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Borrelli S, Guisset F, Vanden Bulcke C, Stölting A, Bugli C, Lolli V, Du Pasquier R, van Pesch V, Absinta M, Pasi M, Maggi P. Enlarged perivascular spaces are associated with brain microangiopathy and aging in multiple sclerosis. Mult Scler 2024:13524585241256881. [PMID: 38850029 DOI: 10.1177/13524585241256881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Growing evidence links brain-MRI enlarged perivascular spaces (EPVS) and multiple sclerosis (MS), but their role remains unclear. OBJECTIVE This study aimed to investigate the cross-sectional associations of EPVS with several neuroinflammatory and neurodegenerative features in a large multicentric-MS cohort. METHODS In total, 207 patients underwent 3T axial-T2-weighted brain-MRI for EPVS assessment (EPVS dichotomized into high/low according to ⩾ 2/< 2 rating categories). MRI biomarkers included brain-predicted age and brain-predicted age difference (brain-PAD), central vein sign (CVS)-positive lesion percentage (CVS%), paramagnetic rim and cortical lesions, T2-lesion load, and brain volumetry. The variable relative importance for EPVS-category prediction was explored using a classification random forest approach. RESULTS High EPVS patients were older (49 vs 44 years, p = 0.003), had ⩾ 1 vascular risk factors (VRFs; p = 0.005), lower CVS% (67% vs 78%, p < 0.001), reduced brain volumes (whole brain: 0.63 vs 0.73, p = 0.01; gray matter: 0.36 vs 0.40; p = 0.002), and older brain-predicted age (58 vs 50 years, p < 0.001). No differences were found for neuroinflammatory markers. After adjusting for age and VFRs (multivariate analyses), the high EPVS category correlated with lower CVS% (odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.96-0.99; p = 0.02), lower whole brain (OR = 0.01, 95% CI = 0.0003-0.5; p = 0.02), gray matter (OR = 0.0004, 95% CI = 0.0000004-0.4; p = 0.03) volumes, and higher brain-PAD (OR = 1.05, 95% CI = 1.01-1.09; p = 0.02). Random forest identified brain-PAD as the most important predictor of high EPVS. CONCLUSION EPVS in MS likely reflect microangiopathic disease rather than neuroinflammation, potentially contributing to accelerated neurodegeneration.
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Affiliation(s)
- Serena Borrelli
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium/Department of Neurology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Brussels, Brussels, Belgium
| | - François Guisset
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
| | - Colin Vanden Bulcke
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium/ICTEAM Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Anna Stölting
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
| | - Céline Bugli
- Plateforme technologique de Support en Méthodologie et Calcul Statistique, Université catholique de Louvain, Brussels, Belgium
| | - Valentina Lolli
- Department of Radiology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Brussels, Brussels, Belgium
| | - Renaud Du Pasquier
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Martina Absinta
- Vita-Salute San Raffaele University, Milan, Italy/Translational Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marco Pasi
- Stroke Unit, Department of Neurology, CIC-IT 1415, CHRU de Tours, INSERM 1253 iBrain, Tours, France
| | - Pietro Maggi
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium/Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland/Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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Seehafer S, Larsen N, Aludin S, Jansen O, Schmill LPA. Perivascular spaces and where to find them - MR imaging and evaluation methods. ROFO-FORTSCHR RONTG 2024. [PMID: 38408476 DOI: 10.1055/a-2254-5651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Perivascular spaces (synonym: Virchow-Robin spaces) were first described over 150 years ago. They are defined as the fluid-filled spaces surrounding the small penetrating cerebral vessels. They gained growing scientific interest especially with the postulation of the so-called glymphatic system and their possible role in neurodegenerative and neuroinflammatory diseases. METHODS PubMed was used for a systematic search with a focus on literature regarding MRI imaging and evaluation methods of perivascular spaces. Studies on human in-vivo imaging were included with a focus on studies involving healthy populations. No time frame was set. The nomenclature in the literature is very heterogeneous with terms like "large", "dilated", "enlarged" perivascular spaces whereas borders and definitions often remain unclear. This work generally talks about perivascular spaces. RESULTS This review article discusses the morphologic MRI characteristics in different sequences. With the continual improvement of image quality, more and tinier structures can be depicted in detail. Visual analysis and semi or fully automated segmentation methods are briefly discussed. CONCLUSION If they are looked for, perivascular spaces are apparent in basically every cranial MRI examination. Their physiologic or pathologic value is still under debate. KEY POINTS · Perivascular spaces can be seen in basically every cranial MRI examination.. · Primarily T2-weighend sequences are used for visual analysis. Additional sequences are helpful for distinction from their differential diagnoses.. · There are promising approaches for the semi or fully automated segmentation of perivascular spaces with the possibility to collect more quantitative parameters.. CITATION FORMAT · Seehafer S, Larsen N, Aludin S et al. Perivascular spaces and where to find them - MRI imaging and evaluation methods. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2254-5651.
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Affiliation(s)
- Svea Seehafer
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Naomi Larsen
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Schekeb Aludin
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Olav Jansen
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
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Libecap T, Bauer CE, Zachariou V, Pappas CA, Raslau FD, Liu P, Lu H, Gold BT. Association of Baseline Cerebrovascular Reactivity and Longitudinal Development of Enlarged Perivascular Spaces in the Basal Ganglia. Stroke 2023; 54:2785-2793. [PMID: 37712232 PMCID: PMC10615859 DOI: 10.1161/strokeaha.123.043882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/24/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Increasing evidence suggests that enlarged perivascular spaces (ePVS) are associated with cognitive dysfunction in aging. However, the pathogenesis of ePVS remains unknown. Here, we tested the possibility that baseline cerebrovascular dysfunction, as measured by a magnetic resonance imaging measure of cerebrovascular reactivity, contributes to the later development of ePVS. METHODS Fifty cognitively unimpaired, older adults (31 women; age range, 60-84 years) underwent magnetic resonance imaging scanning at baseline and follow-up separated by ≈2.5 years. ePVS were counted in the basal ganglia, centrum semiovale, midbrain, and hippocampus. Cerebrovascular reactivity, an index of the vasodilatory capacity of cerebral small vessels, was assessed using carbon dioxide inhalation while acquiring blood oxygen level-dependent magnetic resonance images. RESULTS Low baseline cerebrovascular reactivity values in the basal ganglia were associated with increased follow-up ePVS counts in the basal ganglia after controlling for age, sex, and baseline ePVS values (estimate [SE]=-3.18 [0.96]; P=0.002; [95% CI, -5.11 to -1.24]). This effect remained significant after accounting for self-reported risk factors of cerebral small vessel disease (estimate [SE]=-3.10 [1.00]; P=0.003; [CI, -5.11 to -1.09]) and neuroimaging markers of cerebral small vessel disease (estimate [SE]=-2.72 [0.99]; P=0.009; [CI, -4.71 to -0.73]). CONCLUSIONS Our results demonstrate that low baseline cerebrovascular reactivity is a risk factor for later development of ePVS.
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Affiliation(s)
- T.J. Libecap
- Department of Neuroscience, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Christopher E. Bauer
- Department of Neuroscience, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Valentinos Zachariou
- Department of Neuroscience, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Colleen A. Pappas
- Department of Neuroscience, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Flavius D. Raslau
- Department of Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Peiying Liu
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian T. Gold
- Department of Neuroscience, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Department of Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, Kentucky, USA
- Sanders-Brown Center on Aging University of Kentucky, Lexington, Kentucky, USA
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Kern KC, Zagzoug MS, Gottesman RF, Wright CB, Leigh R. Diffusion tensor free water MRI predicts progression of FLAIR white matter hyperintensities after ischemic stroke. Front Neurol 2023; 14:1172031. [PMID: 37808483 PMCID: PMC10559725 DOI: 10.3389/fneur.2023.1172031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background The progression of FLAIR white matter hyperintensities (WMHs) on MRI heralds vascular-mediated cognitive decline. Even before FLAIR WMH progression, adjacent normal appearing white matter (NAWM) already demonstrates microstructural deterioration on diffusion tensor imaging (DTI). We hypothesized that elevated DTI free water (FW) would precede FLAIR WMH progression, implicating interstitial fluid accumulation as a key pathological step in the progression of cerebral small vessel disease. Methods Participants at least 3 months after an ischemic stroke or TIA with WMH on MRI underwent serial brain MRIs every 3 months over the subsequent year. For each participant, the WMHs were automatically segmented, serial MRIs were aligned, and a region of WMH penumbra tissue at risk was defined by dilating lesions at any time point and subtracting baseline lesions. Penumbra voxels were classified as either stable or progressing to WMH if they were segmented as new lesions and demonstrated increasing FLAIR intensity over time. Aligned DTI images included FW and FW-corrected fractional anisotropy (FATissue) and mean diffusivity (MDTissue). Logistic regression and area under the receiver-operator characteristic curve (AUC) were used to test whether baseline DTI predicted voxel-wise classification of stable penumbra or progression to WMH while covarying for clinical risk factors. Results In the included participants (n = 26, mean age 71 ± 9 years, 31% female), we detected a median annual voxel-wise WMH growth of 2.9 ± 2.6 ml. Each baseline DTI metric was associated with lesion progression in the penumbra, but FW had the greatest AUC of 0.732 (0.730 - 0.733) for predicting voxel-wise WMH progression pooled across participants. Discussion Baseline increased interstitial fluid, estimated as FW on DTI, predicted the progression of NAWM to WMH over the following year. These results implicate the presence of FW in the pathogenesis of cerebral small vessel disease progression.
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Affiliation(s)
- Kyle C. Kern
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Marwah S. Zagzoug
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Clinton B. Wright
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Richard Leigh
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
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Vedaei F, Fayed I, Alizadeh M, Miller C, Zhang AB, Koa V, Khan S, Mohamed FB, Wu C. Effect of Enlarged Perivascular Spaces in Reliable Distinction of Prospective Targeting During Deep Brain Stimulation in Patients With Advanced Parkinson's Disease: A Study of Deterministic and Probabilistic Tractography. Neurosurgery 2023; 93:691-698. [PMID: 37010304 DOI: 10.1227/neu.0000000000002478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/06/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Precise electrode position is vital for effective deep brain stimulation in treating motor symptoms in Parkinson's disease (PD). Enlarged perivascular spaces (PVSs) are associated with pathophysiology of neurodegenerative diseases including PD and may affect the microstructure of surrounding brain tissue. OBJECTIVE To quantify the clinical implications of enlarged PVS on tractography-based stereotactic targeting in patients with advanced PD selected to undergo deep brain stimulation. METHODS Twenty patients with PD underwent MRI scanning. The PVS areas were visualized and segmented. Based on the size of the PVS areas, the patient group was split into 2 categories of large vs small PVSs. Probabilistic and deterministic tractography methods were applied to a diffusion-weighted data set. Fiber assignment was performed using motor cortex as an initiation seed and the globus pallidus interna and subthalamic nucleus, separately, as inclusion masks. Two exclusion masks used consisted of cerebral peduncles and the PVS mask. The center of gravity of the tract density map was measured and compared between the tracts generated with and without consideration of the PVS mask. RESULTS The average differences between the center of gravity of the tracts made by excluding PVS and without excluding PVS using deterministic and probabilistic tractography methods were less than 1 mm. Statistical analysis showed nonsignificant differences between deterministic and probabilistic methods and differences between patients with large and small PVSs ( P > .05). CONCLUSION This study demonstrated that the presence of enlarged PVS is unlikely to affect targeting of basal ganglia nuclei based on tractography.
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Affiliation(s)
- Faezeh Vedaei
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Islam Fayed
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Mahdi Alizadeh
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Christopher Miller
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Ashley B Zhang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Victoria Koa
- College of Medicine, Drexel University, Philadelphia , Pennsylvania , USA
| | - Suharto Khan
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Feroze B Mohamed
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Chengyuan Wu
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
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Haller S, Jäger HR, Vernooij MW, Barkhof F. Neuroimaging in Dementia: More than Typical Alzheimer Disease. Radiology 2023; 308:e230173. [PMID: 37724973 DOI: 10.1148/radiol.230173] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Alzheimer disease (AD) is the most common cause of dementia. The prevailing theory of the underlying pathology assumes amyloid accumulation followed by tau protein aggregation and neurodegeneration. However, the current antiamyloid and antitau treatments show only variable clinical efficacy. Three relevant points are important for the radiologic assessment of dementia. First, besides various dementing disorders (including AD, frontotemporal dementia, and dementia with Lewy bodies), clinical variants and imaging subtypes of AD include both typical and atypical AD. Second, atypical AD has overlapping radiologic and clinical findings with other disorders. Third, the diagnostic process should consider mixed pathologies in neurodegeneration, especially concurrent cerebrovascular disease, which is frequent in older age. Neuronal loss is often present at, or even before, the onset of cognitive decline. Thus, for effective emerging treatments, early diagnosis before the onset of clinical symptoms is essential to slow down or stop subsequent neuronal loss, requiring molecular imaging or plasma biomarkers. Neuroimaging, particularly MRI, provides multiple imaging parameters for neurodegenerative and cerebrovascular disease. With emerging treatments for AD, it is increasingly important to recognize AD variants and other disorders that mimic AD. Describing the individual composition of neurodegenerative and cerebrovascular disease markers while considering overlapping and mixed diseases is necessary to better understand AD and develop efficient individualized therapies.
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Affiliation(s)
- Sven Haller
- From the Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (S.H.); Tanta University, Faculty of Medicine, Tanta, Egypt (S.H.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology (H.R.J., F.B.), and Centre for Medical Image Computing, Institute of Healthcare Engineering (F.B.), University College London, London, England; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England (H.R.J.); Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (M.W.V.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
| | - Hans Rolf Jäger
- From the Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (S.H.); Tanta University, Faculty of Medicine, Tanta, Egypt (S.H.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology (H.R.J., F.B.), and Centre for Medical Image Computing, Institute of Healthcare Engineering (F.B.), University College London, London, England; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England (H.R.J.); Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (M.W.V.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
| | - Meike W Vernooij
- From the Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (S.H.); Tanta University, Faculty of Medicine, Tanta, Egypt (S.H.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology (H.R.J., F.B.), and Centre for Medical Image Computing, Institute of Healthcare Engineering (F.B.), University College London, London, England; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England (H.R.J.); Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (M.W.V.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
| | - Frederik Barkhof
- From the Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (S.H.); Tanta University, Faculty of Medicine, Tanta, Egypt (S.H.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology (H.R.J., F.B.), and Centre for Medical Image Computing, Institute of Healthcare Engineering (F.B.), University College London, London, England; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England (H.R.J.); Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (M.W.V.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
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Pham W, Lynch M, Spitz G, O’Brien T, Vivash L, Sinclair B, Law M. A critical guide to the automated quantification of perivascular spaces in magnetic resonance imaging. Front Neurosci 2022; 16:1021311. [PMID: 36590285 PMCID: PMC9795229 DOI: 10.3389/fnins.2022.1021311] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
The glymphatic system is responsible for waste clearance in the brain. It is comprised of perivascular spaces (PVS) that surround penetrating blood vessels. These spaces are filled with cerebrospinal fluid and interstitial fluid, and can be seen with magnetic resonance imaging. Various algorithms have been developed to automatically label these spaces in MRI. This has enabled volumetric and morphological analyses of PVS in healthy and disease cohorts. However, there remain inconsistencies between PVS measures reported by different methods of automated segmentation. The present review emphasizes that importance of voxel-wise evaluation of model performance, mainly with the Sørensen Dice similarity coefficient. Conventional count correlations for model validation are inadequate if the goal is to assess volumetric or morphological measures of PVS. The downside of voxel-wise evaluation is that it requires manual segmentations that require large amounts of time to produce. One possible solution is to derive these semi-automatically. Additionally, recommendations are made to facilitate rigorous development and validation of automated PVS segmentation models. In the application of automated PVS segmentation tools, publication of image quality metrics, such as the contrast-to-noise ratio, alongside descriptive statistics of PVS volumes and counts will facilitate comparability between studies. Lastly, a head-to-head comparison between two algorithms, applied to two cohorts of astronauts reveals how results can differ substantially between techniques.
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Affiliation(s)
- William Pham
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Miranda Lynch
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Gershon Spitz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Terence O’Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin Sinclair
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Meng Law
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Radiology, Alfred Health Hospital, Melbourne, VIC, Australia
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC, Australia
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Monte B, Constantinou S, Koundal S, Lee H, Dai F, Gursky Z, Van Nostrand WE, Darbinyan A, Zlokovic BV, Wardlaw J, Benveniste H. Characterization of perivascular space pathology in a rat model of cerebral small vessel disease by in vivo magnetic resonance imaging. J Cereb Blood Flow Metab 2022; 42:1813-1826. [PMID: 35673963 PMCID: PMC9536121 DOI: 10.1177/0271678x221105668] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
Abstract
One of the most common causes of dementia is cerebral small vessel disease (SVD), which is associated with enlarged perivascular spaces (PVS). Clinically, PVS are visible as hyperintensities on T2-weighted (T2w) magnetic resonance images (MRI). While rodent SVD models exhibit arteriolosclerosis, PVS have not been robustly documented by MRI casting doubts on their clinical relevance. Here we established that the severity of SVD in spontaneously hypertensive stroke prone (SHRSP) rats correlated to 'moderate' SVD in human post-mortem tissue. We then developed two approaches for detecting PVS in SHRSP rats: 1) T2w imaging and 2) T1-weighted imaging with administration of gadoteric acid into cerebrospinal fluid. We applied the two protocols to six Wistar-Kyoto (WKY) control rats and thirteen SHRSP rats at ∼12 month of age. The primary endpoint was the number of hyperintense lesions. We found more hyperintensities on T2w MRI in the SHRSP compared to WKY rats (p-value = 0.023). CSF enhancement with gadoteric acid increased the visibility of PVS-like lesions in SHRSP rats. In some of the SHRSP rats, the MRI hyperintensities corresponded to enlarged PVS on histopathology. The finding of PVS-like hyperintensities on T2w MRI support the SHRSP rat's clinical relevance for studying the underlying pathophysiology of SVD.
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Affiliation(s)
- Brittany Monte
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | | | - Sunil Koundal
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Hedok Lee
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Feng Dai
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Zachary Gursky
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - William E Van Nostrand
- George and Anne Ryan Institute for Neuroscience and the Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA
| | - Armine Darbinyan
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, USA
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Joanna Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences; UK Dementia Research Institute Centre at the University of Edinburgh; and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Helene Benveniste
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale School of Medicine New Haven, CT, USA
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Zhu R, Li Y, Chen L, Wang Y, Cai G, Chen X, Ye Q, Chen Y. Total Burden of Cerebral Small Vessel Disease on MRI May Predict Cognitive Impairment in Parkinson’s Disease. J Clin Med 2022; 11:jcm11185381. [PMID: 36143028 PMCID: PMC9501874 DOI: 10.3390/jcm11185381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Objective: to investigate the association between the total burden of cerebral small vessel disease (CSVD) and cognitive function in Parkinson’s disease (PD). (2) Methods: this retrospective study compared clinical and neuroimaging characteristics of 122 PD patients to determine the association between cognitive decline and total burden of CSVD in PD. All patients underwent brain MRI examinations, and their total CSVD burden scores were evaluated by silent lacunar infarction (SLI), cerebral microbleeds (CMB), white matter hyperintensities (WMH), and enlarged perivascular spaces (EPVS). The cognitive function was assessed by administering Mini-Mental State Examination (MMSE). Receiver-operating characteristic (ROC) curve and the area under the ROC curve (AUC) were performed to quantify the accuracy of the total burden of CSVD and PVH in discriminating PD patients with or without cognitive impairment. (3) Results: the PD patients with cognitive impairment had a significantly higher SLI, CMB, periventricular hyperintensities (PVH), deep white matter hyperintensities (DWMH), enlarged perivascular spaces of basal ganglia (BG-EPVS), and the total CSVD score compared with no cognitive impairment. Total CSVD score and MMSE had a significant negative correlation (r = −0. 483). Furthermore, total burden of CSVD and PVH were the independent risk factors of cognitive impairment in PD, and their good accuracy in discriminating PD patients with cognitive impairment from those with no cognitive impairment was confirmed by the results of ROC curves. (4) Conclusions: total burden of CSVD tightly linked to cognitive impairment in PD patients. The total burden of CSVD or PVH may predict the cognitive impairment in PD.
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Affiliation(s)
- Ruihan Zhu
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Department of Neurology, The Second Affiliated Hospital, Xiamen Medical College, Xiamen 361021, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350004, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350004, China
| | - Yunjing Li
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350004, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350004, China
| | - Lina Chen
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350004, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350004, China
| | - Yingqing Wang
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350004, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350004, China
| | - Guoen Cai
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350004, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350004, China
| | - Xiaochun Chen
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350004, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350004, China
| | - Qinyong Ye
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350004, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350004, China
- Correspondence: (Q.Y.); (Y.C.)
| | - Ying Chen
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350004, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350004, China
- Correspondence: (Q.Y.); (Y.C.)
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10
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Libecap TJ, Zachariou V, Bauer CE, Wilcock DM, Jicha GA, Raslau FD, Gold BT. Enlarged Perivascular Spaces Are Negatively Associated With Montreal Cognitive Assessment Scores in Older Adults. Front Neurol 2022; 13:888511. [PMID: 35847209 PMCID: PMC9283758 DOI: 10.3389/fneur.2022.888511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Emerging evidence suggests that enlarged perivascular spaces (ePVS) may be a clinically significant neuroimaging marker of global cognitive function related to cerebral small vessel disease (cSVD). We tested this possibility by assessing the relationship between ePVS and both a standardized measure of global cognitive function, the Montreal Cognitive Assessment (MoCA), and an established marker of cSVD, white matter hyperintensity volume (WMH) volume. One hundred and eleven community-dwelling older adults (56-86) underwent neuroimaging and MoCA testing. Quantification of region-specific ePVS burden was performed using a previously validated visual rating method and WMH volumes were computed using the standard ADNI pipeline. Separate linear regression models were run with ePVS as a predictor of MoCA scores and whole brain WMH volume. Results indicated a negative association between MoCA scores and both total ePVS counts (P ≤ 0.001) and centrum semiovale ePVS counts (P ≤ 0.001), after controlling for other relevant cSVD variables. Further, WMH volumes were positively associated with total ePVS (P = 0.010), basal ganglia ePVS (P ≤ 0.001), and centrum semiovale ePVS (P = 0.027). Our results suggest that ePVS burden, particularly in the centrum semiovale, may be a clinically significant neuroimaging marker of global cognitive dysfunction related to cSVD.
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Affiliation(s)
- Timothy J. Libecap
- Department of Neuroscience, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Valentinos Zachariou
- Department of Neuroscience, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Christopher E. Bauer
- Department of Neuroscience, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Donna M. Wilcock
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, United States
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Gregory A. Jicha
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, KY, United States
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Flavius D. Raslau
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Brian T. Gold
- Department of Neuroscience, College of Medicine, University of Kentucky, Lexington, KY, United States
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, KY, United States
- Magnetic Resonance Imaging and Spectroscopy Center, College of Medicine, University of Kentucky, Lexington, KY, United States
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11
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Kolbe S, Garcia L, Yu N, Boonstra F, Clough M, Sinclair B, White O, van der Walt A, Butzkueven H, Fielding J, Law M. Lesion Volume in Relapsing Multiple Sclerosis is Associated with Perivascular Space Enlargement at the Level of the Basal Ganglia. AJNR Am J Neuroradiol 2022; 43:238-244. [PMID: 35121585 PMCID: PMC8985682 DOI: 10.3174/ajnr.a7398] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Perivascular spaces surround the blood vessels of the brain and are involved in neuroimmune functions and clearance of metabolites via the glymphatic system of the brain. Enlarged perivascular spaces could be a marker of dysfunction in these processes and, therefore, are highly relevant to monitoring disease activity in MS. This study aimed to compare the number of enlarged perivascular spaces in people with relapsing MS with MR imaging markers of inflammation and brain atrophy. MATERIALS AND METHODS Fifty-nine patients (18 with clinically isolated syndrome, 22 with early and 19 with late relapsing-remitting MS) were scanned longitudinally (mean follow-up duration = 19.6 [SD, 0.5] months) using T2-weighted, T1-weighted, and FLAIR MR imaging. Two expert raters identified and counted enlarged perivascular spaces on T2-weighted MR images from 3 ROIs (the centrum semiovale, basal ganglia, and midbrain). Baseline and change with time in the number of enlarged perivascular spaces were correlated with demographics and lesion and brain volumes. RESULTS Late relapsing-remitting MS had a greater average number of enlarged perivascular spaces at baseline at the level of the basal ganglia (72.3) compared with early relapsing-remitting MS (60.5) and clinically isolated syndrome (54.7) (F = 3.4, P = .042), and this finding correlated with lesion volume (R = 0.44, P = .0004) but not brain atrophy (R = -0.16). Enlarged perivascular spaces increased in number with time in all regions, and the rate of increase did not differ among clinical groups. CONCLUSIONS Enlarged perivascular spaces at the level of the basal ganglia are associated with greater neuroinflammatory burden, and the rate of enlargement appears constant in patients with relapsing-remitting disease phenotypes.
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Affiliation(s)
- S.C. Kolbe
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Departments of Radiology (S.C.K., M.L.)
| | - L.M. Garcia
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - N. Yu
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Department of Neurology (N.Y.), The Nanjing Brain Hospital Affiliated with Nanjing Medical University, Nanjing, Jiangsu, China
| | - F.M. Boonstra
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - M. Clough
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - B. Sinclair
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - O. White
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Neurology (O.W., A.v.d.W., H.B.), Alfred Hospital, Melbourne, Victoria, Australia
| | - A. van der Walt
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Neurology (O.W., A.v.d.W., H.B.), Alfred Hospital, Melbourne, Victoria, Australia
| | - H. Butzkueven
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Neurology (O.W., A.v.d.W., H.B.), Alfred Hospital, Melbourne, Victoria, Australia
| | - J. Fielding
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - M. Law
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Departments of Radiology (S.C.K., M.L.)
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12
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Rundek T, Tolea M, Ariko T, Fagerli EA, Camargo CJ. Vascular Cognitive Impairment (VCI). Neurotherapeutics 2022; 19:68-88. [PMID: 34939171 PMCID: PMC9130444 DOI: 10.1007/s13311-021-01170-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 01/03/2023] Open
Abstract
Vascular cognitive impairment (VCI) is predominately caused by vascular risk factors and cerebrovascular disease. VCI includes a broad spectrum of cognitive disorders, from mild cognitive impairment to vascular dementia caused by ischemic or hemorrhagic stroke, and vascular factors alone or in a combination with neurodegeneration including Alzheimer's disease (AD) and AD-related dementia. VCI accounts for at least 20-40% of all dementia diagnosis. Growing evidence indicates that cerebrovascular pathology is the most important contributor to dementia, with additive or synergistic interactions with neurodegenerative pathology. The most common underlying mechanism of VCI is chronic age-related dysregulation of CBF, although other factors such as inflammation and cardiovascular dysfunction play a role. Vascular risk factors are prevalent in VCI and if measured in midlife they predict cognitive impairment and dementia in later life. Particularly, hypertension, high cholesterol, diabetes, and smoking at midlife are each associated with a 20 to 40% increased risk of dementia. Control of these risk factors including multimodality strategies with an inclusion of lifestyle modification is the most promising strategy for treatment and prevention of VCI. In this review, we present recent developments in age-related VCI, its mechanisms, diagnostic criteria, neuroimaging correlates, vascular risk determinants, and current intervention strategies for prevention and treatment of VCI. We have also summarized the most recent and relevant literature in the field of VCI.
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Affiliation(s)
- Tatjana Rundek
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Magdalena Tolea
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Taylor Ariko
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric A Fagerli
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian J Camargo
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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13
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Kim J, Joo B, Kim JW, Park M, Ahn SJ, Park SK, Suh SH. Aggravation of Enlarged Perivascular Spaces in the Centrum Semiovale of Patients with Aneurysmal Subarachnoid Hemorrhage. Clin Neuroradiol 2021; 32:79-87. [PMID: 34618170 DOI: 10.1007/s00062-021-01098-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to investigate whether enlarged perivascular spaces (ePVS) within the basal ganglia (BG) or centrum semiovale (CSO) aggravate in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS We retrospectively evaluated 139 patients who had undergone brain magnetic resonance imaging (MRI) within 1 month of aSAH occurrence from January 2007 to November 2018. Follow-up brain MRI of 99 patients were available. We scored ePVS in the BG and CSO on a score of 0-4 (0 = no ePVS, 4 ≥ 40 ePVS) on initial and follow-up T2-weighted MRI. Aggravation of ePVS was defined as an ePVS score increase of ≥ 1 on follow-up MRI compared to the initial score. We compared the characteristics between patients with and without aggravation of ePVS and investigated associated variables using logistic regression. RESULTS Aggravation of ePVS in the CSO and BG was noted in 31 (31.3%) and 6 (6.1%) patients, respectively. After adjusting for age, sex, and the MRI follow-up period, aggravation of ePVS in the CSO was independently associated with a high Fisher grade (p = 0.007) and high burden of initial ePVS in the CSO (p = 0.049). CONCLUSION Aggravation of ePVS, particularly those in the CSO, had occurred in the long-term follow-up of aSAH patients. This was independently associated with a high burden of aSAH. The amount of subarachnoid blood might have aggravated the drainage of interstitial fluid through glymphatic dysfunction.
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Affiliation(s)
- Jina Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Jin Woo Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of).
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 63-gil 20, Gangnam-gu, Seoul, Korea (Republic of)
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14
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Lysen TS, Yilmaz P, Dubost F, Ikram MA, de Bruijne M, Vernooij MW, Luik AI. Sleep and perivascular spaces in the middle-aged and elderly population. J Sleep Res 2021; 31:e13485. [PMID: 34549850 PMCID: PMC9285071 DOI: 10.1111/jsr.13485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 12/29/2022]
Abstract
Sleep has been hypothesised to facilitate waste clearance from the brain. We aimed to determine whether sleep is associated with perivascular spaces on brain magnetic resonance imaging (MRI), a potential marker of impaired brain waste clearance, in a population-based cohort of middle-aged and elderly people. In 559 participants (mean [SD] age 62 [6] years, 52% women) from the population-based Rotterdam Study, we measured total sleep time, sleep onset latency, wake after sleep onset and sleep efficiency with actigraphy and polysomnography. Perivascular space load was determined with brain MRI in four regions (centrum semiovale, basal ganglia, hippocampus, and midbrain) via a validated machine learning algorithm using T2-weighted MR images. Associations between sleep characteristics and perivascular space load were analysed with zero-inflated negative binomial regression models adjusted for various confounders. We found that higher actigraphy-estimated sleep efficiency was associated with a higher perivascular space load in the centrum semiovale (odds ratio 1.10, 95% confidence interval 1.04-1.16, p = 0.0008). No other actigraphic or polysomnographic sleep characteristics were associated with perivascular space load in other brain regions. We conclude that, contrary to our hypothesis, associations of sleep with perivascular space load in this middle-aged and elderly population remained limited to an association of a high actigraphy-estimated sleep efficiency with a higher perivascular space load in the centrum semiovale.
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Affiliation(s)
- Thom S Lysen
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Pinar Yilmaz
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Florian Dubost
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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15
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Kim HJ, Cho H, Park M, Kim JW, Ahn SJ, Lyoo CH, Suh SH, Ryu YH. MRI-Visible Perivascular Spaces in the Centrum Semiovale Are Associated with Brain Amyloid Deposition in Patients with Alzheimer Disease-Related Cognitive Impairment. AJNR Am J Neuroradiol 2021; 42:1231-1238. [PMID: 33985952 DOI: 10.3174/ajnr.a7155] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/21/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The association of perivascular spaces in the centrum semiovale with amyloid accumulation among patients with Alzheimer disease-related cognitive impairment is unknown. We evaluated this association in patients with Alzheimer disease-related cognitive impairment and β-amyloid deposition, assessed with [18F] florbetaben PET/CT. MATERIALS AND METHODS MR imaging and [18F] florbetaben PET/CT images of 144 patients with Alzheimer disease-related cognitive impairment were retrospectively evaluated. MR imaging-visible perivascular spaces were rated on a 4-point visual scale: a score of ≥3 or <3 indicated a high or low degree of MR imaging-visible perivascular spaces, respectively. Amyloid deposition was evaluated using the brain β-amyloid plaque load scoring system. RESULTS Compared with patients negative for β-amyloid, those positive for it were older and more likely to have lower cognitive function, a diagnosis of Alzheimer disease, white matter hyperintensity, the Apolipoprotein E ε4 allele, and a high degree of MR imaging-visible perivascular spaces in the centrum semiovale. Multivariable analysis, adjusted for age and Apolipoprotein E status, revealed that a high degree of MR imaging-visible perivascular spaces in the centrum semiovale was independently associated with β-amyloid positivity (odds ratio, 2.307; 95% CI, 1.036-5.136; P = .041). CONCLUSIONS A high degree of MR imaging-visible perivascular spaces in the centrum semiovale independently predicted β-amyloid positivity in patients with Alzheimer disease-related cognitive impairment. Thus, MR imaging-visible perivascular spaces in the centrum semiovale are associated with amyloid pathology of the brain and could be an indirect imaging marker of amyloid burden in patients with Alzheimer disease-related cognitive impairment.
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Affiliation(s)
- H J Kim
- From the Department of Nuclear Medicine (H.J.K., Y.H.R.)
- Department of Nuclear Medicine (H.J.K.), Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, South Korea
| | | | - M Park
- Radiology (M.P., J.W.K., S.J.A., S.H.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - J W Kim
- Radiology (M.P., J.W.K., S.J.A., S.H.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Ahn
- Radiology (M.P., J.W.K., S.J.A., S.H.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | | | - S H Suh
- Radiology (M.P., J.W.K., S.J.A., S.H.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Ryu
- From the Department of Nuclear Medicine (H.J.K., Y.H.R.)
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16
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Resistance to developing brain pathology due to vascular risk factors: the role of educational attainment. Neurobiol Aging 2021; 106:197-206. [PMID: 34298318 DOI: 10.1016/j.neurobiolaging.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/19/2021] [Accepted: 06/10/2021] [Indexed: 11/22/2022]
Abstract
Brain pathology develops at different rates between individuals with similar burden of risk factors, possibly explained by brain resistance. We examined if education contributes to brain resistance by studying its influence on the association between vascular risk factors and brain pathology. In 4111 stroke-free and dementia-free community-dwelling participants (62.9 ± 10.7 years), we explored the association between vascular risk factors (hypertension and the Framingham Stroke Risk Profile [FRSP]) and imaging markers of brain pathology (markers of cerebral small vessel disease and brain volumetry), stratified by educational attainment level. Associations of hypertension and FSRP with markers of brain pathology were not significantly different between levels of educational attainment. Certain associations appeared weaker in those with higher compared to lower educational attainment, particularly for white matter hyperintensities (WMH). Supplementary residual analyses showed significant associations between higher educational attainment and stronger resistance to WMH among others. Our results suggest a role for educational attainment in resistance to vascular brain pathology. Yet, further research is needed to better characterize determinants of brain resistance.
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17
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Gouveia-Freitas K, Bastos-Leite AJ. Perivascular spaces and brain waste clearance systems: relevance for neurodegenerative and cerebrovascular pathology. Neuroradiology 2021; 63:1581-1597. [PMID: 34019111 PMCID: PMC8460534 DOI: 10.1007/s00234-021-02718-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/12/2021] [Indexed: 12/28/2022]
Abstract
Perivascular spaces (PVS) of the brain, often called Virchow-Robin spaces, comprise fluid, cells and connective tissue, and are externally limited by astrocytic endfeet. PVS are involved in clearing brain waste and belong to the "glymphatic" system and/or the "intramural periarterial drainage" pathway through the basement membranes of the arteries. Related brain waste clearance systems include the blood-brain barrier, scavenger cells, cerebrospinal fluid, perineural lymphatic drainage pathways and the newly characterised meningeal lymphatic vessels. Any functional abnormality of PVS or related clearance systems might lead to accumulation of brain waste. It has been postulated that PVS enlargement can be secondary to accumulation of β-amyloid. Lack of integrity of the vascular wall, microbleeds, cerebral amyloid angiopathy (CAA) and enlarged PVS often occur in the preclinical stages of Alzheimer's disease, preceding substantial brain atrophy. PVS enlargement in the form of état criblé at the basal ganglia has also been considered to reflect focal atrophy, most probably secondary to ischaemic injury, based upon both pathological and imaging arguments. In addition, distinct topographic patterns of enlarged PVS are related to different types of microangiopathy: CAA is linked to enlarged juxtacortical PVS, whereas subjects with vascular risk factors tend to have enlarged PVS in the basal ganglia. Therefore, enlarged PVS are progressively being regarded as a marker of neurodegenerative and cerebrovascular pathology. The present review addresses the evolving concept of PVS and brain waste clearance systems, the potential relevance of their dysfunction to neurodegenerative and cerebrovascular pathology, and potential therapeutic approaches of interest.
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Affiliation(s)
- Kaylene Gouveia-Freitas
- Faculty of Medicine, University of Porto, Alameda do Professor Hernâni Monteiro, 4200-319, Porto, Portugal
| | - António J Bastos-Leite
- Faculty of Medicine, University of Porto, Alameda do Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
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Wang L, Lin H, Peng Y, Zhao Z, Chen L, Wu L, Liu T, Li J, Liu A, Lo CYZ, Gao X. Incidental Brain Magnetic Resonance Imaging Findings and the Cognitive and Motor Performance in the Elderly: The Shanghai Changfeng Study. Front Neurosci 2021; 15:631087. [PMID: 33679312 PMCID: PMC7933572 DOI: 10.3389/fnins.2021.631087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background The frequently discovered incidental findings (IFs) from imaging observations are increasing. The IFs show the potential clues of structural abnormalities underlying cognitive decline in elders. Detecting brain IFs and their relationship with cognitive and behavioral functions helps provide the information for clinical strategies. Methods Five hundred and seventy-nine participants were recruited in the Shanghai Changfeng Study. All participants performed the demographic, biochemical, and cognitive functions and gait speed assessment and underwent the high-resolution multimodal magnetic resonance imaging scans. We calculated the detection rate of brain IFs. The association between cardiovascular risk factors and IFs and the associations between IFs and cognitive and motor functions were assessed using regression models. The relationships among gray matter volume, cognitive function, and gait speed were assessed with/without adjusting the IFs to evaluate the effects of potential IFs confounders. Results IFs were found in a total of 578 subjects with a detection rate of 99.8%. Age and blood pressure were the most significant cardiovascular risk factors correlated with IFs. IFs were found to be negatively associated with Montreal Cognitive Assessment, Mini-Mental State Examination, and gait speed. The gray matter volume was found to be positively correlated with the cognitive function without adjusting the white matter hyperintensity but not if adjusted. Conclusion IFs are commonly found in the elderly population and related to brain functions. The adequate intervention of IFs related cardiovascular risk factors that may slow down the progression of brain function decline. We also suggest that IFs should be considered as confounding factors that may affect cognitive issues on the structural neuroimaging researches in aging or diseases.
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Affiliation(s)
- Liangqi Wang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,School of Life Sciences, Fudan University, Shanghai, China.,Department of Radiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,Institute for Metabolic Diseases, Fudan University, Shanghai, China
| | - Yifeng Peng
- Department of Radiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zehua Zhao
- Department of Radiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingyan Chen
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Wu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Institute for Metabolic Diseases, Fudan University, Shanghai, China
| | - Ting Liu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Li
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Anna Liu
- Department of Radiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Yi Zac Lo
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,Institute for Metabolic Diseases, Fudan University, Shanghai, China
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19
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Shen T, Yue Y, Zhao S, Xie J, Chen Y, Tian J, Lv W, Lo CYZ, Hsu YC, Kober T, Zhang B, Lai HY. The role of brain perivascular space burden in early-stage Parkinson's disease. NPJ Parkinsons Dis 2021; 7:12. [PMID: 33547311 PMCID: PMC7864928 DOI: 10.1038/s41531-021-00155-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/22/2020] [Indexed: 01/30/2023] Open
Abstract
Perivascular space (PVS) is associated with neurodegenerative diseases, while its effect on Parkinson's disease (PD) remains unclear. We aimed to investigate the clinical and neuroimaging significance of PVS in basal ganglia (BG) and midbrain in early-stage PD. We recruited 40 early-stage PD patients and 41 healthy controls (HCs). Both PVS number and volume were calculated to evaluate PVS burden on 7 T magnetic resonance imaging images. We compared PVS burden between PD and HC, and conducted partial correlation analysis between PVS burden and clinical and imaging features. PD patients had a significantly more serious PVS burden in BG and midbrain, and the PVS number in BG was significantly correlated to the PD disease severity and L-dopa equivalent dosage. The fractional anisotropy and mean diffusivity values of certain subcortical nuclei and white matter fibers within or nearby the BG and midbrain were significantly correlated with the ipsilateral PVS burden indexes. Regarding to the midbrain, the difference between bilateral PVS burden was, respectively, correlated to the difference between fiber counts of white fiber tract passing through bilateral substantia nigra in PD. Our study suggests that PVS burden indexes in BG are candidate biomarkers to evaluate PD motor symptom severity and aid in predicting medication dosage. And our findings also highlight the potential correlations between PVS burden and both grey and white matter microstructures.
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Affiliation(s)
- Ting Shen
- grid.13402.340000 0004 1759 700XDepartment of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China ,grid.13402.340000 0004 1759 700XDepartment of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China ,grid.13402.340000 0004 1759 700XCollege of Biomedical Engineering and Instrument Science, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Yumei Yue
- grid.13402.340000 0004 1759 700XDepartment of Neurology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuai Zhao
- grid.13402.340000 0004 1759 700XDepartment of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Juanjuan Xie
- grid.13402.340000 0004 1759 700XDepartment of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China ,grid.13402.340000 0004 1759 700XDepartment of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanxing Chen
- grid.13402.340000 0004 1759 700XDepartment of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Tian
- grid.13402.340000 0004 1759 700XDepartment of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen Lv
- grid.13402.340000 0004 1759 700XDepartment of Neurology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Chun-Yi Zac Lo
- grid.8547.e0000 0001 0125 2443Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Yi-Cheng Hsu
- grid.452598.7MR collaboration NE Asia, Siemens Healthcare, Shanghai, China
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland
| | - Baorong Zhang
- grid.13402.340000 0004 1759 700XDepartment of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Hsin-Yi Lai
- grid.13402.340000 0004 1759 700XDepartment of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China ,grid.13402.340000 0004 1759 700XCollege of Biomedical Engineering and Instrument Science, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China ,grid.13402.340000 0004 1759 700XDepartment of Neurology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
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Abstract
Perivascular compartments surrounding the penetrating arteries in the brain are part of a physiologic system, which facilitates fluids exchange and clearance of solutes from the brain. The perivascular compartments become visible on MRI when enlarged and are commonly referred to as perivascular spaces (ePVS). Previous studies on the association between ePVS and dementia have been inconsistent due to varying methods of measuring ePVS. As a frame of reference for future MRI studies on ePVS, we systematically review the literature on ePVS as a marker of vascular brain injury related to dementia from population-based as well as hospital-based settings. We identified three longitudinal and ten cross-sectional studies involving 7,581 persons. Potential outcomes were all-cause dementia, Alzheimer's disease, and vascular dementia. There was considerable heterogeneity in ePVS assessment: with studies using either visual inspection or segmentation, examining different brain locations and implementing different grading scales. Moreover, out of the total of 13 studies, all five studies on vascular dementia reported an association with presence of basal ganglia ePVS after adjustment for age, gender, and white matter hyperintensities. For seven studies on Alzheimer's disease and all-cause dementia, the results were ambiguous. This review did not identify an independent association of ePVS with prevalent or incident dementia. Harmonized methods for ePVS assessment, tested across different populations, may benefit future MRI studies on ePVS and dementia.
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Affiliation(s)
- David Smeijer
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Saima Hilal
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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21
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Si XL, Gu LY, Song Z, Zhou C, Fang Y, Jin CY, Wu JJ, Gao T, Guo T, Guan XJ, Xu XJ, Yin XZ, Yan YP, Zhang MM, Pu JL. Different Perivascular Space Burdens in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson's Disease. Front Aging Neurosci 2020; 12:580853. [PMID: 33250763 PMCID: PMC7674841 DOI: 10.3389/fnagi.2020.580853] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/20/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Excessive aggregation of α-synuclein is the key pathophysiological feature of Parkinson's disease (PD). Rapid eye movement sleep behavior disorder (RBD) is also associated with synucleinopathies and considered as a powerful predictor of PD. Growing evidence suggests the diminished clearance of α-synuclein may be partly attributable to poor interstitial fluid drainage, which can be reflected by magnetic resonance imaging (MRI)-visible enlarged perivascular space (EPVS). However, the effect of MRI-visible EPVS on iRBD and PD, and their correlation with clinical characteristics remain unclear. OBJECTIVE To evaluate the clinical and neuroimaging significance of MRI-visible EPVS in iRBD and PD patients. METHODS We enrolled 33 iRBD patients, 82 PD (with and without RBD) patients, and 35 healthy controls (HCs), who underwent clinical evaluation and 3.0 Tesla MRI. Two neurologists assessed MRI-visible EPVS in centrum semiovale (CSO), basal ganglia (BG), substantia nigra (SN), and brainstem (BS). Independent risk factors for iRBD and PD were investigated using multivariable logistic regression analysis. Spearman analysis was used to test the correlation of MRI-visible EPVS with clinical characteristics of patients. RESULTS iRBD patients had significantly higher EPVS burdens (CSO, BG, SN, and BS) than PD patients. Higher CSO-EPVS and BS-EPVS burdens were independent risk factors for iRBD. Furthermore, higher CSO-EPVS and SN-EPVS burdens were positively correlated with the severity of clinical symptom in iRBD patients, and higher BG-EPVS burden was positively correlated with the severity of cognitive impairment in PD patients. CONCLUSION iRBD and PD patients have different MRI-visible EPVS burdens, which may be related with a compensatory mechanism in glymphatic system. Lower MRI-visible EPVS burden in PD patients may be a manifestation of severe brain waste drainage dysfunction. These findings shed light on the pathophysiologic relationship between iRBD and PD with respect to neuroimaging marker of PD.
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Affiliation(s)
- Xiao-li Si
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lu-yan Gu
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhe Song
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Fang
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chong-yao Jin
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jing-jing Wu
- Department of Radiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-jun Guan
- Department of Radiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-jun Xu
- Department of Radiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xin-zhen Yin
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ya-ping Yan
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Min-min Zhang
- Department of Radiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jia-li Pu
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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22
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Ghali MGZ, Marchenko V, Yaşargil MG, Ghali GZ. Structure and function of the perivascular fluid compartment and vertebral venous plexus: Illumining a novel theory on mechanisms underlying the pathogenesis of Alzheimer's, cerebral small vessel, and neurodegenerative diseases. Neurobiol Dis 2020; 144:105022. [PMID: 32687942 DOI: 10.1016/j.nbd.2020.105022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/13/2020] [Accepted: 07/15/2020] [Indexed: 01/14/2023] Open
Abstract
Blood dynamically and richly supplies the cerebral tissue via microvessels invested in pia matter perforating the cerebral substance. Arteries penetrating the cerebral substance derive an investment from one or two successive layers of pia mater, luminally apposed to the pial-glial basal lamina of the microvasculature and abluminally apposed to a series of aquaporin IV-studded astrocytic end feet constituting the soi-disant glia limitans. The full investment of successive layers forms the variably continuous walls of the periarteriolar, pericapillary, and perivenular divisions of the perivascular fluid compartment. The pia matter disappears at the distal periarteriolar division of the perivascular fluid compartment. Plasma from arteriolar blood sequentially transudates into the periarteriolar division of the perivascular fluid compartment and subarachnoid cisterns in precession to trickling into the neural interstitium. Fluid from the neural interstitium successively propagates into the venules through the subarachnoid cisterns and perivenular division of the perivascular fluid compartment. Fluid fluent within the perivascular fluid compartment flows gegen the net direction of arteriovenular flow. Microvessel oscillations at the central tendency of the cerebral vasomotion generate corresponding oscillations of within the surrounding perivascular fluid compartment, interposed betwixt the abluminal surface of the vessels and internal surface of the pia mater. The precise microanatomy of this most fascinating among designable spaces has eluded the efforts of various investigators to interrogate its structure, though most authors non-consensusly concur the investing layers effectively and functionally segregate the perivascular and subarachnoid fluid compartments. Enlargement of the perivascular fluid compartment in a variety of neurological disorders, including senile dementia of the Alzheimer's type and cerebral small vessel disease, may alternately or coordinately constitute a correlative marker of disease severity and a possible cause implicated in the mechanistic pathogenesis of these conditions. Venular pressures modulating oscillatory dynamic flow within the perivascular fluid compartment may similarly contribute to the development of a variety among neurological disorders. An intimate understanding of subtle features typifying microanatomy and microphysiology of the investing structures and spaces of the cerebral microvasculature may powerfully inform mechanistic pathophysiology mediating a variety of neurovascular ischemic, neuroinfectious, neuroautoimmune, and neurodegenerative diseases.
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Affiliation(s)
- Michael George Zaki Ghali
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Street, San Francisco, CA 94143, United States; Department of Neurobiology and Anatomy, 2900 W. Queen Lane, Philadelphia, PA 19129, United States.
| | - Vitaliy Marchenko
- Department of Neurobiology and Anatomy, 2900 W. Queen Lane, Philadelphia, PA 19129, United States; Department of Neurophysiology, Bogomoletz Institute, Kyiv, Ukraine; Department of Neuroscience, Московский государственный университет имени М. В., Ломоносова GSP-1, Leninskie Gory, Moscow 119991, Russian Federation
| | - M Gazi Yaşargil
- Department of Neurosurgery, University Hospital Zurich Rämistrasse 100, 8091 Zurich, Switzerland
| | - George Zaki Ghali
- United States Environmental Protection Agency, Arlington, Virginia, USA; Emeritus Professor of Toxicology, Purdue University, West Lafayette, Indiana, USA
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23
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Troili F, Cipollini V, Moci M, Morena E, Palotai M, Rinaldi V, Romano C, Ristori G, Giubilei F, Salvetti M, Orzi F, Guttmann CRG, Cavallari M. Perivascular Unit: This Must Be the Place. The Anatomical Crossroad Between the Immune, Vascular and Nervous System. Front Neuroanat 2020; 14:17. [PMID: 32372921 PMCID: PMC7177187 DOI: 10.3389/fnana.2020.00017] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/23/2020] [Indexed: 12/25/2022] Open
Abstract
Most neurological disorders seemingly have heterogenous pathogenesis, with overlapping contribution of neuronal, immune and vascular mechanisms of brain injury. The perivascular space in the brain represents a crossroad where those mechanisms interact, as well as a key anatomical component of the recently discovered glymphatic pathway, which is considered to play a crucial role in the clearance of brain waste linked to neurodegenerative diseases. The pathological interplay between neuronal, immune and vascular factors can create an environment that promotes self-perpetration of mechanisms of brain injury across different neurological diseases, including those that are primarily thought of as neurodegenerative, neuroinflammatory or cerebrovascular. Changes of the perivascular space can be monitored in humans in vivo using magnetic resonance imaging (MRI). In the context of glymphatic clearance, MRI-visible enlarged perivascular spaces (EPVS) are considered to reflect glymphatic stasis secondary to the perivascular accumulation of brain debris, although they may also represent an adaptive mechanism of the glymphatic system to clear them. EPVS are also established correlates of dementia and cerebral small vessel disease (SVD) and are considered to reflect brain inflammatory activity. In this review, we describe the “perivascular unit” as a key anatomical and functional substrate for the interaction between neuronal, immune and vascular mechanisms of brain injury, which are shared across different neurological diseases. We will describe the main anatomical, physiological and pathological features of the perivascular unit, highlight potential substrates for the interplay between different noxae and summarize MRI studies of EPVS in cerebrovascular, neuroinflammatory and neurodegenerative disorders.
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Affiliation(s)
- Fernanda Troili
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Virginia Cipollini
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Moci
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
| | - Emanuele Morena
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Miklos Palotai
- Harvard Medical School, Center for Neurological Imaging, Brigham and Women's Hospital, Boston, MA, United States
| | - Virginia Rinaldi
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Carmela Romano
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giovanni Ristori
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Franco Giubilei
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Salvetti
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesco Orzi
- Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Charles R G Guttmann
- Harvard Medical School, Center for Neurological Imaging, Brigham and Women's Hospital, Boston, MA, United States
| | - Michele Cavallari
- Harvard Medical School, Center for Neurological Imaging, Brigham and Women's Hospital, Boston, MA, United States
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Yilmaz P, Ikram MA, Ikram MK, Niessen WJ, Viswanathan A, Charidimou A, Vernooij MW. Application of an Imaging-Based Sum Score for Cerebral Amyloid Angiopathy to the General Population: Risk of Major Neurological Diseases and Mortality. Front Neurol 2019; 10:1276. [PMID: 31866930 PMCID: PMC6908500 DOI: 10.3389/fneur.2019.01276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/18/2019] [Indexed: 12/23/2022] Open
Abstract
Objective: To assess the relation between a sum score of imaging markers indicative of cerebral amyloid angiopathy (CAA) and cognitive impairment, stroke, dementia, and mortality in a general population. Methods: One thousand six hundred twenty-two stroke-free and dementia-free participants of the population-based Rotterdam Study (mean age 73.1 years, 54.3% women) underwent brain MRI (1.5 tesla) in 2005–2011 and were followed for stroke, dementia and death until 2016–2017. Four MRI markers (strictly lobar cerebral microbleeds, cortical superficial siderosis, centrum semiovale perivascular spaces, and white matter hyperintensities) were combined to construct the CAA sum score, ranging from 0 to 4. Neuropsychological testing measured during the research visit closest to scan date were used to assess general cognitive function and cognitive domains. The associations of the CAA sum score with cognition cross-sectionally and with stroke, dementia, and mortality longitudinally were determined using linear regression and Cox proportional hazard modeling adjusted for age, sex, hypertension, cholesterol, lipid lowering medication, atrial fibrillation, antithrombotic medication and APOE-ε2/ε4 carriership. Additionally, we accounted for competing risks of death due to other causes for stroke and dementia, and calculated absolute risk estimates. Results: During a mean follow-up of 7.2 years, 62 participants suffered a stroke, 77 developed dementia and 298 died. Participants with a CAA score of 1 showed a lower Mini-Mental-State-Exam (fully-adjusted mean difference −0.21, 95% CI (−0.42–0.00) compared to a score of 0. In general, for increased CAA scores we saw a lower g-factor. The age and sex-adjusted hazard ratios (HRs) per point increase of the CAA score were 1.41 for stroke (95% CI, 0.99–2.00), 1.19 for dementia (95% CI, 0.86–1.65), and 1.26 for mortality (95% CI, 1.07–1.48). The results for dementia and stroke risk did not differ after correcting for the competing risk of death. For all outcomes, higher CAA scores showed higher absolute risk estimates over 10 years. Conclusions: Our results suggest that in this community-dwelling population, a higher CAA score is related to cognitive impairment and a higher risk of stroke, dementia, and death. The composite CAA score can be used to practically quantify the severity of vascular brain injury.
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Affiliation(s)
- Pinar Yilmaz
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Mohammad Kamran Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Wiro J Niessen
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Medical Informatics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, United States
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, United States
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands
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Smith EE, Biessels GJ, De Guio F, de Leeuw FE, Duchesne S, Düring M, Frayne R, Ikram MA, Jouvent E, MacIntosh BJ, Thrippleton MJ, Vernooij MW, Adams H, Backes WH, Ballerini L, Black SE, Chen C, Corriveau R, DeCarli C, Greenberg SM, Gurol ME, Ingrisch M, Job D, Lam BY, Launer LJ, Linn J, McCreary CR, Mok VC, Pantoni L, Pike GB, Ramirez J, Reijmer YD, Romero JR, Ropele S, Rost NS, Sachdev PS, Scott CJ, Seshadri S, Sharma M, Sourbron S, Steketee RM, Swartz RH, van Oostenbrugge R, van Osch M, van Rooden S, Viswanathan A, Werring D, Dichgans M, Wardlaw JM. Harmonizing brain magnetic resonance imaging methods for vascular contributions to neurodegeneration. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:191-204. [PMID: 30859119 PMCID: PMC6396326 DOI: 10.1016/j.dadm.2019.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Many consequences of cerebrovascular disease are identifiable by magnetic resonance imaging (MRI), but variation in methods limits multicenter studies and pooling of data. The European Union Joint Program on Neurodegenerative Diseases (EU JPND) funded the HARmoNizing Brain Imaging MEthodS for VaScular Contributions to Neurodegeneration (HARNESS) initiative, with a focus on cerebral small vessel disease. METHODS Surveys, teleconferences, and an in-person workshop were used to identify gaps in knowledge and to develop tools for harmonizing imaging and analysis. RESULTS A framework for neuroimaging biomarker development was developed based on validating repeatability and reproducibility, biological principles, and feasibility of implementation. The status of current MRI biomarkers was reviewed. A website was created at www.harness-neuroimaging.org with acquisition protocols, a software database, rating scales and case report forms, and a deidentified MRI repository. CONCLUSIONS The HARNESS initiative provides resources to reduce variability in measurement in MRI studies of cerebral small vessel disease.
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Affiliation(s)
- Eric E. Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - François De Guio
- Department of Neurology, Lariboisière Hospital, University Paris Diderot, Paris, France
| | - Frank Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simon Duchesne
- CERVO Research Center, Quebec Mental Health Institute, Québec, Canada
- Radiology Department, Université Laval, Québec, Canada
| | - Marco Düring
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Richard Frayne
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
- Seaman Family MR Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eric Jouvent
- Department of Neurology, Lariboisière Hospital, University Paris Diderot, Paris, France
| | - Bradley J. MacIntosh
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hieab Adams
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Walter H. Backes
- Department of Radiology & Nuclear Medicine, School for Mental Health & Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lucia Ballerini
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sandra E. Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, National University of Singapore, Singapore
| | - Rod Corriveau
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California at Davis, Davis, CA, USA
| | - Steven M. Greenberg
- J. Philip Kistler Stroke Research Center, Stroke Service and Memory Disorders Unit, Massachusetts General Hospital, Boston, MA, USA
| | - M. Edip Gurol
- J. Philip Kistler Stroke Research Center, Stroke Service and Memory Disorders Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Ingrisch
- Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Dominic Job
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Bonnie Y.K. Lam
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lenore J. Launer
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Linn
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Cheryl R. McCreary
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Seaman Family MR Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Vincent C.T. Mok
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Leonardo Pantoni
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - G. Bruce Pike
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Joel Ramirez
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Yael D. Reijmer
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jose Rafael Romero
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Natalia S. Rost
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Christopher J.M. Scott
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Mukul Sharma
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine (Neurology) McMaster University, Hamilton, Ontario, Canada
| | - Steven Sourbron
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Rebecca M.E. Steketee
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Richard H. Swartz
- Department of Medicine (Neurology), University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Robert van Oostenbrugge
- Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthias van Osch
- C.J. Gorter Center for high field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanneke van Rooden
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anand Viswanathan
- J. Philip Kistler Stroke Research Center, Stroke Service and Memory Disorders Unit, Massachusetts General Hospital, Boston, MA, USA
| | - David Werring
- University College London Queen Square institute of Neurology, London, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
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Gyanwali B, Vrooman H, Venketasubramanian N, Wong TY, Cheng CY, Chen C, Hilal S. Cerebral Small Vessel Disease and Enlarged Perivascular Spaces-Data From Memory Clinic and Population-Based Settings. Front Neurol 2019; 10:669. [PMID: 31293506 PMCID: PMC6603207 DOI: 10.3389/fneur.2019.00669] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/07/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Enlarged perivascular spaces (ePVS) are common finding on magnetic resonance imaging (MRI) in elderly. ePVS are thought to be associated with cerebral small vessel disease (SVD) such as white matter hyperintensities (WMH), lacunes, and cerebral microbleeds (CMBs). However, the different location of SVD and its relationship to ePVS distribution requires further investigation. Objective: To study the association between location and severity of SVD with ePVS from memory clinic and population-based settings. Methods: This study includes patients from an ongoing memory clinic based case-control study and participants from the population-based: Epidemiology of Dementia in Singapore study (EDIS). All participants underwent a comprehensive standardized evaluation including physical, medical and neuropsychological assessment and a brain MRI. CMBs and lacune location were categorized into strictly lobar, strictly deep and mixed, and ePVS location into centrum semiovale and basal ganglia. WMH volume was automatically segmented and was classified into anterior and posterior distribution. Negative binomial regression models were constructed to analyse associations between SVD and ePVS and the rate ratios (RR) and 95% confidence intervals (CI) were reported. Results: Of 375 patients (median age = 73 years) from memory clinic and 583 participants (median age = 70 years) from EDIS, the median total ePVS count was 17.0 and 7.0, respectively. Increased severity of SVD was not associated with total ePVS counts in both memory clinic and EDIS study. Analysis with the location of SVD and ePVS also showed similar results. However, in EDIS study, presence of ≥2 lacunes [RR = 1.61, 95% CI = 1.3, 2.30, p = 0.009], presence of ≥2 CMBs [RR = 1.40, 95% CI = 1.08, 1.83, p = 0.012], and higher volume of WMH [RR = 1.41, 95% CI = 1.10, 1.81, p = 0.006] were associated with basal ganglia ePVS independent of age, gender and vascular risk factors. Conclusion: In this study, we found that the ePVS were not associated with the location and severity of SVD in the memory-clinic patients. However, only severity of SVD was associated with basal ganglia ePVS in the population-based setting. Our findings will need to be studied further in different cohorts so as to understand the mechanism underlying different SVD types in subclinical and clinical phases as well as for predicting cognitive decline.
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Affiliation(s)
- Bibek Gyanwali
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore.,Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Henri Vrooman
- Departments of Radiology and Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Tien Yin Wong
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore.,Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Saima Hilal
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore.,Department of Pharmacology, National University of Singapore, Singapore, Singapore.,Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
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Del Brutto OH, Mera RM, Del Brutto VJ, Castillo PR. Enlarged basal ganglia perivascular spaces and sleep parameters. A population-based study. Clin Neurol Neurosurg 2019; 182:53-57. [DOI: 10.1016/j.clineuro.2019.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 01/20/2019] [Accepted: 05/05/2019] [Indexed: 11/24/2022]
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Caunca MR, De Leon-Benedetti A, Latour L, Leigh R, Wright CB. Neuroimaging of Cerebral Small Vessel Disease and Age-Related Cognitive Changes. Front Aging Neurosci 2019; 11:145. [PMID: 31316367 PMCID: PMC6610261 DOI: 10.3389/fnagi.2019.00145] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/31/2019] [Indexed: 01/04/2023] Open
Abstract
Subclinical cerebrovascular disease is frequently identified in neuroimaging studies and is thought to play a role in the pathogenesis of cognitive disorders. Identifying the etiologies of different types of lesions may help investigators differentiate between age-related and pathological cerebrovascular damage in cognitive aging. In this review article, we aim to describe the epidemiology and etiology of various brain magnetic resonance imaging (MRI) measures of vascular damage in cognitively normal, older adult populations. We focus here on population-based prospective cohort studies of cognitively unimpaired older adults, as well as discuss the heterogeneity of MRI findings and their relationships with cognition. This review article emphasizes the need for a better understanding of subclinical cerebrovascular disease in cognitively normal populations, in order to more effectively identify and prevent cognitive decline in our rapidly aging population.
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Affiliation(s)
- Michelle R Caunca
- Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, Leonard M. Miller School of Medicine, Evelyn F. McKnight Brain Institute, University of Miami, Miami, FL, United States.,Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Andres De Leon-Benedetti
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Lawrence Latour
- National Institute of Neurological Diseases and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States
| | - Richard Leigh
- National Institute of Neurological Diseases and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States
| | - Clinton B Wright
- National Institute of Neurological Diseases and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States
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29
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Enlarged perivascular spaces in brain MRI: Automated quantification in four regions. Neuroimage 2018; 185:534-544. [PMID: 30326293 DOI: 10.1016/j.neuroimage.2018.10.026] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/20/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022] Open
Abstract
Enlarged perivascular spaces (PVS) are structural brain changes visible in MRI, are common in aging, and are considered a reflection of cerebral small vessel disease. As such, assessing the burden of PVS has promise as a brain imaging marker. Visual and manual scoring of PVS is a tedious and observer-dependent task. Automated methods would advance research into the etiology of PVS, could aid to assess what a "normal" burden is in aging, and could evaluate the potential of PVS as a biomarker of cerebral small vessel disease. In this work, we propose and evaluate an automated method to quantify PVS in the midbrain, hippocampi, basal ganglia and centrum semiovale. We also compare associations between (earlier established) determinants of PVS and visual PVS scores versus the automated PVS scores, to verify whether automated PVS scores could replace visual scoring of PVS in epidemiological and clinical studies. Our approach is a deep learning algorithm based on convolutional neural network regression, and is contingent on successful brain structure segmentation. In our work we used FreeSurfer segmentations. We trained and validated our method on T2-contrast MR images acquired from 2115 subjects participating in a population-based study. These scans were visually scored by an expert rater, who counted the number of PVS in each brain region. Agreement between visual and automated scores was found to be excellent for all four regions, with intraclass correlation coefficients (ICCs) between 0.75 and 0.88. These values were higher than the inter-observer agreement of visual scoring (ICCs between 0.62 and 0.80). Scan-rescan reproducibility was high (ICCs between 0.82 and 0.93). The association between 20 determinants of PVS, including aging, and the automated scores were similar to those between the same 20 determinants of PVS and visual scores. We conclude that this method may replace visual scoring and facilitate large epidemiological and clinical studies of PVS.
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Hilal S, Tan CS, Adams HHH, Habes M, Mok V, Venketasubramanian N, Hofer E, Ikram MK, Abrigo J, Vernooij MW, Chen C, Hosten N, Volzke H, Grabe HJ, Schmidt R, Ikram MA. Enlarged perivascular spaces and cognition: A meta-analysis of 5 population-based studies. Neurology 2018; 91:e832-e842. [PMID: 30068634 DOI: 10.1212/wnl.0000000000006079] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/25/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the association of enlarged perivascular spaces (ePVS) with cognition in elderly without dementia. METHODS We included 5 studies from the Uniform Neuro-Imaging of Virchow-Robin Space Enlargement (UNIVRSE) consortium, namely the Austrian Stroke Prevention Family Study, Study of Health in Pomerania, Rotterdam Study, Epidemiology of Dementia in Singapore study, and Risk Index for Subclinical Brain Lesions in Hong Kong study. ePVS were counted in 4 regions (mesencephalon, hippocampus, basal ganglia, and centrum semiovale) with harmonized rating across studies. Mini-Mental State Examination (MMSE) and general fluid cognitive ability factor (G-factor) were used to assess cognitive function. For each study, a linear regression model was performed to estimate the effect of ePVS on MMSE and G-factor. Estimates were pooled across studies with the use of inverse variance meta-analysis with fixed- or random-effect models when appropriate. RESULTS The final sample size consisted of 3,575 persons (age range 63.4-73.2 years, 50.6% women). Total ePVS counts were not significantly associated with MMSE score (mean difference per ePVS score increase 0.001, 95% confidence interval [CI] -0.007 to 0.008, p = 0.885) or G-factor (mean difference per ePVS score increase 0.002, 95% CI -0.001 to 0.006, p = 0.148) in age-, sex-, and education-adjusted models. Adjustments for cardiovascular risk factors and MRI markers did not change the results. Repeating the analyses with region-specific ePVS rendered similar results. CONCLUSIONS In this study, we found that ePVS counts were not associated with cognitive dysfunction in the general population. Future studies with longitudinal designs are warranted to examine whether ePVS contribute to cognitive decline.
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Affiliation(s)
- Saima Hilal
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Chuen Seng Tan
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Hieab H H Adams
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Mohamad Habes
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Vincent Mok
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Narayanaswamy Venketasubramanian
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Edith Hofer
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - M Kamran Ikram
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Jill Abrigo
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Meike W Vernooij
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Christopher Chen
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Norbert Hosten
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Henry Volzke
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Hans J Grabe
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - Reinhold Schmidt
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany
| | - M Arfan Ikram
- From the Departments of Radiology and Nuclear Medicine (S.H., H.H.H.A., M.W.V., M.A.I.), Epidemiology (S.H., H.H.H.A., M.K.I., M.W.V., M.A.I.), and Neurology (M.K.I., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pharmacology (S.H., C.C.), National University of Singapore; Memory, Aging and Cognition Center (S.H., C.C.), National University Health System; Saw Swee Hock School of Public Health (C.S.T.), National University of Singapore; Department of Radiology (M.H.), University of Pennsylvania, Philadelphia; Department of Psychiatry and Psychotherapy (M.H., H.J.G.), Institute for Community Medicine (M.H., H.V., H.J.G.), and Institute of Diagnostic Radiology and Neuroradiology (N.H.), University Medicine Greifswald, Germany; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M.), LuiChe Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Centre; Department of Medicine and Therapeutics (V.M.) and Department of Imaging & Interventional Radiology (J.A.), Chinese University of Hong Kong, China; Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore; Department of Neurology (E.H.), Medical University of Graz, Austria; and German Center for Neurodegenerative Diseases (DZNE) (R.S.), Site Rostock/Greifswald, Germany.
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Duperron MG, Tzourio C, Sargurupremraj M, Mazoyer B, Soumaré A, Schilling S, Amouyel P, Chauhan G, Zhu YC, Debette S. Burden of Dilated Perivascular Spaces, an Emerging Marker of Cerebral Small Vessel Disease, Is Highly Heritable. Stroke 2018; 49:282-287. [PMID: 29311265 DOI: 10.1161/strokeaha.117.019309] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The genetic contribution to dilated perivascular space (dPVS) burden-an emerging MRI marker of cerebral small vessel disease-is unknown. We measured the heritability of dPVS burden and its shared heritability with other MRI markers of cerebral small vessel disease. METHODS The study sample comprised 1597 participants from the population-based Three City (3C) Dijon Study, with brain MRI and genome-wide genotyping (mean age, 72.8±4.1 years; 61% women). dPVS burden and lacunar brain infarcts were rated on a semiquantitative scale, whereas an automated algorithm generated white matter hyperintensity volume (WMHV). We estimated dPVS burden heritability and shared heritability with WMHV and lacunar brain infarcts using the genome-wide complex trait analysis tool, on unrelated participants, adjusting for age, sex, intracranial volume, and principal components of population stratification. RESULTS dPVS burden was significantly correlated with WMHV and lacunar brain infarcts, the strongest correlation being found between WMHV and dPVS in basal ganglia. Heritability estimates were h2=0.59±0.24 (P=0.007) for dPVS burden, h2=0.54±0.24 (P=0.010) for WMHV, and h2=0.48±0.81 (P=0.278) for lacunar brain infarcts. We found a nonsignificant trend toward shared heritability between dPVS and WMHV (rg=0.41±0.28; P=0.096), which seemed driven by dPVS in basal ganglia (rg=0.72±0.61; P=0.126) and not dPVS in white matter (rg=-0.10±0.36; P=0.393). A genetic risk score for WMHV based on published loci was associated with increased dPVS burden in basal ganglia (P=0.031). CONCLUSIONS We provide evidence for important genetic contribution to dPVS burden in older community-dwelling people, some of which may be shared with WMHV. Differential heritability patterns for dPVS in white matter and basal ganglia suggest at least partly distinct underlying biological processes.
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Affiliation(s)
- Marie-Gabrielle Duperron
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Christophe Tzourio
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Muralidharan Sargurupremraj
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Bernard Mazoyer
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Aïcha Soumaré
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Sabrina Schilling
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Philippe Amouyel
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Ganesh Chauhan
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Yi-Cheng Zhu
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Stéphanie Debette
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.).
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Del Brutto OH, Mera RM. Enlarged perivascular spaces in the basal ganglia are independently associated with intracranial atherosclerosis in the elderly. Atherosclerosis 2017; 267:34-38. [DOI: 10.1016/j.atherosclerosis.2017.10.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/11/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
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Mufford MS, Stein DJ, Dalvie S, Groenewold NA, Thompson PM, Jahanshad N. Neuroimaging genomics in psychiatry-a translational approach. Genome Med 2017; 9:102. [PMID: 29179742 PMCID: PMC5704437 DOI: 10.1186/s13073-017-0496-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Neuroimaging genomics is a relatively new field focused on integrating genomic and imaging data in order to investigate the mechanisms underlying brain phenotypes and neuropsychiatric disorders. While early work in neuroimaging genomics focused on mapping the associations of candidate gene variants with neuroimaging measures in small cohorts, the lack of reproducible results inspired better-powered and unbiased large-scale approaches. Notably, genome-wide association studies (GWAS) of brain imaging in thousands of individuals around the world have led to a range of promising findings. Extensions of such approaches are now addressing epigenetics, gene–gene epistasis, and gene–environment interactions, not only in brain structure, but also in brain function. Complementary developments in systems biology might facilitate the translation of findings from basic neuroscience and neuroimaging genomics to clinical practice. Here, we review recent approaches in neuroimaging genomics—we highlight the latest discoveries, discuss advantages and limitations of current approaches, and consider directions by which the field can move forward to shed light on brain disorders.
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Affiliation(s)
- Mary S Mufford
- UCT/MRC Human Genetics Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, 7925
| | - Dan J Stein
- MRC Unit on Risk and Resilience, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, 7925.,Department of Psychiatry and Mental Health, Groote Schuur Hospital, Cape Town, South Africa, 7925
| | - Shareefa Dalvie
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, 7925
| | - Nynke A Groenewold
- Department of Psychiatry and Mental Health, Groote Schuur Hospital, Cape Town, South Africa, 7925
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, 90292, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, 90292, USA.
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Favaretto A, Lazzarotto A, Riccardi A, Pravato S, Margoni M, Causin F, Anglani MG, Seppi D, Poggiali D, Gallo P. Enlarged Virchow Robin spaces associate with cognitive decline in multiple sclerosis. PLoS One 2017; 12:e0185626. [PMID: 29045421 PMCID: PMC5646763 DOI: 10.1371/journal.pone.0185626] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/15/2017] [Indexed: 11/19/2022] Open
Abstract
The clinical significance of Virchow Robin spaces (VRS) in inflammatory brain disorders, especially in multiple sclerosis (MS), is still undefined. We analysed enlarged VRS (eVRS) by means of phase sensitive inversion recovery (PSIR) MRI sequence and investigated their association with inflammation or brain atrophy, and to clinical or physical disability. Forty-three MS patients (21 clinically isolated syndrome suggestive of MS [CIS], 15 RRMS, 7 progressive [PMS]) and 10 healthy controls (HC) were studied. 3DT1, 3DFLAIR and 2DPSIR images were obtained with a 3T MRI scanner. eVRS number and volume were calculated by manual segmentation (ITK-SNAP). Freesurfer was used to assess brain parenchymal fraction (BPF). All patients underwent clinical (EDSS) and cognitive (Rao’s BRB and DKEFS) evaluation. eVRS number and volume resulted significantly higher on 2D-PSIR compared to both 3D-T1 (p<0.001) and 3D-FLAIR (p<0.001) and were significantly increased in CIS compared to HC (p<0.05), in PMS and RRMS compared to CIS (p<0.001) and in male versus female patients (p<0.05). eVRS volume increased significantly with disease duration (r = 0.6) but did not correlate with EDSS. eVRS significantly correlated with SPARTd (r = -0.47) and DKEFSfs (r = -0.46), especially when RRMS and PMS were merged in a single group (r = 0.89, p = 0.002 and r = 0.66, p = 0.009 respectively), while no correlation was found with BPF (r = 0.3), gadolinium-enhancing lesions (r = 0.2) and WMT2 lesion volume (r = 0.2). 2DPSIR allowed the detection of an impressive higher number of eVRS compared to 3DT1 and 3DFLAIR. eVRS associate with SPARTd and DKEFSfs failure in relapse-onset MS, suggesting they may contribute to cognitive decline in MS.
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Affiliation(s)
- Alice Favaretto
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, University Hospital of Padova–Medical School, Padova, Italy
| | - Andrea Lazzarotto
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, University Hospital of Padova–Medical School, Padova, Italy
| | - Alice Riccardi
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, University Hospital of Padova–Medical School, Padova, Italy
| | - Stefano Pravato
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, University Hospital of Padova–Medical School, Padova, Italy
| | - Monica Margoni
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, University Hospital of Padova–Medical School, Padova, Italy
| | - Francesco Causin
- Neuroradiology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | | | - Dario Seppi
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, University Hospital of Padova–Medical School, Padova, Italy
| | - Davide Poggiali
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, University Hospital of Padova–Medical School, Padova, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, University Hospital of Padova–Medical School, Padova, Italy
- * E-mail:
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Staffaroni AM, Elahi FM, McDermott D, Marton K, Karageorgiou E, Sacco S, Paoletti M, Caverzasi E, Hess CP, Rosen HJ, Geschwind MD. Neuroimaging in Dementia. Semin Neurol 2017; 37:510-537. [PMID: 29207412 PMCID: PMC5823524 DOI: 10.1055/s-0037-1608808] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Although the diagnosis of dementia still is primarily based on clinical criteria, neuroimaging is playing an increasingly important role. This is in large part due to advances in techniques that can assist with discriminating between different syndromes. Magnetic resonance imaging remains at the core of differential diagnosis, with specific patterns of cortical and subcortical changes having diagnostic significance. Recent developments in molecular PET imaging techniques have opened the door for not only antemortem but early, even preclinical, diagnosis of underlying pathology. This is vital, as treatment trials are underway for pharmacological agents with specific molecular targets, and numerous failed trials suggest that earlier treatment is needed. This article provides an overview of classic neuroimaging findings as well as new and cutting-edge research techniques that assist with clinical diagnosis of a range of dementia syndromes, with an emphasis on studies using pathologically proven cases.
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Affiliation(s)
- Adam M. Staffaroni
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Fanny M. Elahi
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Dana McDermott
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Kacey Marton
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Elissaios Karageorgiou
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
- Neurological Institute of Athens, Athens, Greece
| | - Simone Sacco
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
- Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Matteo Paoletti
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
- Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Eduardo Caverzasi
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Christopher P. Hess
- Division of Neuroradiology, Department of Radiology, University of California, San Francisco (UCSF), California
| | - Howard J. Rosen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Michael D. Geschwind
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
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Ikram MA, Brusselle GGO, Murad SD, van Duijn CM, Franco OH, Goedegebure A, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BH, Tiemeier H, Uitterlinden AG, Vernooij MW, Hofman A. The Rotterdam Study: 2018 update on objectives, design and main results. Eur J Epidemiol 2017; 32:807-850. [PMID: 29064009 PMCID: PMC5662692 DOI: 10.1007/s10654-017-0321-4] [Citation(s) in RCA: 329] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sarwa Darwish Murad
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Gastro-Enterology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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37
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Dichgans M, Leys D. Vascular Cognitive Impairment. Circ Res 2017; 120:573-591. [PMID: 28154105 DOI: 10.1161/circresaha.116.308426] [Citation(s) in RCA: 291] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/28/2016] [Accepted: 08/29/2016] [Indexed: 01/10/2023]
Abstract
Cerebrovascular disease typically manifests with stroke, cognitive impairment, or both. Vascular cognitive impairment refers to all forms of cognitive disorder associated with cerebrovascular disease, regardless of the specific mechanisms involved. It encompasses the full range of cognitive deficits from mild cognitive impairment to dementia. In principle, any of the multiple causes of clinical stroke can cause vascular cognitive impairment. Recent work further highlights a role of microinfarcts, microhemorrhages, strategic white matter tracts, loss of microstructural tissue integrity, and secondary neurodegeneration. Vascular brain injury results in loss of structural and functional connectivity and, hence, compromise of functional networks within the brain. Vascular cognitive impairment is common both after stroke and in stroke-free individuals presenting to dementia clinics, and vascular pathology frequently coexists with neurodegenerative pathology, resulting in mixed forms of mild cognitive impairment or dementia. Vascular dementia is now recognized as the second most common form of dementia after Alzheimer's disease, and there is increasing awareness that targeting vascular risk may help to prevent dementia, even of the Alzheimer type. Recent advances in neuroimaging, neuropathology, epidemiology, and genetics have led to a deeper understanding of how vascular disease affects cognition. These new findings provide an opportunity for the present reappraisal of vascular cognitive impairment. We further briefly address current therapeutic concepts.
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Affiliation(s)
- Martin Dichgans
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.).
| | - Didier Leys
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.)
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Ikram MA, van der Lugt A, Niessen WJ, Koudstaal PJ, Krestin GP, Hofman A, Bos D, Vernooij MW. The Rotterdam Scan Study: design update 2016 and main findings. Eur J Epidemiol 2015; 30:1299-315. [PMID: 26650042 PMCID: PMC4690838 DOI: 10.1007/s10654-015-0105-7] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/25/2015] [Indexed: 12/20/2022]
Abstract
Imaging plays an essential role in research on neurological diseases in the elderly. The Rotterdam Scan Study was initiated as part of the ongoing Rotterdam Study with the aim to elucidate the causes of neurological disease by performing imaging of the brain in a prospective population-based setting. Initially, in 1995 and 1999, random subsamples of participants from the Rotterdam Study underwent neuroimaging, whereas from 2005 onwards MRI has been implemented into the core protocol of the Rotterdam Study. In this paper, we discuss the background and rationale of the Rotterdam Scan Study. Moreover, we describe the imaging protocol, image post-processing techniques, and the main findings to date. Finally, we provide recommendations for future research, which will also be topics of investigation in the Rotterdam Scan Study.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Biomedical Imaging Group Rotterdam, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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