi e Cura Hermitage-Capodimonte, Naples, Italy; Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Holtzer R, Epstein N, Mahoney JR, Izzetoglu M, Blumen HM. Neuroimaging of mobility in aging: a targeted review. J Gerontol A Biol Sci Med Sci 2014; 69:1375-88. [PMID: 24739495 DOI: 10.1093/gerona/glu052] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The relationship between mobility and cognition in aging is well established, but the relationship between mobility and the structure and function of the aging brain is relatively unknown. This, in part, is attributed to the technological limitations of most neuroimaging procedures, which require the individual to be immobile or in a supine position. Herein, we provide a targeted review of neuroimaging studies of mobility in aging to promote (i) a better understanding of this relationship, (ii) future research in this area, and (iii) development of applications for improving mobility. METHODS A systematic search of peer-reviewed studies was performed using PubMed. Search terms included (i) aging, older adults, or elderly; (ii) gait, walking, balance, or mobility; and (iii) magnetic resonance imaging, voxel-based morphometry, fluid-attenuated inversion recovery, diffusion tensor imaging, positron emission tomography, functional magnetic resonance imaging, electroencephalography, event-related potential, and functional near-infrared spectroscopy. RESULTS Poor mobility outcomes were reliably associated with reduced gray and white matter volume. Fewer studies examined the relationship between changes in task-related brain activation and mobility performance. Extant findings, however, showed that activation patterns in the cerebellum, basal ganglia, parietal and frontal cortices were related to mobility. Increased involvement of the prefrontal cortex was evident in both imagined walking conditions and conditions where the cognitive demands of locomotion were increased. CONCLUSIONS Cortical control of gait in aging is bilateral, widespread, and dependent on the integrity of both gray and white matter.
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Affiliation(s)
- Roee Holtzer
- Department of Neurology, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Ferkauf Graduate School of Psychology of Yeshiva University, Bronx, New York.
| | - Noah Epstein
- Ferkauf Graduate School of Psychology of Yeshiva University, Bronx, New York
| | - Jeannette R Mahoney
- Department of Neurology, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York
| | - Meltem Izzetoglu
- Drexel University School of Biomedical Engineering, Philadelphia, Pennsylvania
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York
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White matter disease as a biomarker for long-term cerebrovascular disease and dementia. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:292. [PMID: 24496967 DOI: 10.1007/s11936-013-0292-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OPINION STATEMENT White matter disease is commonly detected on brain MRI of aging individuals as white matter hyperintensities (WMH), or 'leukoaraiosis." Over the years, it has become increasingly clear that the presence and extent of WMH is a radiographic marker of small cerebral vessel disease and an important predictor of the lifelong risk of stroke, cognitive impairment, and functional disability. A number of large population-based studies have outlined the significance of WMH as a biomarker for long-term cerebrovascular disease and dementia. In this review, we describe the conceptual framework and methodology that support this association and link the existing knowledge to future lines of investigation in the field.
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49
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Polussa J, Schneider A, Hagerman R. Molecular Advances Leading to Treatment Implications for Fragile X Premutation Carriers. ACTA ACUST UNITED AC 2014; 3. [PMID: 25436181 PMCID: PMC4245015 DOI: 10.4172/2168-975x.1000119] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fragile X syndrome (FXS) is the most common single gene cause of intellectual disability and it is characterized by a CGG expansion of more than 200 repeats in the FMR1 gene, leading to methylation of the promoter and gene silencing. The fragile X premutation, characterized by a 55 to 200 CGG repeat expansion, causes health problems and developmental difficulties in some, but not all, carriers. The premutation causes primary ovarian insufficiency in approximately 20% of females, psychiatric problems (including depression and/or anxiety) in approximately 50% of carriers and a neurodegenerative disorder, the fragile X-associated tremor ataxia syndrome (FXTAS), in approximately 40% of males and 16% of females later in life. Recent clinical studies in premutation carriers have expanded the health problems that may be seen. Advances in the molecular pathogenesis of the premutation have shown significant mitochondrial dysfunction and oxidative stress in neurons which may be amenable to treatment. Here we review the clinical problems of carriers and treatment recommendations.
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Affiliation(s)
- Jonathan Polussa
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health System, Sacramento, California, USA ; Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health System, Sacramento, California, USA ; Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health System, Sacramento, California, USA ; Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
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Executive dysfunction correlates with caudate nucleus atrophy in patients with white matter changes on MRI: a subset of LADIS. Psychiatry Res 2013; 214:16-23. [PMID: 23916538 DOI: 10.1016/j.pscychresns.2013.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 04/19/2013] [Accepted: 05/17/2013] [Indexed: 11/22/2022]
Abstract
White matter changes (WMC) are common magnetic resonance imaging (MRI) findings, particularly in the elderly. Recent studies such as the Leukoaraiosis and Disability Study (LADIS) have found that WMC relate to adverse outcomes including cognitive impairment, depression, disability, unsteadiness and falls in cross-sectional and follow-up studies. Frontostriatal (or frontosubcortical) brain circuits may serve many of these functions, with the caudate nuclei playing a role in convergence of cognitive functions. This study aimed to determine whether reduced caudate volume relates to cognitive functions (executive functions, memory functions and speed of processing) and WMC. We determined caudate nuclei volumes, through manual tracing, on a subgroup of the LADIS study (n=66) from four centres with baseline and 3-year follow-up MRI scans. Regression analysis was used to assess relationships between caudate volume, cognitive function and WMC. Severity of WMC did not relate to caudate volume. Smaller caudate volumes were significantly associated with poorer executive functioning at baseline and at 3 years, but were not associated with scores of memory or speed of processing. Thus, in patients with WMC, a surrogate of small vessel disease, caudate atrophy relates to the dysexecutive syndrome, supporting the role of caudate as an important part of the frontostriatal circuit.
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