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Kim DH, Grodstein F, Newman AB, Chaves PHM, Odden MC, Klein R, Sarnak MJ, Lipsitz LA. Microvascular and Macrovascular Abnormalities and Cognitive and Physical Function in Older Adults: Cardiovascular Health Study. J Am Geriatr Soc 2015; 63:1886-93. [PMID: 26338279 DOI: 10.1111/jgs.13594] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate and compare the associations between microvascular and macrovascular abnormalities and cognitive and physical function DESIGN Cross-sectional analysis of the Cardiovascular Health Study (1998-1999). SETTING Community. PARTICIPANTS Individuals with available data on three or more of five microvascular abnormalities (brain, retina, kidney) and three or more of six macrovascular abnormalities (brain, carotid artery, heart, peripheral artery) (N = 2,452; mean age 79.5). MEASUREMENTS Standardized composite scores derived from three cognitive tests (Modified Mini-Mental State Examination, Digit-Symbol Substitution Test, Trail-Making Test (TMT)) and three physical tests (gait speed, grip strength, 5-time sit to stand) RESULTS Participants with high microvascular and macrovascular burden had worse cognitive (mean score difference = -0.30, 95% confidence interval (CI) = -0.37 to -0.24) and physical (mean score difference = -0.32, 95% CI = -0.38 to -0.26) function than those with low microvascular and macrovascular burden. Individuals with high microvascular burden alone had similarly lower scores than those with high macrovascular burden alone (cognitive function: -0.16, 95% CI = -0.24 to -0.08 vs -0.13, 95% CI = -0.20 to -0.06; physical function: -0.15, 95% CI = -0.22 to -0.08 vs -0.12, 95% CI = -0.18 to -0.06). Psychomotor speed and working memory, assessed using the TMT, were only impaired in the presence of high microvascular burden. Of the 11 vascular abnormalities considered, white matter hyperintensity, cystatin C-based glomerular filtration rate, large brain infarct, and ankle-arm index were independently associated with cognitive and physical function. CONCLUSION Microvascular and macrovascular abnormalities assessed using noninvasive tests of the brain, kidney, and peripheral artery were independently associated with poor cognitive and physical function in older adults. Future research should evaluate the usefulness of these tests in prognostication.
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Affiliation(s)
- Dae Hyun Kim
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
| | - Francine Grodstein
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Michelle C Odden
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Mark J Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Lewis A Lipsitz
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
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Iseki K, Fukuyama H, Oishi N, Tomimoto H, Otsuka Y, Nankaku M, Benninger D, Hallett M, Hanakawa T. Freezing of gait and white matter changes: a tract-based spatial statistics study. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2015; 2:1. [PMID: 26788337 PMCID: PMC4711070 DOI: 10.1186/s40734-014-0011-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/17/2014] [Indexed: 11/13/2022]
Abstract
Background We hypothesized that the integrity of white matter might be related to the severity of freezing of gait in age-related white matter changes. Methods Twenty subjects exhibiting excessive hyperintensities in the periventricular and deep white matter were recruited. The subjects underwent the Freezing of Gait Questionnaire, computerized gait analyses, and diffusion tensor magnetic resonance imaging. Images of axial, radial and mean diffusivity, and fractional anisotropy were calculated as indices of white matter integrity and analyzed with tract-based spatial statistics. Results The fractional anisotropy, mean, axial and radial diffusivity averaged across the whole white matter structure were all significantly correlated with Freezing of Gait Questionnaire scores. Regionally, a negative correlation between Freezing of Gait Questionnaire scores and fractional anisotropy was found in the left superior longitudinal fasciculus beneath the left premotor cortex, right corpus callosum, and left cerebral peduncle. The scores of the Freezing of Gait Questionnaire were positively correlated with mean diffusivity in the left corona radiata and right corpus callosum, and with both axial and radial diffusivity in the left corona radiata. The white matter integrity in these tracts (except the corpus callosum) showed no correlation with cognitive or other gait measures, supporting the specificity of those abnormalities to freezing of gait. Conclusion Divergent pathological lesions involved neural circuits composed of the cerebral cortex, basal ganglia and brainstem, suggesting that freezing of gait has a multifactorial nature.
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Affiliation(s)
- Kazumi Iseki
- Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan ; Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA ; Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University, Graduate School of Medicine, Sendai, Miyagi Japan ; Department of Neurology, Sakakibara-Hakuho Hospital, Tsu, Mie Japan
| | - Hidenao Fukuyama
- Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan
| | - Naoya Oishi
- Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University, Graduate School of Medicine, Tsu, Mie Japan
| | - Yoshinobu Otsuka
- Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan
| | - Manabu Nankaku
- Department of Physical Therapy, Kyoto University Hospital, Kyoto, Japan
| | - David Benninger
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA
| | - Takashi Hanakawa
- Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 Japan ; Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan ; PRESTO, JST, Kawaguchi, Saitama Japan
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Cifuentes D, Poittevin M, Dere E, Broquères-You D, Bonnin P, Benessiano J, Pocard M, Mariani J, Kubis N, Merkulova-Rainon T, Lévy BI. Hypertension Accelerates the Progression of Alzheimer-Like Pathology in a Mouse Model of the Disease. Hypertension 2015; 65:218-24. [DOI: 10.1161/hypertensionaha.114.04139] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cerebrovascular impairment is frequent in patients with Alzheimer disease and is believed to influence clinical manifestation and severity of the disease. Cardiovascular risk factors, especially hypertension, have been associated with higher risk of developing Alzheimer disease. To investigate the mechanisms underlying the hypertension, Alzheimer disease cross talk, we established a mouse model of dual pathology by infusing hypertensive doses of angiotensin II into transgenic APPPS1 mice overexpressing mutated human amyloid precursor and presenilin 1 proteins. At 4.5 months, at the early stage of disease progression, only hypertensive APPPS1 mice presented impairment of temporal order memory performance in the episodic-like memory task. This cognitive deficit was associated with an increased number of cortical amyloid deposits (223±5 versus 207±5 plaques/mm
2
;
P
<0.05) and a 2-fold increase in soluble amyloid levels in the brain and in plasma. Hypertensive APPPS1 mice presented several cerebrovascular alterations, including a 25% reduction in cerebral microvessel density and a 30% to 40% increase in cerebral vascular amyloid deposits, as well as a decrease in vascular endothelial growth factor A expression in the brain, compared with normotensive APPPS1 mice. Moreover, the brain levels of nitric oxide synthase 1 and 3 and the nitrite/nitrate levels were reduced in hypertensive APPPS1 mice (by 49%, 34%, and 33%, respectively, compared with wild-type mice;
P
<0.05). Our results indicate that hypertension accelerates the development of Alzheimer disease–related structural and functional alterations, partially through cerebral vasculature impairment and reduced nitric oxide production.
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Affiliation(s)
- Diana Cifuentes
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Marine Poittevin
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Ekrem Dere
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Dong Broquères-You
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Philippe Bonnin
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Joëlle Benessiano
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Marc Pocard
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Jean Mariani
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Nathalie Kubis
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Tatyana Merkulova-Rainon
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
| | - Bernard I. Lévy
- From the Institut des Vaisseaux et du Sang, Paris, France (D.C., M.P., D.B.-Y., T.M.-R., B.I.L.); INSERM, U965, Paris, France (D.C., M.P., D.B.-Y., P.B., M.P., N.K., T.M.-R.); Max Planck Institute of Experimental Medicine, Göttingen, Germany (E.D.); Université Paris Diderot, Sorbonne Paris Cité, Paris, France (P.B., M.P., N.K., B.I.L.); AP-HP, Hôpital Lariboisière, Paris, France (P.B., N.K.); AP-HP, Hôpital Bichat—Claude-Bernard, Paris, France (J.B.); CNRS UMR 8256, Paris, France (J.M.); and INSERM,
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