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Wang Y, Liu Z. Research progress on the correlation between MRI and impairment caused by cerebral small vessel disease: A review. Medicine (Baltimore) 2023; 102:e35389. [PMID: 37800770 PMCID: PMC10553107 DOI: 10.1097/md.0000000000035389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is a chronic global brain disease mainly involving small blood vessels in the brain. The disease can be gradually aggravated with the increase of age, so it is the primary cause of brain dysfunction in the elderly. With the increasing aging of the world population and the high incidence of cerebrovascular risk factors, the incidence of CSVD is increasing day by day. CSVD is characterized by insidious onset, slow progression, diverse clinical manifestations, and difficult early diagnosis. CSVD can lead to cognitive impairment, gait impairment, affective impairment, and so on. however, it has not received enough attention from researchers in the past. In recent years, some studies have shown that CSVD patients have a high proportion of related impairment, which seriously affect patients daily life and social functions. Currently, no clear preventive measures or treatments exist to improve the condition. With the development of magnetic resonance imaging, CSVD has become more and more recognized and the detection rate has gradually improved. This paper reviews the research progress of magnetic resonance imaging and cognitive impairment, gait impairment, affective impairment, urination disorder, swallowing disorder, and other disorders to provide a useful reference for the early diagnosis and treatment of CSVD and expand new ideas.
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Affiliation(s)
- Yang Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- Department of Neurology, 980th Hospital of PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Zhirong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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2
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Wen D, Xu Y. Comprehensive investigations of cerebral hemodynamic responses in CSVD patients with mental disorders: a pilot study. Front Psychiatry 2023; 14:1229436. [PMID: 37795515 PMCID: PMC10546028 DOI: 10.3389/fpsyt.2023.1229436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
Although a portion of patients with cerebral small vessel disease (CSVD) present mental disorders, there is currently a lack of appropriate technologies to evaluate brain functions that are relevant to neurovascular coupling. Furthermore, there are no established objective criteria for diagnosing and distinguishing CSVD-induced mental disorders and psychiatric diseases. In this study, we report the first comprehensive investigation of the cerebral hemodynamics of CSVD patients who also presented with mental disorders. Two CSVD patients with similar magnetic resonance imaging (MRI) outcomes but with non-identical mental symptoms participated in this study. The patients were instructed to perform the verbal fluency task (VFT), high-level cognition task (HCT), as well as voluntary breath holding (VBH). A functional near-infrared spectroscopy (fNIRS) was used to measure the cerebral oxygenation responses. Additionally, a diffuse correlation spectroscopy (DCS) was used to measure the cerebral blood flow (CBF) responses. Both technologies were also applied to a healthy subject for comparison. The fNIRS results showed that both CSVD patients presented abnormal cerebral oxygenation responses during the VFT, HCT, and VBH tasks. Moreover, the patient with cognition impairment showed fluctuations in CBF during these tasks. In contrast, the patient without cognition impairment mostly presented typical CBF responses during the tasks, which was consistent with the healthy subject. The cognitive impairment in CSVD patients may be due to the decoupling of the neurons from the cerebrovascular, subsequently affecting the autoregulation capacity. The results of the fNIRS and DCS combined provide a comprehensive evaluation of the neurovascular coupling and, hence, offer great potential in diagnosing cerebrovascular or psychiatric diseases.
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Affiliation(s)
- Dan Wen
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Psychiatry, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yong Xu
- Department of Psychiatry, Shanxi Medical University, Taiyuan, Shanxi, China
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Özel F, Hilal S, de Feijter M, van der Velpen I, Direk N, Ikram MA, Vernooij MW, Luik AI. Associations of neuroimaging markers with depressive symptoms over time in middle-aged and elderly persons. Psychol Med 2023; 53:4355-4363. [PMID: 35534463 PMCID: PMC10388307 DOI: 10.1017/s003329172200112x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Cerebrovascular disease is regarded as a potential cause of late-life depression. Yet, evidence for associations of neuroimaging markers of vascular brain disease with depressive symptoms is inconclusive. We examined the associations of neuroimaging markers and depressive symptoms in a large population-based study of middle-aged and elderly persons over time. METHODS A total of 4943 participants (mean age = 64.6 ± 11.1 years, 55.7% women) from the Rotterdam Study were included. At baseline, total brain volume, gray matter volume, white matter volume, white matter hyperintensities volume, cortical infarcts, lacunar infarcts, microbleeds, white matter fractional anisotropy, and mean diffusivity (MD) were measured with a brain MRI (1.5T). Depressive symptoms were assessed twice with the Center for Epidemiologic Studies Depression scale (median follow-up time: 5.5 years, IQR = 0.9). To assess temporal associations of neuroimaging markers and depressive symptoms, linear mixed models were used. RESULTS A smaller total brain volume (β = -0.107, 95% CI -0.192 to -0.022), larger white matter hyperintensities volume (β = 0.047, 95% CI 0.010-0.084), presence of cortical infarcts (β = 0.194, 95% CI 0.047-0.341), and higher MD levels (β = 0.060, 95% CI 0.022-0.098) were cross-sectionally associated with more depressive symptoms. Longitudinal analyses showed that small total brain volume (β = -0.091, 95% CI -0.167 to -0.015) and presence of cortical infarcts (β = 0.168, 95% CI 0.022-0.314) were associated with increasing depressive symptoms over time. After stratification on age, effect sizes were more pronounced at older ages. CONCLUSIONS Neuroimaging markers of white matter microstructural damage were associated with depressive symptoms longitudinally in this study of middle-aged and elderly persons. These associations were more pronounced at older ages, providing evidence for the role of white matter structure in late-life depressive symptomatology.
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Affiliation(s)
- Fatih Özel
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maud de Feijter
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabelle van der Velpen
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nese Direk
- Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul University, Istanbul, Turkey
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annemarie I. Luik
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Botz J, Lohner V, Schirmer MD. Spatial patterns of white matter hyperintensities: a systematic review. Front Aging Neurosci 2023; 15:1165324. [PMID: 37251801 PMCID: PMC10214839 DOI: 10.3389/fnagi.2023.1165324] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background White matter hyperintensities are an important marker of cerebral small vessel disease. This disease burden is commonly described as hyperintense areas in the cerebral white matter, as seen on T2-weighted fluid attenuated inversion recovery magnetic resonance imaging data. Studies have demonstrated associations with various cognitive impairments, neurological diseases, and neuropathologies, as well as clinical and risk factors, such as age, sex, and hypertension. Due to their heterogeneous appearance in location and size, studies have started to investigate spatial distributions and patterns, beyond summarizing this cerebrovascular disease burden in a single metric-its volume. Here, we review the evidence of association of white matter hyperintensity spatial patterns with its risk factors and clinical diagnoses. Design/methods We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. We used the standards for reporting vascular changes on neuroimaging criteria to construct a search string for literature search on PubMed. Studies written in English from the earliest records available until January 31st, 2023, were eligible for inclusion if they reported on spatial patterns of white matter hyperintensities of presumed vascular origin. Results A total of 380 studies were identified by the initial literature search, of which 41 studies satisfied the inclusion criteria. These studies included cohorts based on mild cognitive impairment (15/41), Alzheimer's disease (14/41), Dementia (5/41), Parkinson's disease (3/41), and subjective cognitive decline (2/41). Additionally, 6 of 41 studies investigated cognitively normal, older cohorts, two of which were population-based, or other clinical findings such as acute ischemic stroke or reduced cardiac output. Cohorts ranged from 32 to 882 patients/participants [median cohort size 191.5 and 51.6% female (range: 17.9-81.3%)]. The studies included in this review have identified spatial heterogeneity of WMHs with various impairments, diseases, and pathologies as well as with sex and (cerebro)vascular risk factors. Conclusion The results show that studying white matter hyperintensities on a more granular level might give a deeper understanding of the underlying neuropathology and their effects. This motivates further studies examining the spatial patterns of white matter hyperintensities.
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Affiliation(s)
- Jonas Botz
- Computational Neuroradiology, Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, Germany
| | - Valerie Lohner
- Cardiovascular Epidemiology of Aging, Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Markus D. Schirmer
- Computational Neuroradiology, Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Reiländer A, Pilatus U, Schüre JR, Shrestha M, Deichmann R, Nöth U, Hattingen E, Gracien RM, Wagner M, Seiler A. Impaired oxygen extraction and adaptation of intracellular energy metabolism in cerebral small vessel disease. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 4:100162. [PMID: 36851996 PMCID: PMC9957754 DOI: 10.1016/j.cccb.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND We aimed to investigate whether combined phosphorous (31P) magnetic resonance spectroscopic imaging (MRSI) and quantitative T 2 ' mapping are able to detect alterations of the cerebral oxygen extraction fraction (OEF) and intracellular pH (pHi) as markers the of cellular energy metabolism in cerebral small vessel disease (SVD). MATERIALS AND METHODS 32 patients with SVD and 17 age-matched healthy control subjects were examined with 3-dimensional 31P MRSI and oxygenation-sensitive quantitative T 2 ' mapping (1/ T 2 ' = 1/T2* - 1/T2) at 3 Tesla (T). PHi was measured within the white matter hyperintensities (WMH) in SVD patients. Quantitative T 2 ' values were averaged across the entire white matter (WM). Furthermore, T 2 ' values were extracted from normal-appearing WM (NAWM) and the WMH and compared between patients and controls. RESULTS Quantitative T 2 ' values were significantly increased across the entire WM and in the NAWM in patients compared to control subjects (149.51 ± 16.94 vs. 138.19 ± 12.66 ms and 147.45 ± 18.14 vs. 137.99 ± 12.19 ms, p < 0.05). WM T 2 ' values correlated significantly with the WMH load (ρ=0.441, p = 0.006). Increased T 2 ' was significantly associated with more alkaline pHi (ρ=0.299, p < 0.05). Both T 2 ' and pHi were significantly positively correlated with vascular pulsatility in the distal carotid arteries (ρ=0.596, p = 0.001 and ρ=0.452, p = 0.016). CONCLUSIONS This exploratory study found evidence of impaired cerebral OEF in SVD, which is associated with intracellular alkalosis as an adaptive mechanism. The employed techniques provide new insights into the pathophysiology of SVD with regard to disease-related consequences on the cellular metabolic state.
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Key Words
- BBB, blood-brain barrier
- CBF, cerebral blood flow
- CBV, cerebral blood volume
- CMRO2, Cerebral metabolic rate of oxygen
- Cellular energy metabolism
- DTI, diffusion tensor imaging
- GE, gradient echo
- Hb, hemoglobin
- ICA, internal carotid artery
- MR spectroscopy
- MRI, magnetic resonance imaging
- MRS, magnetic resonance spectroscopy
- MRSI, magnetic resonance spectroscopic imaging
- Microstructural impairment
- NAWM, normal-appearing white matter
- OEF, oxygen extraction fraction
- Oxygen extraction fraction
- PI, Pulsatility index
- RF, radio frequency
- SVD, cerebral small vessel disease
- Small vessel disease
- TR, repetition time
- WM, white matter
- WMH, white matter hyperintensities
- pHi, intracellular pH
- quantitative MRI
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Affiliation(s)
- Annemarie Reiländer
- Department of Neurology, Goethe University Hospital Frankfurt, Schleusenweg 2-16, Frankfurt 60528, Germany
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Jan-Rüdiger Schüre
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Manoj Shrestha
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Hospital Frankfurt, Schleusenweg 2-16, Frankfurt 60528, Germany
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Marlies Wagner
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Alexander Seiler
- Department of Neurology, Goethe University Hospital Frankfurt, Schleusenweg 2-16, Frankfurt 60528, Germany
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
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Huo Y, Wang Y, Guo C, Liu Q, Shan L, Liu M, Wu H, Li G, Lv H, Lu L, Zhou Y, Feng J, Han Y. Deep white matter hyperintensity is spatially correlated to MRI-visible perivascular spaces in cerebral small vessel disease on 7 Tesla MRI. Stroke Vasc Neurol 2022; 8:144-150. [PMID: 36170993 PMCID: PMC10176991 DOI: 10.1136/svn-2022-001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/14/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The association between perivascular space (PVS) and white matter hyperintensity (WMH) has been unclear. Normal-appearing white matter (NAWM) around WMH is also found correlated with the development of focal WMH. This study aims to investigate the topological connections among PVS, deep WMH (dWMH) and NAWM around WMH using 7 Tesla (7T) MRI. METHODS Thirty-two patients with non-confluent WMHs and 16 subjects without WMHs were recruited from our department and clinic. We compared the PVS burden between patients with and without WMHs using a 5-point scale. Then, the dilatation and the number of PVS within a radius of 1 cm around each dWMH were compared with those of a reference site (without WMH) in the contralateral hemisphere. In this study, we define NAWM as an area within the radius of 1 cm around each dWMH. Furthermore, we assessed the spatial relationship between dWMH and PVS. RESULTS Higher PVS scores in the centrum semiovale were found in patients with >5 dWMHs (median 3) than subjects without dWMH (median 2, p = 0.014). We found there was a greater dilatation and a higher number of PVS in NAWM around dWMH than at the reference sites (p<0.001, p<0.001). In addition, 79.59% of the dWMHs were spatially connected with PVS. CONCLUSION dWMH, NAWM surrounding WMH and MRI-visible PVS are spatially correlated in the early stage of cerebral small vessel disease. Future study of WMH and NAWM should not overlook MRI-visible PVS.
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Affiliation(s)
- Yajing Huo
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yilin Wang
- Georgetown Preparatory School, North Bethesda, Maryland, USA
| | - Cen Guo
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qianyun Liu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lili Shan
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mingyuan Liu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haibo Wu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guanwu Li
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huihui Lv
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingdan Lu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yintin Zhou
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Yan Han
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Reduced white matter microstructural integrity in prediabetes and diabetes: A population-based study. EBioMedicine 2022; 82:104144. [PMID: 35810560 PMCID: PMC9278067 DOI: 10.1016/j.ebiom.2022.104144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/06/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background White matter (WM) microstructural abnormalities have been observed in diabetes. However, evidence of prediabetes is currently lacking. This study aims to investigate the WM integrity in prediabetes and diabetes. We also assess the association of WM abnormalities with glucose metabolism status and continuous glucose measures. Methods The WM integrity was analyzed using cross-sectional baseline data from a population-based PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study. The cohort, including a total of 2218 cases with the mean age of 61.3 ± 6.6 years and 54.1% female, consisted of 1205 prediabetes which are categorized into two subgroups (a group of 254 prediabetes with combined impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and the other group of 951 prediabetes without combined IFG/IGT), 504 diabetes, and 509 normal control subjects. Alterations of WM integrity were determined by diffusion tensor imaging along with tract-based spatial statistics analysis to compare diffusion metrics on WM skeletons between groups. The mixed-effects multivariate linear regression models were used to assess the association between WM microstructural alterations and glucose status. Findings Microstructural abnormalities distributed in local WM tracts in prediabetes with combined IFG/IGT and spread widely in diabetes. These WM abnormalities are associated with higher glucose measures. Interpretation Our findings suggest that WM microstructural abnormalities are already present at the prediabetes with combined IFG/IGT stage. Preventative strategies should begin early to maintain normal glucose metabolism and avert further destruction of WM integrity. Funding Partially supported by National Key R&D Program of China (2016YFC0901002).
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da Silva PHR, Paschoal AM, Secchinatto KF, Zotin MCZ, Dos Santos AC, Viswanathan A, Pontes-Neto OM, Leoni RF. Contrast agent-free state-of-the-art magnetic resonance imaging on cerebral small vessel disease - Part 2: Diffusion tensor imaging and functional magnetic resonance imaging. NMR IN BIOMEDICINE 2022; 35:e4743. [PMID: 35429070 DOI: 10.1002/nbm.4743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
Cerebral small vessel disease (cSVD) has been widely studied using conventional magnetic resonance imaging (MRI) methods, although the association between MRI findings and clinical features of cSVD is not always concordant. We assessed the additional contribution of contrast agent-free, state-of-the-art MRI techniques, particularly diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI), to understand brain damage and structural and functional connectivity impairment related to cSVD. We performed a review following the PICOS worksheet and Search Strategy, including 152 original papers in English, published from 2000 to 2022. For each MRI method, we extracted information about their contributions regarding the origins, pathology, markers, and clinical outcomes in cSVD. In general, DTI studies have shown that changes in mean, radial, and axial diffusivity measures are related to the presence of cSVD. In addition to the classical deficit in executive functions and processing speed, fMRI studies indicate connectivity dysfunctions in other domains, such as sensorimotor, memory, and attention. Neuroimaging metrics have been correlated with the diagnosis, prognosis, and rehabilitation of patients with cSVD. In short, the application of contrast agent-free, state-of-the-art MRI techniques has provided a complete picture of cSVD markers and tools to explore questions that have not yet been clarified about this clinical condition. Longitudinal studies are desirable to look for causal relationships between image biomarkers and clinical outcomes.
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Affiliation(s)
| | - André Monteiro Paschoal
- Department of Physics, FFCLRP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Maria Clara Zanon Zotin
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antônio Carlos Dos Santos
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Anand Viswanathan
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Octavio M Pontes-Neto
- Department of Neurosciences and Behavioral Science, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Renata Ferranti Leoni
- Department of Physics, FFCLRP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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9
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Lohner V, Pehlivan G, Sanroma G, Miloschewski A, Schirmer MD, Stöcker T, Reuter M, Breteler MMB. The Relation Between Sex, Menopause, and White Matter Hyperintensities: The Rhineland Study. Neurology 2022; 99:e935-e943. [PMID: 35768207 DOI: 10.1212/wnl.0000000000200782] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Mounting evidence implies that there are sex differences in white matter hyperintensity (WMH) burden in the elderly. Questions remain regarding possible differences in WMH burden between men and women of younger age, sex-specific age trajectories and effects of (un)controlled hypertension, and the effect of menopause on WMH. Therefore, our aim is to investigate these sex differences and age-dependencies in WMH load across the adult life span, and to examine the effect of menopause. METHODS This cross-sectional analysis was based on participants of the population-based Rhineland Study (30 - 95 years) who underwent brain MRI. We automatically quantified WMH using T1-weighted, T2-weighted and FLAIR images. Menopausal status was self-reported. We examined associations of sex and menopause with WMH load (logit-transformed and z-standardised) using linear regression models, while adjusting for age, age-squared, and vascular risk factors. We checked for an age*sex and (un)controlled hypertension*sex interaction and stratified for menopausal status comparing men with premenopausal women (persons aged ≤ 59 years), men with postmenopausal women (persons aged ≥ 45 years), and pre- with postmenopausal women (age range 45 - 59 years). RESULTS Of 3410 participants with a mean age of 54.3 years (SD = 13.7), 1973 (57.9%) were women, of which 1167 (59.1%) were postmenopausal. We found that the increase in WMH load accelerates with age and in a sex-dependent way. Premenopausal women and men of similar age did not differ in WMH burden. WMH burden was higher and accelerated faster in postmenopausal women compared to men of similar age. Additionally, we observed changes related to menopause, in that postmenopausal women had more WMH than premenopausal women of similar age.. Women with uncontrolled hypertension had a higher WMH burden compared to men, which was unrelated to menopausal status. DISCUSSION After menopause, women displayed a higher burden of WMH than contemporary premenopausal women and men, and an accelerated increase in WMH. Sex-specific effects of uncontrolled hypertension on WMH were not related to menopause. Further studies are warranted to investigate menopause-related physiological changes, that may inform on causal mechanisms involved in cerebral small vessel disease progression.
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Affiliation(s)
- Valerie Lohner
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Gökhan Pehlivan
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Gerard Sanroma
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Anne Miloschewski
- Statistics and Machine Learning, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Markus D Schirmer
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.,Clinic for Neuroradiology, University Hospital Bonn, Germany
| | - Tony Stöcker
- MR Physics, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Physics and Astronomy, University of Bonn, Bonn, Germany
| | - Martin Reuter
- Image Analysis, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Monique M B Breteler
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany .,Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, Germany
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10
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Castello JP, Pasi M, Kubiszewski P, Abramson JR, Charidimou A, Kourkoulis C, DiPucchio Z, Schwab K, Anderson CD, Gurol ME, Greenberg SM, Rosand J, Viswanathan A, Biffi A. Cerebral Small Vessel Disease and Depression Among Intracerebral Hemorrhage Survivors. Stroke 2022; 53:523-531. [PMID: 34587793 PMCID: PMC8792169 DOI: 10.1161/strokeaha.121.035488] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage (ICH) is an acute manifestation of cerebral small vessel disease (CSVD), usually cerebral amyloid angiopathy or hypertensive arteriopathy. CSVD-related imaging findings are associated with increased depression incidence in the general population. Neuroimaging may, therefore, provide insight on depression risk among ICH survivors. We sought to determine whether CSVD CT and magnetic resonance imaging markers are associated with depression risk (before and after ICH), depression remission, and effectiveness of antidepressant treatment. METHODS We analyzed data from the single-center longitudinal ICH study conducted at Massachusetts General Hospital. Participants underwent CT and magnetic resonance imaging imaging and were followed longitudinally. We extracted information for neuroimaging markers of CSVD subtype and severity. Outcomes of interest included pre-ICH depression, new-onset depression after ICH, resolution of depressive symptoms, and response to antidepressant treatment. RESULTS We followed 612 ICH survivors for a median of 47.2 months. Multiple CSVD-related markers were associated with depression risk. Survivors of cerebral amyloid angiopathy-related lobar ICH were more likely to be diagnosed with depression before ICH (odds ratio, 1.68 [95% CI, 1.14-2.48]) and after ICH (sub-hazard ratio, 1.52 [95% CI, 1.12-2.07]), less likely to achieve remission of depressive symptoms (sub-hazard ratio, 0.69 [95% CI, 0.51-0.94]), and to benefit from antidepressant therapy (P=0.041). Cerebral amyloid angiopathy disease burden on magnetic resonance imaging was associated with depression incidence and treatment resistance (interaction P=0.037), whereas hypertensive arteriopathy disease burden was only associated with depression incidence after ICH. CONCLUSIONS CSVD severity is associated with depression diagnosis, both before and after ICH. Cerebral amyloid angiopathy-related ICH survivors are more likely to experience depression (both before and after ICH) than patients diagnosed with hypertensive arteriopathy-related ICH, and more likely to report persistent depressive symptoms and display resistance to antidepressant treatment.
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Affiliation(s)
- Juan Pablo Castello
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Marco Pasi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Univ.Lille, Inserm, CHU Lille, U 1172 - LilNCog - Lille Neuroscience and Cognition, F-59000 Lille, France
| | - Patryk Kubiszewski
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica R. Abramson
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Christina Kourkoulis
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Zora DiPucchio
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher D. Anderson
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - M. Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M. Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Boston, MA, USA,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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11
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Huang H, Zhao K, Zhu W, Li H, Zhu W. Abnormal Cerebral Blood Flow and Functional Connectivity Strength in Subjects With White Matter Hyperintensities. Front Neurol 2021; 12:752762. [PMID: 34744987 PMCID: PMC8564178 DOI: 10.3389/fneur.2021.752762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
White matter hyperintensities (WMHs) are common neuroimaging findings in the aging population and are associated with various clinical symptoms, especially cognitive impairment. Abnormal global cerebral blood flow (CBF) and specific functional connections have been reported in subjects with higher WMH loads. Nevertheless, the comprehensive functional mechanisms underlying WMH are yet to be established. In this study, by combining resting-state functional magnetic resonance imaging and arterial spin labeling, we investigated the neurovascular dysfunction in subjects with WMH in CBF, functional connectivity strength (FCS), and CBF–FCS coupling. The whole-brain alterations of all these measures were explored among non-dementia subjects with different WMH loads using a fine-grained Human Brainnetome Atlas. In addition, exploratory mediation analyses were conducted to further determine the relationships between these neuroimaging indicators, WMH load, and cognition. The results showed that subjects with higher WMH loads displayed decreased CBF and FCS mainly in regions involving the cognitive- and emotional-related brain networks, including the default mode network, salience network, and central executive network. Notably, subjects with higher WMH loads also showed an abnormal regional CBF–FCS coupling in several regions of the thalamus, posterior cingulate cortex, and parahippocampal gyrus involving the default mode network. Furthermore, regional CBF in the right inferior temporal gyrus and right dorsal caudate may mediate the relationship between WMH load and cognition in WMH subjects. These findings indicated characteristic changes in cerebral blood supply, brain activity, and neurovascular coupling in regions involving specific brain networks with the development of WMH, providing further information on pathophysiology underpinnings of the WMH and related cognitive impairment.
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Affiliation(s)
- Hao Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Zhao
- School of Biological Science & Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenhao Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Lu Y, Li Y, Feng Q, Shen R, Zhu H, Zhou H, Zhao Z. Rich-Club Analysis of the Structural Brain Network in Cases with Cerebral Small Vessel Disease and Depression Symptoms. Cerebrovasc Dis 2021; 51:92-101. [PMID: 34537766 DOI: 10.1159/000517243] [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: 03/20/2021] [Accepted: 05/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Altered white matter brain networks have been extensively studied in cerebral small vessel disease (SVD). However, there exists currently a deficiency of comprehending the performance of changes within the structural networks of the brain in cases with cerebral SVD and depression symptoms. The main aim of the present research is to study the network topology behaviors and features of rich-club organization in SVD patients using graph theory and diffusion tensor imaging (DTI) to characterize changes in the microstructure of the brain. METHODS DTI datasets were acquired from 26 SVD patients with symptoms of depression (SVD + D) and 26 SVD patients without symptoms of depression (SVD - D), and a series of neuropsychological assessments were completed. A structural network was created using a deterministic fiber tracking method. The analysis of rich-club was performed in company with analysis of the global network features of the network to characterize the topological properties of all subjects. RESULTS DTI data were obtained from SVD patients who manifested symptoms of depression (SVD + D) and from control SVD patients (SVD - D). In comparison with SVD - D patients, SVD + D cases demonstrated a diminished coefficient of clustering along with lower global efficiencies and longer path length characteristics. Rich-club analysis showed SVD + D patients had decreased feeder connectivity and local connectivity strengths compared to SVD - D patients. Our data also showed that the feeder connections in the brain correlated significantly with the severity of depression in SVD + D patients. CONCLUSIONS Our study revealed that SVD patients with depressive symptoms have disrupted white matter networks that characteristically have reduced network efficiency compared to the networks in other SVD patients. Disrupted information interactions among the regions of nonrich-club and rich-club in SVD cases are related to the severity of depression. Our data suggest that DTI may be utilized as an appropriate biomarker for the diagnosis of depression in comorbid SVD patients.
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Affiliation(s)
- Yanjing Lu
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yifan Li
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Qian Feng
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Rong Shen
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Hao Zhu
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Hua Zhou
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Zhong Zhao
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
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13
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Gunning FM, Oberlin LE, Schier M, Victoria LW. Brain-based mechanisms of late-life depression: Implications for novel interventions. Semin Cell Dev Biol 2021; 116:169-179. [PMID: 33992530 PMCID: PMC8548387 DOI: 10.1016/j.semcdb.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
Late-life depression (LLD) is a particularly debilitating illness. Older adults suffering from depression commonly experience poor outcomes in response to antidepressant treatments, medical comorbidities, and declines in daily functioning. This review aims to further our understanding of the brain network dysfunctions underlying LLD that contribute to disrupted cognitive and affective processes and corresponding clinical manifestations. We provide an overview of a network model of LLD that integrates the salience network, the default mode network (DMN) and the executive control network (ECN). We discuss the brain-based structural and functional mechanisms of LLD with an emphasis on their link to clinical subtypes that often fail to respond to available treatments. Understanding the brain networks that underlie these disrupted processes can inform the development of targeted interventions for LLD. We propose behavioral, cognitive, or computational approaches to identifying novel, personalized interventions that may more effectively target the key cognitive and affective symptoms of LLD.
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Affiliation(s)
- Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Lauren E Oberlin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Maddy Schier
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Lindsay W Victoria
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA.
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14
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Kim YD, Kim JY, Park YJ, Park SJ, Baik SH, Kang J, Jung C, Woo SJ. Cerebral magnetic resonance imaging of coincidental infarction and small vessel disease in retinal artery occlusion. Sci Rep 2021; 11:864. [PMID: 33441709 PMCID: PMC7806736 DOI: 10.1038/s41598-020-80014-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
There are several reports in the literature on the association between non-arteritic retinal artery occlusion (NA-RAO) and acute ischemic stroke. We investigated the burden of small vessel disease (SVD) and cerebral coincident infarction observed on cerebral magnetic resonance imaging (MRI) in patients with newly diagnosed NA-RAO. In this retrospective, observational, case-series study, consecutive patients with NA-RAO who underwent cerebral MRI within one month of diagnosis between September 2003 and October 2018 were included. The classification of NA-RAO was based on ophthalmologic and systemic examinations. We also investigated the co-incident infarction and burden of underlying SVD, which were categorized as white matter hyperintensity lesion (WMH), cerebral microbleeds (CMB), and silent lacunar infarction (SLI). Among the 272 patients enrolled in the study, 18% presented co-incident infarction and 73% had SVD, which included WMH (70%), CMB (14%), and SLI (30%). Co-incident infarction, WMH, and SLI significantly increased with age: co-incident infarction was observed in 8% of young (< 50 years) patients and 30% of old (≥ 70 years) patients. The embolic etiology of RAO (large artery atherosclerosis, cardioembolism, and undetermined etiology) was significantly associated with the prevalence of SVD (82%: 70%: 64%, P = 0.002) and co-incident infarction (30%: 19%: 8%; P = 0.009). Therefore, high co-incidence of acute cerebral infarction and underlying SVD burden warrant careful neurologic examination and appropriate brain imaging, followed by management of NA-RAO. Urgent brain imaging is particularly pertinent in elderly patients with NA-RAO.
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Affiliation(s)
- Yong Dae Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Department of Ophthalmology, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Jun Yup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young Joo Park
- Department of Ophthalmology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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15
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Kim YK, Han KM. Neural substrates for late-life depression: A selective review of structural neuroimaging studies. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110010. [PMID: 32544600 DOI: 10.1016/j.pnpbp.2020.110010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022]
Abstract
Recent neuroimaging studies have characterized the pathophysiology of late-life depression (LLD) as a dysfunction of the brain networks involved in the regulation of emotion, motivational behavior, cognitive control, executive function, and self-referential thinking. In this article, we reviewed LLD-associated structural neuroimaging markers such as white matter hyperintensity (WMH), white matter integrity measured by diffusion tensor imaging, cortical and subcortical volumes, and cortical thickness, which may provide a structural basis for brain network dysfunction in LLD. LLD was associated with greater severity or volumes of deep, periventricular, or overall WMH and with decreased white matter integrity in the brain regions belonging to the fronto-striatal-limbic circuits and reduced white matter tract integrity which connects these circuits, such as the cingulum, corpus callosum, or uncinate fasciculus. Decreased volumes or cortical thickness in the prefrontal cortex, orbitofrontal cortex, anterior and posterior cingulate cortex, several temporal and parietal regions, hippocampus, amygdala, striatum, thalamus, and the insula were associated with LLD. These structural neuroimaging findings were also associated with cognitive dysfunction, which is a prominent clinical feature in LLD. Several structural neuroimaging markers including the WMH burden, white matter integrity, and cortical and subcortical volumes predicted antidepressant response in LLD. These structural neuroimaging findings support the hypothesis that disruption of the brain networks involved in emotion regulation and cognitive processing by impaired structural connectivity is strongly associated with the pathophysiology of LLD.
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Affiliation(s)
- Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea.
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16
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Xu Z, Wang J, Lyu H, Wang R, Hu Y, Guo Z, Xu J, Hu Q. Alterations of White Matter Microstructure in Subcortical Vascular Mild Cognitive Impairment with and without Depressive Symptoms. J Alzheimers Dis 2020; 73:1565-1573. [PMID: 31958086 DOI: 10.3233/jad-190890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ziyun Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jianjun Wang
- Department of Neurology and Psychiatry, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Hanqing Lyu
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Runshi Wang
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanming Hu
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Zhouke Guo
- Department of Neurology and Psychiatry, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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17
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Marebwa BK, Adams RJ, Magwood GS, Basilakos A, Mueller M, Rorden C, Fridriksson J, Bonilha L. Cardiovascular Risk Factors and Brain Health: Impact on Long-Range Cortical Connections and Cognitive Performance. J Am Heart Assoc 2019; 7:e010054. [PMID: 30520672 PMCID: PMC6405561 DOI: 10.1161/jaha.118.010054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Cardiovascular risk factor burden in the absence of clinical or radiological "events" is associated with mild cognitive impairment. Magnetic resonance imaging techniques exploring the integrity of neuronal fiber connectivity within white matter networks supporting cognitive processing could be used to measure the impact of cardiovascular disease on brain health and be used beyond bedside neuropsychological tests to detect subclinical changes and select or stratify participants for entry into clinical trials. Methods and Results We assessed the relationship between verbal IQ and brain network integrity and the effect of cardiovascular risk factors on network integrity by constructing whole-brain structural connectomes from magnetic resonance imaging diffusion images (N=60) from people with various degrees of cardiovascular risk factor burden. We measured axonal integrity by calculating network density and determined the effect of fiber loss on network topology and efficiency, using graph theory. Multivariate analyses were used to evaluate the relationship between cardiovascular risk factor burden, physical activity, age, education, white matter integrity, and verbal IQ . Reduced network density, resulting from a disproportionate loss of long-range white matter fibers, was associated with white matter network fragmentation ( r=-0.52, P<10-4), lower global efficiency ( r=0.91, P<10-20), and decreased verbal IQ (adjusted R2=0.23, P<10-4). Conclusions Cardiovascular risk factors may mediate negative effects on brain health via loss of energy-dependent long-range white matter fibers, which in turn leads to disruption of the topological organization of the white matter networks, lowered efficiency, and reduced cognitive function.
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Affiliation(s)
- Barbara K Marebwa
- 1 Department of Neurology Medical University of South Carolina Charleston SC
| | - Robert J Adams
- 1 Department of Neurology Medical University of South Carolina Charleston SC
| | - Gayenell S Magwood
- 2 Department of Nursing Medical University of South Carolina Charleston SC
| | - Alexandra Basilakos
- 3 Department of Communication Sciences and Disorders University of South Carolina Columbia SC
| | - Martina Mueller
- 2 Department of Nursing Medical University of South Carolina Charleston SC
| | - Chris Rorden
- 4 Department of Psychology University of South Carolina Columbia SC
| | - Julius Fridriksson
- 3 Department of Communication Sciences and Disorders University of South Carolina Columbia SC
| | - Leonardo Bonilha
- 1 Department of Neurology Medical University of South Carolina Charleston SC
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18
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Yatawara C, Lee D, Ng KP, Chander R, Ng D, Ji F, Shim HY, Hilal S, Venketasubramanian N, Chen C, Zhou J, Kandiah N. Mechanisms Linking White Matter Lesions, Tract Integrity, and Depression in Alzheimer Disease. Am J Geriatr Psychiatry 2019; 27:948-959. [PMID: 31109898 DOI: 10.1016/j.jagp.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/04/2019] [Accepted: 04/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Late-life depression involves the disconnection of white matter tracts that regulate mood. A pathogenic link between poor tract integrity and depressive symptoms is believed to be white matter lesions (WML), however the mechanisms linking tract integrity, WML, and depression remains unexplored. The authors sought to identify whether the association between reduced tract integrity and depressive symptoms is mediated by WML in patients with Alzheimer disease (AD), and whether individual characteristics moderate this effect. METHODS This was a cross-sectional study in a tertiary memory clinic. A total of 91 patients with mild AD and 79 healthy elderly, comparable in depressive symptoms, white matter hyperintensities (WMH) volume, cardiovascular risk, age, and sex were chosen. Tract integrity was assessed using diffusion tensor imaging, WML were indexed as WMH, measured using fluid-attenuation inversion recovery imaging, and depressive symptoms were measured with the informant-based Geriatric Depression Scale. RESULTS In patients with mild AD, reduced tract integrity in right hemispheric cortical-subcortical tracts and the genu of the corpus callosum was moderately associated with depressive symptoms. This association was fully mediated by WML. Moderation analysis indicated that old age strengthened the association between all tracts and depressive symptoms, as mediated by WML. In cognitively healthy elderly, neither tracts nor WML were related to depressive symptoms. CONCLUSION Reduced tract integrity may be important but not sufficient for the manifestation of depressive symptoms in mild AD. Instead, WML may drive the pathogenic link between reduced tract integrity and depressive symptoms.
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Affiliation(s)
- Chathuri Yatawara
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Daryl Lee
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Russell Chander
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Debby Ng
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Fang Ji
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program (FJ, HYS, JZ, NK), Duke-NUS Medical School, Singapore
| | - Hee Youn Shim
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program (FJ, HYS, JZ, NK), Duke-NUS Medical School, Singapore
| | - Saima Hilal
- National University Health System (SH, CC), Memory Aging & Cognition Centre, Singapore
| | | | - Christopher Chen
- National University Health System (SH, CC), Memory Aging & Cognition Centre, Singapore
| | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program (FJ, HYS, JZ, NK), Duke-NUS Medical School, Singapore
| | - Nagaendran Kandiah
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore; Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program (FJ, HYS, JZ, NK), Duke-NUS Medical School, Singapore.
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19
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Ter Telgte A, van Leijsen EMC, Wiegertjes K, Klijn CJM, Tuladhar AM, de Leeuw FE. Cerebral small vessel disease: from a focal to a global perspective. Nat Rev Neurol 2019; 14:387-398. [PMID: 29802354 DOI: 10.1038/s41582-018-0014-y] [Citation(s) in RCA: 287] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cerebral small vessel disease (SVD) is commonly observed on neuroimaging among elderly individuals and is recognized as a major vascular contributor to dementia, cognitive decline, gait impairment, mood disturbance and stroke. However, clinical symptoms are often highly inconsistent in nature and severity among patients with similar degrees of SVD on brain imaging. Here, we provide a new framework based on new advances in structural and functional neuroimaging that aims to explain the remarkable clinical variation in SVD. First, we discuss the heterogeneous pathology present in SVD lesions despite an identical appearance on imaging and the perilesional and remote effects of these lesions. We review effects of SVD on structural and functional connectivity in the brain, and we discuss how network disruption by SVD can lead to clinical deficits. We address reserve and compensatory mechanisms in SVD and discuss the part played by other age-related pathologies. Finally, we conclude that SVD should be considered a global rather than a focal disease, as the classically recognized focal lesions affect remote brain structures and structural and functional network connections. The large variability in clinical symptoms among patients with SVD can probably be understood by taking into account the heterogeneity of SVD lesions, the effects of SVD beyond the focal lesions, the contribution of neurodegenerative pathologies other than SVD, and the interaction with reserve mechanisms and compensatory mechanisms.
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Affiliation(s)
- Annemieke Ter Telgte
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Esther M C van Leijsen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands.
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20
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Chavda R, Cao JS, Benge JF. Neuropsychological impact of white matter hyperintensities in older adults without dementia. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:354-362. [PMID: 31287337 DOI: 10.1080/23279095.2019.1633536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to determine (a) if simple clinical judgements of white matter hyperintensities (WMH) on imaging are associated with measurable cognitive impacts in otherwise cognitively normal older adults, (b) if neuropsychological measures can predict those with WMH, and (c) the frequency of low cognitive scores in those with WMH on a battery of measures. Forty-four individuals judged free of other cognitive disorders despite moderate to extensive WMH were compared with 50 individuals matched on age (mean of 83), education (college educated), and gender (predominantly female). Data was obtained from the National Alzheimer's Coordinating Center database. The group with at least moderate WMH had lower scores on the Trail Making Test A, verbal fluency, and digit span. A component score derived from these measures was a significant predictor of the presence of WMH, though only correctly classified 68% of participants. Even in individuals free from other suspected conditions, clinically judged moderate to extensive WMH was associated with cognitive weaknesses for processing speed, working memory, and executive functioning. This shows that a relatively simple judgment of WMH burden is meaningfully associated with worse cognition. Implications and future directions for are discussed.
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Affiliation(s)
- Rihin Chavda
- College of Medicine, Texas A&M Health Science Center, Temple, Texas, USA
| | - Jeffrey S Cao
- College of Medicine, Texas A&M Health Science Center, Temple, Texas, USA
| | - Jared F Benge
- College of Medicine, Texas A&M Health Science Center, Temple, Texas, USA.,Department of Neurology and Plummer Movement Disorders Center, Baylor Scott and White Health, Temple, Texas, USA
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21
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Leeuwis AE, Weaver NA, Biesbroek JM, Exalto LG, Kuijf HJ, Hooghiemstra AM, Prins ND, Scheltens P, Barkhof F, van der Flier WM, Biessels GJ. Impact of white matter hyperintensity location on depressive symptoms in memory-clinic patients: a lesion–symptom mapping study. J Psychiatry Neurosci 2019; 44:E1-E10. [PMID: 31021068 PMCID: PMC6606429 DOI: 10.1503/jpn.180136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We investigated the association between white matter hyperintensity location and depressive symptoms in a memoryclinic population using lesion–symptom mapping. METHODS We included 680 patients with vascular brain injury from the TRACE-VCI cohort (mean age ± standard deviation: 67 ± 8 years; 52% female): 168 patients with subjective cognitive decline, 164 with mild cognitive impairment and 348 with dementia. We assessed depressive symptoms using the Geriatric Depression Scale. We applied assumptionfree voxel-based lesion–symptom mapping, adjusted for age, sex, total white matter hyperintensity volume and multiple testing. Next, we applied exploratory region-of-interest linear regression analyses of major white matter tracts, with additional adjustment for diagnosis. RESULTS Voxel-based lesion–symptom mapping identified voxel clusters related to the Geriatric Depression Scale in the left corticospinal tract. Region-of-interest analyses showed no relation between white matter hyperintensity volume and the Geriatric Depression Scale, but revealed an interaction with diagnosis in the forceps minor, where larger regional white matter hyperintensity volume was associated with more depressive symptoms in subjective cognitive decline (β = 0.26, p < 0.05), but not in mild cognitive impairment or dementia. LIMITATIONS We observed a lack of convergence of findings between voxel-based lesion–symptom mapping and region-of-interest analyses, which may have been due to small effect sizes and limited lesion coverage despite the large sample size. This warrants replication of our findings and further investigation in other cohorts. CONCLUSION This lesion–symptom mapping study in depressive symptoms indicates the corticospinal tract and forceps minor as strategic tracts in which white matter hyperintensity is associated with depressive symptoms in memory-clinic patients with vascular brain injury. The impact of white matter hyperintensity on depressive symptoms is modest, but it appears to depend on the location of white matter hyperintensity and disease severity.
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Affiliation(s)
- Anna E. Leeuwis
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - Nick A. Weaver
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - J. Matthijs Biesbroek
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - Lieza G. Exalto
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - Hugo J. Kuijf
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - Astrid M. Hooghiemstra
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - Niels D. Prins
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - Philip Scheltens
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - Frederik Barkhof
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - Wiesje M. van der Flier
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
| | - Geert Jan Biessels
- From the Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands (Leeuwis, Hooghiemstra, Prins, Scheltens, van der Flier); the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands (Weaver, Biesbroek, Exalto, Biessels); the Image Sciences Institute, University Medical Centre Utrecht, Utrecht, the Netherlands (Kuijf); the Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Hooghiemstra); the Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom (Barkhof); the Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Barkhof); and the Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Flier)
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22
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Liang Y, Chen YK, Mok VCT, Wang DF, Ungvari GS, Chu WCW, Kang HJ, Tang WK. Cerebral Small Vessel Disease Burden Is Associated With Poststroke Depressive Symptoms: A 15-Month Prospective Study. Front Aging Neurosci 2018. [PMID: 29541025 PMCID: PMC5835754 DOI: 10.3389/fnagi.2018.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: All types of cerebral small vessel disease (SVD) markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds, and perivascular spaces were found to be associated with poststroke depressive symptoms (PDS). This study explored whether the combination of the four markers constituting an overall SVD burden was associated with PDS. Methods: A cohort of 563 patients with acute ischemic stroke were followed over a 15-month period after the index stroke. A score of ≥7 on the 15-item Geriatric Depression Scale was defined as clinically significant PDS. Scores of the four SVD markers ascertained on magnetic resonance imaging were summed up to represent total SVD burden. The association between SVD burden and PDS was assessed with generalized estimating equation models. Results: The study sample had a mean age of 67.0 ± 10.2 years and mild-moderate stroke [National Institutes of Health Stroke Scale score: 3, interquartile, 1-5]. PDS were found in 18.3%, 11.6%, and 12.3% of the sample at 3, 9, and 15 months after stroke, respectively. After adjusting for demographic characteristics, vascular risk factors, social support, stroke severity, physical and cognitive functions, and size and locations of stroke, the SVD burden was associated with an increased risk of PDS [odds ratio = 1.30; 95% confidence interval = 1.07-1.58; p = 0.010]. Other significant predictors of PDS were time of assessment, female sex, smoking, number of acute infarcts, functional independence, and social support. Conclusion: SVD burden was associated with PDS examined over a 15-month follow-up in patients with mild to moderate acute ischemic stroke.
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Affiliation(s)
- Yan Liang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Vincent Chung-Tong Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - De-Feng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Gabor S Ungvari
- Graylands Hospital, The University of Notre Dame Australia, Perth, WA, Australia
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Hospital, Gwangju, South Korea
| | - Wai-Kwong Tang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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23
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Lang B, Kindy MS, Kozel FA, Schultz SK, Taheri S. Multi-Parametric Classification of Vascular Cognitive Impairment and Dementia: The Impact of Diverse Cerebrovascular Injury Biomarkers. J Alzheimers Dis 2018; 62:39-60. [DOI: 10.3233/jad-170733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Brittany Lang
- Clinical Psychology Program, University of South Florida, Tampa, FL, USA
| | - Mark S. Kindy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida Tampa, FL, USA
- James A. Haley VA Medical Center, Tampa, FL, USA
| | - F. Andrew Kozel
- James A. Haley VA Medical Center, Tampa, FL, USA
- Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Susan K. Schultz
- James A. Haley VA Medical Center, Tampa, FL, USA
- Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Saeid Taheri
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida Tampa, FL, USA
- Byrd Alzheimer’s Institute, Tampa, FL, USA
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24
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Emsell L, Adamson C, De Winter FL, Billiet T, Christiaens D, Bouckaert F, Adamczuk K, Vandenberghe R, Seal ML, Sienaert P, Sunaert S, Vandenbulcke M. Corpus callosum macro and microstructure in late-life depression. J Affect Disord 2017; 222:63-70. [PMID: 28672181 DOI: 10.1016/j.jad.2017.06.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/31/2017] [Accepted: 06/26/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Differences in corpus callosum (CC) morphology and microstructure have been implicated in late-life depression and may distinguish between late and early-onset forms of the illness. However, a multimodal approach using complementary imaging techniques is required to disentangle microstructural alterations from macrostructural partial volume effects. METHODS 107 older adults were assessed: 55 currently-depressed patients without dementia and 52 controls without cognitive impairment. We investigated group differences and clinical associations in 7 sub-regions of the mid-sagittal corpus callosum using T1 anatomical data, white matter hyperintensity (WMH) quantification and two different diffusion MRI (dMRI) models (multi-tissue constrained spherical deconvolution, yielding apparent fibre density, AFD; and diffusion tensor imaging, yielding fractional anisotropy, FA and radial diffusivity, RD). RESULTS Callosal AFD was lower in patients compared to controls. There were no group differences in CC thickness, surface area, FA, RD, nor whole brain or WMH volume. Late-onset of depression was associated with lower FA, higher RD and lower AFD. There were no associations between any imaging measures and psychotic features or depression severity as assessed by the geriatric depression scale. WMH volume was associated with lower FA and AFD, and higher RD in patients. LIMITATIONS Patients were predominantly treatment-resistant. Measurements were limited to the mid-sagittal CC. dMRI analysis was performed on a smaller cohort, n=77. AFD was derived from low b-value data. CONCLUSIONS Callosal structure is largely preserved in LLD. WMH burden may impact on CC microstructure in late-onset depression suggesting vascular pathology has additional deleterious effects in these patients.
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Affiliation(s)
- Louise Emsell
- Old Age Psychiatry, University Psychiatric Centre (UPC) - KU Leuven, Belgium; Translational MRI & Radiology, KU Leuven & University Hospital Leuven, Belgium.
| | - Christopher Adamson
- Developmental Imaging, Murdoch Children's Research Institute, Victoria, Australia
| | | | - Thibo Billiet
- Translational MRI & Radiology, KU Leuven & University Hospital Leuven, Belgium
| | - Daan Christiaens
- Department of Electrical Engineering (ESAT), Processing of Speech and Images (PSI), Medical Image Computing, KU Leuven & Medical Imaging Research Center, University Hospital Leuven, Belgium; Division of Imaging Sciences and Biomedical Engineering, Kings College London, UK
| | - Filip Bouckaert
- Old Age Psychiatry, University Psychiatric Centre (UPC) - KU Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neurostimulation (AcCENT), Kortenberg, Belgium
| | - Katarzyna Adamczuk
- Laboratory for Cognitive Neurology, Department of Neurology, KU Leuven & University Hospital Leuven, Belgium; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurology, KU Leuven & University Hospital Leuven, Belgium
| | - Marc L Seal
- Developmental Imaging, Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Pascal Sienaert
- KU Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neurostimulation (AcCENT), Kortenberg, Belgium
| | - Stefan Sunaert
- Translational MRI & Radiology, KU Leuven & University Hospital Leuven, Belgium
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25
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Xie X, Shi Y, Zhang J. Structural network connectivity impairment and depressive symptoms in cerebral small vessel disease. J Affect Disord 2017; 220:8-14. [PMID: 28575716 DOI: 10.1016/j.jad.2017.05.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/13/2017] [Accepted: 05/25/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cerebral small vessel disease (SVD) can disrupt mood regulation circuits and cause depressive symptoms which may occur prior to onset of other symptoms. However, the topological network alterations in SVD with depressive symptoms remained unclear. We aim to investigate how these changes in structural network were related to depressive symptoms in SVD. METHODS We recruited 20 SVD with depressive symptoms (SVD+D), 20 SVD without depressive symptoms (SVD-D) and 16 healthy control (HC) individuals. Graph theory and diffusion tensor imaging (DTI) were applied to construct a structural network. We compared networks between groups, and examined the relationships between network properties, conventional measures of MRI, and depressive symptoms. RESULTS The structural network was significantly disrupted in global and regional levels in both SVD groups. SVD+D group showed more severe impairment of global network efficiency, and lower nodal efficiency and less connections within multiple regions like hippocampus, amygdala and several cortical structures. The disruption of network connectivity was associated with depressive symptoms and MRI measures of SVD, however, no mediation effect of network efficiency was detected between MRI measures and depressive symptoms. LIMITATION The relatively small sample size and lower spatial resolution of DTI-based network limited our power of investigation. CONCLUSIONS The brain structural network is significantly disrupted in SVD+D and the impairment is related to severity of vascular damages and depressive symptoms. The study provides evidence for the role of structural network damage in SVD-related depressive symptoms and might be a potential novel disease marker for SVD and comorbid depression.
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Affiliation(s)
- Xiaofeng Xie
- Department of Neurology, Zhongnan Hospital of Wuhan University, China
| | - Yulu Shi
- Department of Neurology, Zhongnan Hospital of Wuhan University, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, China.
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26
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Ghafoorian M, Karssemeijer N, Heskes T, van Uden IWM, Sanchez CI, Litjens G, de Leeuw FE, van Ginneken B, Marchiori E, Platel B. Location Sensitive Deep Convolutional Neural Networks for Segmentation of White Matter Hyperintensities. Sci Rep 2017; 7:5110. [PMID: 28698556 PMCID: PMC5505987 DOI: 10.1038/s41598-017-05300-5] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/26/2017] [Indexed: 02/06/2023] Open
Abstract
The anatomical location of imaging features is of crucial importance for accurate diagnosis in many medical tasks. Convolutional neural networks (CNN) have had huge successes in computer vision, but they lack the natural ability to incorporate the anatomical location in their decision making process, hindering success in some medical image analysis tasks. In this paper, to integrate the anatomical location information into the network, we propose several deep CNN architectures that consider multi-scale patches or take explicit location features while training. We apply and compare the proposed architectures for segmentation of white matter hyperintensities in brain MR images on a large dataset. As a result, we observe that the CNNs that incorporate location information substantially outperform a conventional segmentation method with handcrafted features as well as CNNs that do not integrate location information. On a test set of 50 scans, the best configuration of our networks obtained a Dice score of 0.792, compared to 0.805 for an independent human observer. Performance levels of the machine and the independent human observer were not statistically significantly different (p-value = 0.06).
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Affiliation(s)
- Mohsen Ghafoorian
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands.
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Nico Karssemeijer
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Inge W M van Uden
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Clara I Sanchez
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Litjens
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elena Marchiori
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Bram Platel
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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27
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van Agtmaal MJM, Houben AJHM, Pouwer F, Stehouwer CDA, Schram MT. Association of Microvascular Dysfunction With Late-Life Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry 2017; 74:729-739. [PMID: 28564681 PMCID: PMC5710252 DOI: 10.1001/jamapsychiatry.2017.0984] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/26/2017] [Indexed: 12/14/2022]
Abstract
Importance The etiologic factors of late-life depression are still poorly understood. Recent evidence suggests that microvascular dysfunction is associated with depression, which may have implications for prevention and treatment. However, this association has not been systematically reviewed. Objective To examine the associations of peripheral and cerebral microvascular dysfunction with late-life depression. Data Sources A systematic literature search was conducted in MEDLINE and EMBASE for and longitudinal studies published since inception to October 16, 2016, that assessed the associations between microvascular dysfunction and depression. Study Selection Three independent researchers performed the study selection based on consensus. Inclusion criteria were a study population 40 years of age or older, a validated method of detecting depression, and validated measures of microvascular function. Data Extraction and Synthesis This systematic review and meta-analysis has been registered at PROSPERO (CRD42016049158) and is reported in accordance with the PRISMA and MOOSE guidelines. Data extraction was performed by an independent researcher. Main Outcomes and Measures The following 5 estimates of microvascular dysfunction were considered in participants with or without depression: plasma markers of endothelial function, albuminuria, measurements of skin and muscle microcirculation, retinal arteriolar and venular diameter, and markers for cerebral small vessel disease. Data are reported as pooled odds ratios (ORs) by use of the generic inverse variance method with the use of random-effects models. Results A total of 712 studies were identified; 48 were included in the meta-analysis, of which 8 described longitudinal data. Data from 43 600 participants, 9203 individuals with depression, and 72 441 person-years (mean follow-up, 3.7 years) were available. Higher levels of plasma endothelial biomarkers (soluble intercellular adhesion molecule-1: OR, 1.58; 95% CI, 1.28-1.96), white matter hyperintensities (OR, 1.29; 95% CI, 1.19-1.39), cerebral microbleeds (OR, 1.18; 95% CI, 1.03-1.34), and cerebral (micro)infarctions (OR, 1.30; 95% CI, 1.21-1.39) were associated with depression. Among the studies available, no significant associations of albuminuria and retinal vessel diameters with depression were reported. Longitudinal data showed a significant association of white matter hyperintensities with incident depression (OR, 1.19; 95% CI, 1.09-1.30). Conclusions and Relevance This meta-analysis shows that both the peripheral and cerebral forms of microvascular dysfunction are associated with higher odds of (incident) late-life depression. This finding may have clinical implications because microvascular dysfunction might provide a potential target for the prevention and treatment of depression.
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Affiliation(s)
- Marnix J. M. van Agtmaal
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Alfons J. H. M. Houben
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Miranda T. Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
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Ghafoorian M, Karssemeijer N, van Uden IWM, de Leeuw FE, Heskes T, Marchiori E, Platel B. Automated detection of white matter hyperintensities of all sizes in cerebral small vessel disease. Med Phys 2017; 43:6246. [PMID: 27908171 DOI: 10.1118/1.4966029] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE White matter hyperintensities (WMH) are seen on FLAIR-MRI in several neurological disorders, including multiple sclerosis, dementia, Parkinsonism, stroke and cerebral small vessel disease (SVD). WMHs are often used as biomarkers for prognosis or disease progression in these diseases, and additionally longitudinal quantification of WMHs is used to evaluate therapeutic strategies. Human readers show considerable disagreement and inconsistency on detection of small lesions. A multitude of automated detection algorithms for WMHs exists, but since most of the current automated approaches are tuned to optimize segmentation performance according to Jaccard or Dice scores, smaller WMHs often go undetected in these approaches. In this paper, the authors propose a method to accurately detect all WMHs, large as well as small. METHODS A two-stage learning approach was used to discriminate WMHs from normal brain tissue. Since small and larger WMHs have quite a different appearance, the authors have trained two probabilistic classifiers: one for the small WMHs (⩽3 mm effective diameter) and one for the larger WMHs (>3 mm in-plane effective diameter). For each size-specific classifier, an Adaboost is trained for five iterations, with random forests as the basic classifier. The feature sets consist of 22 features including intensities, location information, blob detectors, and second order derivatives. The outcomes of the two first-stage classifiers were combined into a single WMH likelihood by a second-stage classifier. Their method was trained and evaluated on a dataset with MRI scans of 362 SVD patients (312 subjects for training and validation annotated by one and 50 for testing annotated by two trained raters). To analyze performance on the separate test set, the authors performed a free-response receiving operating characteristic (FROC) analysis, instead of using segmentation based methods that tend to ignore the contribution of small WMHs. RESULTS Experimental results based on FROC analysis demonstrated a close performance of the proposed computer aided detection (CAD) system to human readers. While an independent reader had 0.78 sensitivity with 28 false positives per volume on average, their proposed CAD system reaches a sensitivity of 0.73 with the same number of false positives. CONCLUSIONS The authors have developed a CAD system with all its ingredients being optimized for a better detection of WMHs of all size, which shows performance close to an independent reader.
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Affiliation(s)
- Mohsen Ghafoorian
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525, The Netherlands and Institute for Computing and Information Sciences, Radboud University, Nijmegen 6525 GA, The Netherlands
| | - Nico Karssemeijer
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| | - Inge W M van Uden
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen 6525 EN, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen 6525 EN, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen 6525 EC, The Netherlands
| | - Elena Marchiori
- Institute for Computing and Information Sciences, Radboud University, Nijmegen 6525 EC, The Netherlands
| | - Bram Platel
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525, The Netherlands
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Scott JA, Tosun D, Braskie MN, Maillard P, Thompson PM, Weiner M, DeCarli C, Carmichael OT. Independent value added by diffusion MRI for prediction of cognitive function in older adults. NEUROIMAGE-CLINICAL 2017; 14:166-173. [PMID: 28180075 PMCID: PMC5279696 DOI: 10.1016/j.nicl.2017.01.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/15/2017] [Accepted: 01/24/2017] [Indexed: 11/04/2022]
Abstract
The purpose of this study was to determine whether white matter microstructure measured by diffusion magnetic resonance imaging (dMRI) provides independent information about baseline level or change in executive function (EF) or memory (MEM) in older adults with and without cognitive impairment. Longitudinal data was acquired from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study from phases GO and 2 (2009–2015). ADNI participants included were diagnosed as cognitively normal (n = 46), early mild cognitive impairment (MCI) (n = 48), late MCI (n = 29), and dementia (n = 39) at baseline. We modeled the association between dMRI-based global white matter mean diffusivity (MD) and baseline level and change in EF and MEM composite scores, in models controlling for baseline bilateral hippocampal volume, regional cerebral FDG PET metabolism and global cerebral AV45 PET uptake. EF and MEM composite scores were measured at baseline, 6, 12, 24 and 36 months. In the baseline late MCI and dementia groups, greater global MD was associated with lesser baseline EF, but not EF change nor MEM baseline or change. As expected, lesser hippocampal volume and lesser FDG PET metabolism was associated with greater rates of EF and MEM decline. In ADNI-GO/2 participants, white matter integrity provided independent information about current executive function, but was not sensitive to future cognitive change. Since individuals experiencing executive function declines progress to dementia more rapidly than those with only memory impairment, better biomarkers of future executive function decline are needed. In the ADNI cohort, MRI and PET predictors of baseline and change in executive function were tested. Global mean diffusivity was associated with baseline, but not change in, executive function. Diffusion MRI provides independent information on current executive function in older adults.
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Affiliation(s)
| | - Duygu Tosun
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Michael Weiner
- University of California San Francisco, San Francisco, CA, USA
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30
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Meissner A, Minnerup J, Soria G, Planas AM. Structural and functional brain alterations in a murine model of Angiotensin II-induced hypertension. J Neurochem 2016; 140:509-521. [DOI: 10.1111/jnc.13905] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Anja Meissner
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Department of Neurology; University Hospital Münster; Münster Germany
| | - Jens Minnerup
- Department of Neurology; University Hospital Münster; Münster Germany
| | - Guadalupe Soria
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Anna M Planas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Departament d'Isquèmia Cerebral i Neurodegeneració; Institut d'Investigacions Biomèdiques de Barcelona (IIBB); Consejo Superior de Investigaciones Científicas (CSIC); Barcelona Spain
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31
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van Uden IW, van der Holst HM, van Leijsen EM, Tuladhar AM, van Norden AG, de Laat KF, Claassen JA, van Dijk EJ, Kessels RP, Richard E, Tendolkar I, de Leeuw FE. Late-onset depressive symptoms increase the risk of dementia in small vessel disease. Neurology 2016; 87:1102-9. [DOI: 10.1212/wnl.0000000000003089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 05/30/2016] [Indexed: 11/15/2022] Open
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32
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Pasi M, Poggesi A, Salvadori E, Diciotti S, Ciolli L, Del Bene A, Marini S, Nannucci S, Pescini F, Valenti R, Ginestroni A, Toschi N, Mascalchi M, Inzitari D, Pantoni L. White matter microstructural damage and depressive symptoms in patients with mild cognitive impairment and cerebral small vessel disease: the VMCI-Tuscany Study. Int J Geriatr Psychiatry 2016; 31:611-8. [PMID: 26489377 DOI: 10.1002/gps.4368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Disruption of cortical-subcortical circuits related to small vessel disease (SVD) may predispose to depression in the elderly. We aimed to determine the independent association between white matter (WM) microstructural damage, evaluated with diffusion tensor imaging (DTI), and depressive symptoms in a cohort of elderly subjects with mild cognitive impairment (MCI) and SVD. METHODS The vascular mild cognitive impairment (VMCI)-Tuscany Study is an observational multicentric longitudinal study that enrolled patients with MCI and moderate to severe degrees of WM hyperintensities on MRI. Lacunar infarcts, cortical atrophy, medial temporal lobe atrophy, microbleeds, and DTI-derived indices (mean diffusivity, MD and fractional anisotropy, FA) were evaluated on baseline MRI. Geriatric Depression Scale (GDS) (score 0-15) was used to assess depressive symptoms. An extensive neuropsychological battery, Instrumental Activities of Daily Living scale, and the Short Physical Performance Battery were used for cognitive, functional, and motor assessments, respectively. RESULTS Seventy-six patients (mean age: 75.1 ± 6.8 years) were included. Univariate analyses showed a significant association between GDS score and both DTI-derived indices (MD: r = 0.307, p = 0.007; FA: r = -0.245; p = 0.033). The association remained significant after adjustment for age, WM hyperintensities severity, global cognitive, functional and motor performances, and antidepressant therapy (MD: r = 0.361, p = 0.002; FA: r = -0.277; p = 0.021). CONCLUSIONS These results outline the presence of an association between WM microstructural damage and depressive symptoms in MCI patients with SVD. This relationship does not seem to be mediated by disability, cognitive, and motor impairment, thus supporting the vascular depression hypothesis.
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Affiliation(s)
- Marco Pasi
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Laura Ciolli
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Alessandra Del Bene
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Sandro Marini
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Serena Nannucci
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Francesca Pescini
- Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Raffaella Valenti
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Andrea Ginestroni
- "Mario Serio" Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Nicola Toschi
- Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Mario Mascalchi
- "Mario Serio" Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy.,Institute of Neuroscience, Italian National Research Council, Florence, Italy
| | - Leonardo Pantoni
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
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Pasi M, van Uden IWM, Tuladhar AM, de Leeuw FE, Pantoni L. White Matter Microstructural Damage on Diffusion Tensor Imaging in Cerebral Small Vessel Disease: Clinical Consequences. Stroke 2016; 47:1679-84. [PMID: 27103015 DOI: 10.1161/strokeaha.115.012065] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/22/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Pasi
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Inge W M van Uden
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Anil M Tuladhar
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Frank-Erik de Leeuw
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Leonardo Pantoni
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.).
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van Uden IWM, Tuladhar AM, van der Holst HM, van Leijsen EMC, van Norden AGW, de Laat KF, Rutten-Jacobs LCA, Norris DG, Claassen JAHR, van Dijk EJ, Kessels RPC, de Leeuw FE. Diffusion tensor imaging of the hippocampus predicts the risk of dementia; the RUN DMC study. Hum Brain Mapp 2016; 37:327-37. [PMID: 26468058 PMCID: PMC6867248 DOI: 10.1002/hbm.23029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/10/2015] [Accepted: 10/07/2015] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Cerebral small vessel disease is one of the most important risk factors for dementia, and has been related to hippocampal atrophy, which is among the first observed changes on conventional MRI in patients with dementia. However, these volumetric changes might be preceded by loss of microstructural integrity of the hippocampus for which conventional MRI is not sensitive enough. Therefore, we investigated the relation between the hippocampal diffusion parameters and the risk of incident dementia, using diffusion tensor imaging, independent of hippocampal volume. METHODS The RUNDMC study is a prospective study among 503 elderly with small vessel disease, without dementia, with 5 years follow-up in 2012 (99.6% response-rate). Cox regression analysis was performed to calculate hazard ratios for dementia, of fractional anisotropy and mean diffusivity within the hippocampus, adjusted for demographics, hippocampal volume, and white matter. This was repeated in participants without evident hippocampal volume loss, because in these participants the visible damage might not yet have already started, whereas damage might have started on a microstructural level. RESULTS 43 participants developed dementia (8.6%), resulting in a 5.5-year cumulative risk of 11.1% (95%CI 7.7-14.6). Higher mean diffusivity was associated with an increased 5-year risk of dementia. In the subgroup of participants with the upper half hippocampal volume, higher hippocampal mean diffusivity, more than doubled the 5-year risk of dementia. CONCLUSION This is the first prospective study showing a relation between a higher baseline hippocampal mean diffusivity and the risk of incident dementia in elderly with small vessel disease at 5-year follow-up, independent of hippocampal volume and white matter volume.
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Affiliation(s)
- I W M van Uden
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - A M Tuladhar
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - H M van der Holst
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - E M C van Leijsen
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - A G W van Norden
- Department of Neurology, Amphia Ziekenhuis Breda, The Netherlands
| | - K F de Laat
- Department of Neurology, HagaZiekenhuis Den Haag, The Netherlands
| | - L C A Rutten-Jacobs
- Department of Clinical Neurosciences, Neurology Unit, University of Cambridge, United Kingdom
| | - D G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, The Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, D-45141, Germany
| | - J A H R Claassen
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Geriatrics, The Netherlands
| | - E J van Dijk
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - R P C Kessels
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Geriatrics, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Medical Psychology, The Netherlands
| | - F-E de Leeuw
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
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van Uden I, van der Holst H, Schaapsmeerders P, Tuladhar A, van Norden A, de Laat K, Norris D, Claassen J, van Dijk E, Richard E, Kessels R, de Leeuw FE. Baseline white matter microstructural integrity is not related to cognitive decline after 5 years: The RUN DMC study. BBA CLINICAL 2015; 4:108-114. [PMID: 26676146 PMCID: PMC4661735 DOI: 10.1016/j.bbacli.2015.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/18/2015] [Accepted: 10/21/2015] [Indexed: 01/20/2023]
Affiliation(s)
- I.W.M. van Uden
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - H.M. van der Holst
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - P. Schaapsmeerders
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
| | - A.M. Tuladhar
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | | | - K.F. de Laat
- HagaZiekenhuis Den Haag, Department of Neurology, The Netherlands
| | - D.G. Norris
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, The Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Arendahls Wiese 199, Tor 3, D-45141 Essen, Germany
| | - J.A.H.R. Claassen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Geriatrics, Nijmegen, The Netherlands
| | - E.J. van Dijk
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - E. Richard
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - R.P.C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Geriatrics, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
| | - F.-E. de Leeuw
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
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van Uden IW, van der Holst HM, Tuladhar AM, van Norden AG, de Laat KF, Rutten-Jacobs LC, Norris DG, Claassen JA, van Dijk EJ, Kessels RP, de Leeuw FE. White Matter and Hippocampal Volume Predict the Risk of Dementia in Patients with Cerebral Small Vessel Disease: The RUN DMC Study. J Alzheimers Dis 2015; 49:863-73. [DOI: 10.3233/jad-150573] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Ingeborg W.M. van Uden
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
| | - Helena M. van der Holst
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
| | - Anil M. Tuladhar
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
| | | | | | - Loes C.A. Rutten-Jacobs
- University of Cambridge, Department of Clinical Neurosciences, Neurology Unit, Cambridge, UK
| | - David G. Norris
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Jurgen A.H.R. Claassen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Geriatrics, Nijmegen, The Netherlands
| | - Ewoud J. van Dijk
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
| | - Roy P.C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
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Hollocks MJ, Lawrence AJ, Brookes RL, Barrick TR, Morris RG, Husain M, Markus HS. Differential relationships between apathy and depression with white matter microstructural changes and functional outcomes. Brain 2015; 138:3803-15. [PMID: 26490330 PMCID: PMC4655344 DOI: 10.1093/brain/awv304] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/26/2015] [Indexed: 01/30/2023] Open
Abstract
Small vessel disease is a stroke subtype characterized by pathology of the small perforating arteries, which supply the sub-cortical structures of the brain. Small vessel disease is associated with high rates of apathy and depression, thought to be caused by a disruption of white matter cortical-subcortical pathways important for emotion regulation. It provides an important biological model to investigate mechanisms underlying these key neuropsychiatric disorders. This study investigated whether apathy and depression can be distinguished in small vessel disease both in terms of their relative relationship with white matter microstructure, and secondly whether they can independently predict functional outcomes. Participants with small vessel disease (n = 118; mean age = 68.9 years; 65% male) defined as a clinical and magnetic resonance imaging confirmed lacunar stroke with radiological leukoaraiosis were recruited and completed cognitive testing, measures of apathy, depression, quality of life and diffusion tensor imaging. Healthy controls (n = 398; mean age = 64.3 years; 52% male) were also studied in order to interpret the degree of apathy and depression found within the small vessel disease group. Firstly, a multilevel structural equation modelling approach was used to identify: (i) the relationships between median fractional anisotropy and apathy, depression and cognitive impairment; and (ii) if apathy and depression make independent contributions to quality of life in patients with small vessel disease. Secondly, we applied a whole-brain voxel-based analysis to investigate which regions of white matter were associated with apathy and depression, controlling for age, gender and cognitive functioning. Structural equation modelling results indicated both apathy (r = -0.23, P ≤ 0.001) and depression (r = -0.41, P ≤ 0.001) were independent predictors of quality of life. A reduced median fractional anisotropy was significantly associated with apathy (r = -0.38, P ≤ 0.001), but not depression (r = -0.16, P = 0.09). On voxel-based analysis, apathy was associated with widespread reduction in white matter integrity, with the strongest effects in limbic association tracts such as the anterior cingulum, fornix and uncinate fasciculus. In contrast, when controlling for apathy, we found no significant relationship between our white matter parameters and symptoms of depression. In conclusion, white matter microstructural changes in small vessel disease are associated with apathy but not directly with depressive symptoms. These results suggest that apathy, but not depression, in small vessel disease is related to damage to cortical-subcortical networks associated with emotion regulation, reward and goal-directed behaviour.
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Affiliation(s)
- Matthew J Hollocks
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Andrew J Lawrence
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Rebecca L Brookes
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Thomas R Barrick
- 2 St. Georges, University of London, Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, London, UK
| | - Robin G Morris
- 3 King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK
| | - Masud Husain
- 4 University of Oxford, Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Hugh S Markus
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
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