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Hase Y, Jobson D, Cheong J, Gotama K, Maffei L, Hase M, Hamdan A, Ding R, Polivkoski T, Horsburgh K, Kalaria RN. Hippocampal capillary pericytes in post-stroke and vascular dementias and Alzheimer's disease and experimental chronic cerebral hypoperfusion. Acta Neuropathol Commun 2024; 12:29. [PMID: 38360798 PMCID: PMC10870440 DOI: 10.1186/s40478-024-01737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
Neurovascular unit mural cells called 'pericytes' maintain the blood-brain barrier and local cerebral blood flow. Pathological changes in the hippocampus predispose to cognitive impairment and dementia. The role of hippocampal pericytes in dementia is largely unknown. We investigated hippocampal pericytes in 90 post-mortem brains from post-stroke dementia (PSD), vascular dementia (VaD), Alzheimer's disease (AD), and AD-VaD (Mixed) subjects, and post-stroke non-demented survivors as well as similar age controls. We used collagen IV immunohistochemistry to determine pericyte densities and a mouse model of VaD to validate the effects of chronic cerebral hypoperfusion. Despite increased trends in hippocampal microvascular densities across all dementias, mean pericyte densities were reduced by ~25-40% in PSD, VaD and AD subjects compared to those in controls, which calculated to 14.1 ± 0.7 per mm capillary length, specifically in the cornu ammonis (CA) 1 region (P = 0.01). In mice with chronic bilateral carotid artery occlusion, hippocampal pericyte loss was ~60% relative to controls (P < 0.001). Pericyte densities were correlated with CA1 volumes (r = 0.54, P = 0.006) but not in any other sub-region. However, mice subjected to the full-time environmental enrichment (EE) paradigm showed remarkable attenuation of hippocampal CA1 pericyte loss in tandem with CA1 atrophy. Our results suggest loss of hippocampal microvascular pericytes across common dementias is explained by a vascular aetiology, whilst the EE paradigm offers significant protection.
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Affiliation(s)
- Yoshiki Hase
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK
| | - Dan Jobson
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK
| | - Jeremy Cheong
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK
| | - Kelvin Gotama
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK
| | - Luciana Maffei
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK
| | - Mai Hase
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK
| | - Alhafidz Hamdan
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK
| | - Ren Ding
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK
| | - Tuomo Polivkoski
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK
| | - Karen Horsburgh
- Centre for Neuroregeneration, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Raj N Kalaria
- Neurovascular Research Group, Translational and Clinical Research Institute, Campus for Ageing & Vitality, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK.
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Zhong W, Chen H, Gong X, Tong L, Xu X, Zong G, Yuan C, Lou M. Prevalent stroke, age of its onset, and post-stroke lifestyle in relation to dementia: A prospective cohort study. Alzheimers Dement 2023; 19:3998-4007. [PMID: 37157186 DOI: 10.1002/alz.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The association of age at stroke onset with dementia and the role of post-stroke lifestyle on dementia risk remains unclear. METHODS We leveraged data of 496,251 dementia-free participants from UK Biobank and explored the relationship between age at stroke onset and incident dementia. Among 8328 participants with stroke history, we further investigated the association of a healthy lifestyle with risk of dementia. RESULTS Participants with stroke history had a higher risk of dementia (hazard ratio [HR], 2.02). The association was stronger among participants with stroke onset at a younger age (≤50: HR, 2.63) compared with those at the age > 50 years (50-60: HR, 2.17; ≥60: HR, 1.58). Among participants with stroke history, a favorable lifestyle was associated with a lower risk of incident dementia. DISCUSSION Stroke onset in earlier life stage predicted a higher risk for dementia, but a favorable post-stroke lifestyle may protect against dementia.
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Affiliation(s)
- Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Hui Chen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoxian Gong
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Lusha Tong
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Xin Xu
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Changzheng Yuan
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition, Harvard T.H. School of Public Health, Boston, Massachusetts, USA
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
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Abstract
Cerebral small vessel disease (CSVD) has emerged as a common factor driving age-dependent diseases, including stroke and dementia. CSVD-related dementia will affect a growing fraction of the aging population, requiring improved recognition, understanding, and treatments. This review describes evolving criteria and imaging biomarkers for the diagnosis of CSVD-related dementia. We describe diagnostic challenges, particularly in the context of mixed pathologies and the absence of highly effective biomarkers for CSVD-related dementia. We review evidence regarding CSVD as a risk factor for developing neurodegenerative disease and potential mechanisms by which CSVD leads to progressive brain injury. Finally, we summarize recent studies on the effects of major classes of cardiovascular medicines relevant to CSVD-related cognitive impairment. Although many key questions remain, the increased attention to CSVD has resulted in a sharper vision for what will be needed to meet the upcoming challenges imposed by this disease.
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Affiliation(s)
- Fanny M. Elahi
- Departments of Neurology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY
- Neurology Service, VA Bronx Healthcare System, Bronx, NY
| | - Michael M. Wang
- Departments of Neurology and Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
- Neurology Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
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Roseborough AD, Saad L, Goodman M, Cipriano LE, Hachinski VC, Whitehead SN. White matter hyperintensities and longitudinal cognitive decline in cognitively normal populations and across diagnostic categories: A meta-analysis, systematic review, and recommendations for future study harmonization. Alzheimers Dement 2023; 19:194-207. [PMID: 35319162 DOI: 10.1002/alz.12642] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The primary aim of this paper is to improve the clinical interpretation of white matter hyperintensities (WMHs) and provide an overarching summary of methodological approaches, allowing researchers to design future studies targeting current knowledge gaps. METHODS A meta-analysis and systematic review was performed investigating associations between baseline WMHs and longitudinal cognitive outcomes in cognitively normal populations, and populations with mild cognitive impairment (MCI), Alzheimer's disease (AD), and stroke. RESULTS Baseline WMHs increase the risk of cognitive impairment and dementia across diagnostic categories and most consistently in MCI and post-stroke populations. Apolipoprotein E (APOE) genotype and domain-specific cognitive changes relating to strategic anatomical locations, such as frontal WMH and executive decline, represent important considerations. Meta-analysis reliability was assessed using multiple methods of estimation, and results suggest that heterogeneity in study design and reporting remains a significant barrier. DISCUSSION Recommendations and future directions for study of WMHs are provided to improve cross-study comparison and translation of research into consistent clinical interpretation.
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Affiliation(s)
- Austyn D Roseborough
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lorenzo Saad
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Maren Goodman
- Western Libraries, The University of Western Ontario, London, Ontario, Canada
| | - Lauren E Cipriano
- Ivey Business School and Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
| | - Vladimir C Hachinski
- Department of Clinical Neurological Sciences, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shawn N Whitehead
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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Heterogeneity of White Matter Hyperintensity and Cognitive Impairment in Patients with Acute Lacunar Stroke. Brain Sci 2022; 12:brainsci12121674. [PMID: 36552134 PMCID: PMC9776102 DOI: 10.3390/brainsci12121674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Background: The severity of white matter hyperintensity (WMH) in patients with acute lacunar stroke (ALS) may be not completely parallel to cognitive impairment. Controversies persist about the effects of WMH on cognitive dysfunction. It is vital to explore whether the association may be affected by certain factors and whether a subsequent subgroup analysis is necessary. The aim of this study was to evaluate the relationship between WMH and cognitive impairment in acute lacunar stroke patients and the possible causal factors. Methods: We continuously enrolled patients with ALS who were hospitalized at the First Affiliated Hospital of Soochow University between October 2017 and June 2022. The cognitive function of all patients was assessed by using the Montreal Cognitive Assessment (MoCA) scale 14 ± 2 days after the onset of AIS, and the results were adjusted to the education level. The MoCA scale was reevaluated at the 6-month (day 182 ± 7) follow-up by outpatient visit or video. Demographic and clinical data were collected. The manifestations of chronic cerebral small-vessel disease (CSVD), including the total Fazekas score and total CSVD burden score, were assessed with an MRI scan. A mismatch refers to an inconsistency between the severity of WMH and cognitive dysfunction. A Type 1 mismatch refers to cognitive impairment with mild WMH (total Fazekas score = 0−1), and a Type 2 mismatch refers to severe WMH (total Fazekas score = 5−6) in patients with normal cognitive function. Results: Among 213 enrolled ALS patients, 66 patients (31.0%) had cognitive dysfunction, and 40 patients (18.8%) had mismatches. Twenty-seven cases (12.7%) were Type 1 mismatched, and seventeen cases (8.0%) were Type 2 mismatched. Age, gender, fibrinogen and cerebral infarction history were independent risk factors for cognitive impairment in ALS patients. Imaging features, including moderate to severe WMH, deep WMH and the total CSVD burden score, were also independently associated with cognitive impairment. The patients in the mismatched group were older, had more severe deep WMH and had a higher occurrence of depression (p < 0.05). The NIHSS score, depression and microbleeds were significantly different between the Type 1 mismatched group and the matched group (p = 0.018, p = 0.012 and p = 0.047). Patients in the Type 2 mismatched group were male (p = 0.04), had a lower level of fibrinogen (p = 0.005), a lower incidence of CMBs (p = 0.003), a lower total CSVD burden score (p = 0.017), more severe paraventricular WMH (p = 0.035) and milder deep WMH (p = 0.026). Conclusions: Our study examined a homogeneous study cohort of recruited patients with symptomatic ALS. We found heterogeneity between WMH and cognitive function in ALS patients. Despite a similar WMH severity, some baseline clinical features and other conventional CSVD imaging characteristics may account for this heterogeneity phenomenon. Our findings provide data for the early diagnosis and prevention of cognitive impairment in ALS patients and suggest that the severity of WMH is not completely parallel to cognitive impairment. The white matter microstructural injury and remote WMH effects may account for the mismatch phenomenon. More attention should be paid to understanding the underlying mechanisms and finding new imaging markers.
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Syeda W, Ermine CM, Khilf MS, Wright D, Brait VH, Nithianantharajah J, Kolbe S, Johnston LA, Thompson LH, Brodtmann A. Long-term structural brain changes in adult rats after mild ischaemic stroke. Brain Commun 2022; 4:fcac185. [PMID: 35898722 PMCID: PMC9309495 DOI: 10.1093/braincomms/fcac185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 03/09/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Preclinical studies of remote degeneration have largely focused on brain changes over the first few days or weeks after stroke. Accumulating evidence suggests that neurodegeneration occurs in other brain regions remote to the site of infarction for months and even years following ischaemic stroke. Brain atrophy appears to be driven by both axonal degeneration and widespread brain inflammation. The evolution and duration of these changes are increasingly being described in human studies, using advanced brain imaging techniques. Here, we sought to investigate long-term structural brain changes in a model of mild focal ischaemic stroke following injection of endothlin-1 in adult Long–Evans rats (n = 14) compared with sham animals (n = 10), over a clinically relevant time-frame of 48 weeks. Serial structural and diffusion-weighted MRI data were used to assess dynamic volume and white matter trajectories. We observed dynamic regional brain volume changes over the 48 weeks, reflecting both normal changes with age in sham animals and neurodegeneration in regions connected to the infarct following ischaemia. Ipsilesional cortical volume loss peaked at 24 weeks but was less prominent at 36 and 48 weeks. We found significantly reduced fractional anisotropy in both ipsi- and contralesional motor cortex and cingulum bundle regions of infarcted rats (P < 0.05) from 4 to 36 weeks, suggesting ongoing white matter degeneration in tracts connected to but distant from the stroke. We conclude that there is evidence of significant cortical atrophy and white matter degeneration up to 48 weeks following infarct, consistent with enduring, pervasive stroke-related degeneration.
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Affiliation(s)
- Warda Syeda
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
- Melbourne Neuropsychiatry Centre, The University of Melbourne , Parkville, Victoria , Australia
| | - Charlotte M Ermine
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - Mohamed Salah Khilf
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - David Wright
- Department of Neuroscience, Monash University , Clayton , Australia
| | - Vanessa H Brait
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - Jess Nithianantharajah
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - Scott Kolbe
- Department of Neuroscience, Monash University , Clayton , Australia
| | - Leigh A Johnston
- The Melbourne Brain Centre Imaging Unit, The University of Melbourne , Parkville, Victoria , Australia
- Department of Biomedical Engineering, The University of Melbourne , Parkville, Victoria , Australia
| | - Lachlan H Thompson
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
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Qu JF, Zhong HH, Liang WC, Chen YK, Liu YL, Li W. Neuroimaging risk factors for participation restriction after acute ischemic stroke: 1-year follow-up study. J Investig Med 2021; 70:363-368. [PMID: 34611033 PMCID: PMC8819659 DOI: 10.1136/jim-2020-001675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/06/2022]
Abstract
The aim of the present study was to determine the neuroimaging predictors of poor participation after acute ischemic stroke. A total of 443 patients who had acute ischemic stroke were assessed. At 1-year recovery, the Reintegration to Normal Living Index was used to assess participation restriction. We also assessed the Activities of Daily Living Scale and modified Rankin Scale (mRS) score. Brain MRI measurement included acute infarcts and pre-existing abnormalities such as enlarged perivascular spaces, white matter lesions, ventricular-brain ratio, and medial temporal lobe atrophy (MTLA). The study included 324 men (73.1%) and 119 women (26.9%). In the univariate analysis, patients with poor participation after 1 year were older, more likely to be men, had higher National Institutes of Health Stroke Scale (NIHSS) score on admission, with more histories of hypertension and atrial fibrillation, larger infarct volume, more severely enlarged perivascular spaces and MTLA, and more severe periventricular hyperintensities and deep white matter hyperintensities. Patients with participation restriction also had poor activities of daily living (ADL) and mRS score. Multiple logistic regression showed that, in model 1, age, male gender, NIHSS score on admission, and ADL on follow-up were significant predictors of poor participation, accounting for 60.2% of the variance. In model 2, which included both clinical and MRI variables, male gender, NIHSS score on admission, ADL on follow-up, and MTLA were significant predictors of poor participation, accounting for 61.2% of the variance. Participation restriction was common after acute ischemic stroke despite good mRS score. Male gender, stroke severity, severity of ADL on follow-up, and MTLA may be predictors of poor participation. Trial registration number ChiCTR1800016665.
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Affiliation(s)
- Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Huo-Hua Zhong
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Wen-Cong Liang
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Wei Li
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
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Interactions Between Acute Infarcts and Cerebrovascular Pathology Predict Poststroke Dementia. Alzheimer Dis Assoc Disord 2021; 34:206-211. [PMID: 32483018 DOI: 10.1097/wad.0000000000000384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic cerebrovascular pathology accelerates the incidence of poststroke dementia (PSD). Whether the risk of PSD varies according to different types of chronic cerebrovascular pathology remains unclear. OBJECTIVES We investigated whether PSD is associated with a unique pattern of interactions between chronic cerebrovascular pathologies and acute stroke lesions. MATERIALS AND METHOD In this case-control study of acute mild stroke patients (n=185), cases included patients who developed PSD at a 6-month poststroke follow-up, and controls included patients who remained nondemented at 6 months, matched on prestroke cognitive status. Magnetic resonance imaging was performed at initial stroke presentation; neuropsychological assessments were performed 6 months after the stroke. RESULTS White matter hyperintensities (WMH), chronic lacunes, microbleeds, and acute infarcts were not associated with PSD after controlling for demographics, cardiovascular risk, and global cortical atrophy. The risk of PSD was largest for patients with acute large subcortical infarcts (>15 mm) and concomitant periventricular WMH compared with patients with large subcortical infarcts and punctate/absent periventricular WMH [odds ratio (OR)=5.85, 95% confidence interval (CI)=1.85-40.04]. A moderate risk of PSD was observed for patients with acute multiple small infarcts (3 to 15 mm) and concomitant lacunes (OR=2.48, 95% CI=0.94-6.51) or concomitant lobar microbleeds (OR=2.20, 95% CI=0.89-5.41), compared with patients with acute multiple small infarcts and absent lacunes or microbleeds. Single small infarcts did not interact with cerebrovascular pathology to affect PSD. CONCLUSIONS The risk of PSD varies depending on the presence of chronic cerebrovascular pathologies and type of acute infarcts. Clinical implications support a precision medicine approach for stratifying those at highest risk of PSD.
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Lee KP, Chang AYW, Sung PS. Association between Blood Pressure, Blood Pressure Variability, and Post-Stroke Cognitive Impairment. Biomedicines 2021; 9:773. [PMID: 34356837 PMCID: PMC8301473 DOI: 10.3390/biomedicines9070773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
After stroke, dynamic changes take place from necrotic-apoptotic continuum, inflammatory response to poststroke neurogenesis, and remodeling of the network. These changes and baseline brain pathology such as small vessel disease (SVD) and amyloid burden may be associated with the occurrence of early or late poststroke cognitive impairment (PSCI) or dementia (PSD), which affect not only stroke victims but also their families and even society. We reviewed the current concepts and understanding of the pathophysiology for PSCI/PSD and identified useful tools for the diagnosis and the prediction of PSCI in serological, CSF, and image characteristics. Then, we untangled their relationships with blood pressure (BP) and blood pressure variability (BPV), important but often overlooked risk factors for PSCI/PSD. Finally, we provided evidence for the modifying effects of BP and BPV on PSCI as well as pharmacological and non-pharmacological interventions and life style modification for PSCI/PSD prevention and treatment.
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Affiliation(s)
- Kang-Po Lee
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Neurology, E-DA Hospital, Kaohsiung 824, Taiwan
| | - Alice Y. W. Chang
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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Brait VH, Wright DK, Nategh M, Oman A, Syeda WT, Ermine CM, O'Brien KR, Werden E, Churilov L, Johnston LA, Thompson LH, Nithianantharajah J, Jackman KA, Brodtmann A. Longitudinal hippocampal volumetric changes in mice following brain infarction. Sci Rep 2021; 11:10269. [PMID: 33986303 PMCID: PMC8119705 DOI: 10.1038/s41598-021-88284-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/05/2021] [Indexed: 01/14/2023] Open
Abstract
Hippocampal atrophy is increasingly described in many neurodegenerative syndromes in humans, including stroke and vascular cognitive impairment. However, the progression of brain volume changes after stroke in rodent models is poorly characterized. We aimed to monitor hippocampal atrophy occurring in mice up to 48-weeks post-stroke. Male C57BL/6J mice were subjected to an intraluminal filament-induced middle cerebral artery occlusion (MCAO). At baseline, 3-days, and 1-, 4-, 12-, 24-, 36- and 48-weeks post-surgery, we measured sensorimotor behavior and hippocampal volumes from T2-weighted MRI scans. Hippocampal volume-both ipsilateral and contralateral-increased over the life-span of sham-operated mice. In MCAO-subjected mice, different trajectories of ipsilateral hippocampal volume change were observed dependent on whether the hippocampus contained direct infarction, with a decrease in directly infarcted tissue and an increase in non-infarcted tissue. To further investigate these volume changes, neuronal and glial cell densities were assessed in histological brain sections from the subset of MCAO mice lacking hippocampal infarction. Our findings demonstrate previously uncharacterized changes in hippocampal volume and potentially brain parenchymal cell density up to 48-weeks in both sham- and MCAO-operated mice.
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Affiliation(s)
- Vanessa H Brait
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
| | - David K Wright
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.,The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mohsen Nategh
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Alexander Oman
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Warda T Syeda
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Charlotte M Ermine
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Katrina R O'Brien
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | - Leigh A Johnston
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia.,Melbourne Brain Centre Imaging Unit, University of Melbourne, Parkville, VIC, Australia
| | - Lachlan H Thompson
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Jess Nithianantharajah
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Katherine A Jackman
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
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Schellhorn T, Aamodt EB, Lydersen S, Aam S, Wyller TB, Saltvedt I, Beyer MK. Clinically accessible neuroimaging predictors of post-stroke neurocognitive disorder: a prospective observational study. BMC Neurol 2021; 21:89. [PMID: 33632149 PMCID: PMC7905565 DOI: 10.1186/s12883-021-02117-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/19/2021] [Indexed: 01/21/2023] Open
Abstract
Background Neurocognitive disorder (NCD) is common in stroke survivors. We aimed to identify clinically accessible imaging markers of stroke and chronic pathology that are associated with early post-stroke NCD. Methods We included 231 stroke survivors from the “Norwegian Cognitive Impairment after Stroke (Nor-COAST)” study who underwent a standardized cognitive assessment 3 months after the stroke. Any NCD (mild cognitive impairment and dementia) and major NCD (dementia) were diagnosed according to “Diagnostic and Statistical Manual of Mental Disorders (DSM-5)” criteria. Clinically accessible imaging findings were analyzed on study-specific brain MRIs in the early phase after stroke. Stroke lesion volumes were semi automatically quantified and strategic stroke locations were determined by an atlas based coregistration. White matter hyperintensities (WMH) and medial temporal lobe atrophy (MTA) were visually scored. Logistic regression was used to identify neuroimaging findings associated with major NCD and any NCD. Results Mean age was 71.8 years (SD 11.1), 101 (43.7%) were females, mean time from stroke to imaging was 8 (SD 16) days. At 3 months 63 (27.3%) had mild NCD and 65 (28.1%) had major NCD. Any NCD was significantly associated with WMH pathology (odds ratio (OR) = 2.73 [1.56 to 4.77], p = 0.001), MTA pathology (OR = 1.95 [1.12 to 3.41], p = 0.019), and left hemispheric stroke (OR = 1.8 [1.05 to 3.09], p = 0.032). Major NCD was significantly associated with WMH pathology (OR = 2.54 [1.33 to 4.84], p = 0.005) and stroke lesion volume (OR (per ml) =1.04 [1.01 to 1.06], p = 0.001). Conclusion WMH pathology, MTA pathology and left hemispheric stroke were associated with the development of any NCD. Stroke lesion volume and WMH pathology were associated with the development of major NCD 3 months after stroke. These imaging findings may be used in the routine clinical setting to identify patients at risk for early post-stroke NCD. Trial registration ClinicalTrials.gov, NCT02650531, Registered 8 January 2016 – Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02117-8.
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Affiliation(s)
- Till Schellhorn
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Eva Birgitte Aamodt
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stina Aam
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torgeir Bruun Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mona Kristiansen Beyer
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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12
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Levin OS, Bogolepova AN. [Poststroke motor and cognitive impairments: clinical features and current approaches to rehabilitation]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:99-107. [PMID: 33340304 DOI: 10.17116/jnevro202012011199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Stroke is one of the most common neurological diseases with high morbidity, disability and mortality, which is an urgent medical and social problem. Clinically, stroke, depending on its nature and location, causes a wide range of neurological disorders, including movement disorders, as well as a variety of cognitive and neuropsychiatric disorders. There is an emerging need for new approaches to manage patients with cerebrovascular diseases during the pandemic of COVID-19. Rehabilitation measures for the correction of motor and cognitive impairments are very diverse. The use of drugs stimulating the production of neurotrophic factors is considered as a promising direction of pharmacotherapy. Cerebrolysin promotes significant regression of motor and cognitive impairments in the acute and recovery period of ischemic stroke. Based on the data of clinical studies, Cerebrolysin is included in the guidelines for the rehabilitation of patients with stroke in Canada and Germany.
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Affiliation(s)
- O S Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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13
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Wang F, Hua S, Zhang Y, Yu H, Zhang Z, Zhu J, Liu R, Jiang Z. Association Between Small Vessel Disease Markers, Medial Temporal Lobe Atrophy and Cognitive Impairment After Stroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2020; 30:105460. [PMID: 33227579 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105460] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Two-thirds of stroke survivors suffer from cognitive impairment, and up to one-third of them progress to dementia. However, the underlying pathogenesis is complex and controversial. Recent evidence has found that cerebral small vessel disease (SVD) markers and the Alzheimer's disease (AD) neuroimaging marker medial temporal lobe atrophy (MTLA), alone or in combination, contribute to the pathogenesis of poststroke cognitive impairment (PSCI). In the present systematic review and meta-analysis, we synthesized proof for these neuroimaging risk factors among stroke patients. MATERIALS AND METHODS PUBMED, MEDLINE, EMBASE and the Cochrane Library were searched for studies investigating imaging predictors of cognitive impairment or dementia following stroke. Meta-analysis was conducted to compute the odds ratios (ORs). RESULTS Thirteen studies were enrolled in the present study, and only ten of them, comprising 2713 stroke patients, were eligible for inclusion in the meta-analysis. MTLA was significantly correlated with PSCI (OR = 1.97, 95% CI: 1.48-2.62, I2 = 0.0%). In addition, white matter hyperintensities (WMH), as a neuroimaging marker of SVD, were associated with PSCI (OR = 1.17, 95% CI: 1.12-1.22, I2 = 0.0%). However, the presence of lacunar infarcts and enlarged perivascular spaces (EPVS) were not associated with the risk of PSCI. CONCLUSIONS The findings of the present study suggest that MTLA and WMH were associated with an increased risk of PSCI.
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Affiliation(s)
- Furu Wang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sunyu Hua
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yue Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongchang Yu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | | | - Jiangtao Zhu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rong Liu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhen Jiang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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14
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White matter hyperintensities and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 36 prospective studies. Neurosci Biobehav Rev 2020; 120:16-27. [PMID: 33188821 DOI: 10.1016/j.neubiorev.2020.11.007] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/20/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND White matter hyperintensities of presumed vascular origin (WMH) are one of the imaging features of cerebral small vessel disease. Controversies persist about the effects of WMH on cognitive dysfunction. This meta-analysis aimed to identify the associations of WMH with risks of cognitive impairment and dementia. METHODS We searched PubMed, EMBASE and Cochrane Library for prospective studies. Primary analyses of cognitive dysfunction and sub-analyses of specific outcomes and study characteristics were conducted using random-effect models. RESULTS Thirty-six prospective studies with 19,040 participants were included. WMH at baseline conferred a 14 % elevated risk of cognitive impairment and all-cause dementia (ACD). WMH also conferred 25 % elevated risk of Alzheimer's disease and 73 % elevated risk of vascular dementia. Risk effects of high-grade WMH and continually increasing WMH (in volume or severity) on ACD were revealed. Periventricular WMH conferred a 1.51-fold excess risk for dementia. CONCLUSIONS WMH were associated with increased risk of cognitive dysfunction and could become a neuroimaging indicator of dementia.
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15
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Etherton MR, Fotiadis P, Giese AK, Iglesias JE, Wu O, Rost NS. White Matter Hyperintensity Burden Is Associated With Hippocampal Subfield Volume in Stroke. Front Neurol 2020; 11:588883. [PMID: 33193055 PMCID: PMC7649326 DOI: 10.3389/fneur.2020.588883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 12/05/2022] Open
Abstract
White matter hyperintensities of presumed vascular origin (WMH) are a prevalent form of cerebral small-vessel disease and an important risk factor for post-stroke cognitive dysfunction. Despite this prevalence, it is not well understood how WMH contributes to post-stroke cognitive dysfunction. Preliminary findings suggest that increasing WMH volume is associated with total hippocampal volume in chronic stroke patients. The hippocampus, however, is a complex structure with distinct subfields that have varying roles in the function of the hippocampal circuitry and unique anatomical projections to different brain regions. For these reasons, an investigation into the relationship between WMH and hippocampal subfield volume may further delineate how WMH predispose to post-stroke cognitive dysfunction. In a prospective study of acute ischemic stroke patients with moderate/severe WMH burden, we assessed the relationship between quantitative WMH burden and hippocampal subfield volumes. Patients underwent a 3T MRI brain within 2–5 days of stroke onset. Total WMH volume was calculated in a semi-automated manner. Mean cortical thickness and hippocampal volumes were measured in the contralesional hemisphere. Total and subfield hippocampal volumes were measured using an automated, high-resolution, ex vivo computational atlas. Linear regression analyses were performed for predictors of total and subfield hippocampal volumes. Forty patients with acute ischemic stroke and moderate/severe white matter hyperintensity burden were included in this analysis. Median WMH volume was 9.0 cm3. Adjusting for intracranial volume and stroke laterality, age (β = −3.7, P < 0.001), hypertension (β = −44.7, P = 0.04), WMH volume (β = −0.89, P = 0.049), and mean cortical thickness (β = 286.2, P = 0.006) were associated with total hippocampal volume. In multivariable analysis, age (β = −3.3, P < 0.001) and cortical thickness (β = 205.2, P = 0.028) remained independently associated with total hippocampal volume. In linear regression for predictors of hippocampal subfield volume, increasing WMH volume was associated with decreased hippocampal-amygdala transition area volume (β = −0.04, P = 0.001). These finding suggest that in ischemic stroke patients, increased WMH burden is associated with selective hippocampal subfield degeneration in the hippocampal-amygdala transition area.
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Affiliation(s)
- Mark R Etherton
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Panagiotis Fotiadis
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anne-Katrin Giese
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Juan E Iglesias
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
| | - Ona Wu
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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16
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Rezaei S, Asgari Mobarake K, Saberi A. BDNF (rs6265) Val < Met polymorphism can buffer cognitive functions against post stroke CT/MRI pathological findings. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:971-982. [PMID: 33073590 DOI: 10.1080/23279095.2020.1830774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Brain lesions following stroke have been shown prevalently in CT/MRI, and it was confirmed that lesions usually are accompanied by cognitive deficits. Although previous studies have emphasized that BDNF Val66Met polymorphism had a substantial role in neurogenesis and synaptic plasticity, it remains unclear to what extent an interaction may be appeared between neuroimaging findings and Val66Met variants on different cognitive functions following stroke. In a case-control study the carriers of at least one Val allele (n = 56), were compared with the carriers of Met/Met homozygotes (n = 156) in order to find possible neuroimaging factors in relation to cognitive functions in a sample from the north of Iran. The third edition of Addenbrooke's Cognitive Examination (ACE-III) was used to determine the cognitive functions. There were interactive effects among Val66Met genotypes with dominant hemisphere lesions [F = 6.97, ή2 = 0.03, p = 0.009], cerebral atrophy [F = 5.43, ή2 = 0.03, p = 0.011] and number of lesions [F = 4.32, ή2 = 0.04, p = 0.014], for visuospatial skills, memory, and attention functions respectively; implying that the effect of dominant hemisphere lesions, cerebral atrophy, and multiple lesions on cognitive functions have been modulated by Met/Met homozygosity. The destructive effect of Val/Met homozygosity on cognitive functions was shown to be exacerbated by dominant hemispheric lesions, cerebral atrophy, and multiple lesions following stroke. The findings of present research support our hypothesis that interaction of Val66Met variants with cerebral lesions is associated with cognitive dysfunctions in post stroke conditions; particularly through Met/Met homozygosity which act as a buffer mechanism against some CT/MRI pathological findings.
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Affiliation(s)
- Sajjad Rezaei
- Department of Psychology, University of Guilan, Rasht, Iran
| | | | - Alia Saberi
- Neuroscience Research Center, Department of Neurology, School of Medicine, PourSina Hospital, Guilan University of Medical Sciences, Rasht, Iran
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17
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Werden E, Khlif MS, Bird LJ, Cumming T, Bradshaw J, Khan W, Pase M, Restrepo C, Veldsman M, Egorova N, Patel SK, Gottlieb E, Brodtmann A. APOE ɛ4 Carriers Show Delayed Recovery of Verbal Memory and Smaller Entorhinal Volume in the First Year After Ischemic Stroke. J Alzheimers Dis 2020; 71:245-259. [PMID: 31381519 DOI: 10.3233/jad-190566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The apolipoprotein E (APOE) gene ɛ4 allele is a risk factor for Alzheimer's disease and cardiovascular disease. However, its relationship with cognition and brain volume after stroke is not clear. OBJECTIVE We compared cognition and medial temporal lobe volumes in APOEɛ4 carriers and non-carriers in the first year after ischemic stroke. METHODS We sampled 20 APOEɛ4 carriers and 20 non-carriers from a larger cohort of 135 ischemic stroke participants in the longitudinal CANVAS study. Participants were matched on a range of demographic and stroke characteristics. We used linear mixed-effect models to compare cognitive domain z-scores (attention, processing speed, executive function, verbal and visual memory, language, visuospatial function) and regional medial temporal lobe volumes (hippocampal, entorhinal cortex) between groups at each time-point (3, 12-months post-stroke), and within groups across time-points. APOE gene single nucleotide polymorphisms (SNPs; rs7412, rs429358) were genotyped on venous blood. RESULTS APOEɛ4 carriers and non-carriers did not differ on any demographic, clinical, or stroke variable. Carriers performed worse than non-carriers in verbal memory at 3 months post-stroke (p = 0.046), but were better in executive function at 12 months (p = 0.035). Carriers demonstrated a significant improvement in verbal memory (p = 0.012) and executive function (p = 0.015) between time-points. Non-carriers demonstrated a significant improvement in visual memory (p = 0.0005). Carriers had smaller bilateral entorhinal cortex volumes (p < 0.05), and larger right sided and contralesional hippocampal volumes, at both time-points (p < 0.05). CONCLUSION APOE ɛ4 is associated with delayed recovery of verbal memory function and reduced entorhinal cortex volumes in the first year after ischemic stroke.
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Affiliation(s)
- Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Laura J Bird
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Toby Cumming
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Wasim Khan
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Matthew Pase
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Carolina Restrepo
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Michele Veldsman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Sheila K Patel
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Elie Gottlieb
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Austin Health, Heidelberg, Melbourne, VIC, Australia.,Eastern Clinical Research Unit, Box Hill Hospital, Melbourne, VIC, Australia
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18
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Veldsman M, Cheng HJ, Ji F, Werden E, Khlif MS, Ng KK, Lim JKW, Qian X, Yu H, Zhou JH, Brodtmann A. Degeneration of structural brain networks is associated with cognitive decline after ischaemic stroke. Brain Commun 2020; 2:fcaa155. [PMID: 33376984 PMCID: PMC7751023 DOI: 10.1093/braincomms/fcaa155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/02/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
Over one-third of stroke patients has long-term cognitive impairment. The likelihood of cognitive dysfunction is poorly predicted by the location or size of the infarct. The macro-scale damage caused by ischaemic stroke is relatively localized, but the effects of stroke occur across the brain. Structural covariance networks represent voxelwise correlations in cortical morphometry. Atrophy and topographical changes within such distributed brain structural networks may contribute to cognitive decline after ischaemic stroke, but this has not been thoroughly investigated. We examined longitudinal changes in structural covariance networks in stroke patients and their relationship to domain-specific cognitive decline. Seventy-three patients (mean age, 67.41 years; SD = 12.13) were scanned with high-resolution magnetic resonance imaging at sub-acute (3 months) and chronic (1 year) timepoints after ischaemic stroke. Patients underwent a number of neuropsychological tests, assessing five cognitive domains including attention, executive function, language, memory and visuospatial function at each timepoint. Individual-level structural covariance network scores were derived from the sub-acute grey-matter probabilistic maps or changes in grey-matter probability maps from sub-acute to chronic using data-driven partial least squares method seeding at major nodes in six canonical high-order cognitive brain networks (i.e. dorsal attention, executive control, salience, default mode, language-related and memory networks). We then investigated co-varying patterns between structural covariance network scores within canonical distributed brain networks and domain-specific cognitive performance after ischaemic stroke, both cross-sectionally and longitudinally, using multivariate behavioural partial least squares correlation approach. We tested our models in an independent validation data set with matched imaging and behavioural testing and using split-half validation. We found that distributed degeneration in higher-order cognitive networks was associated with attention, executive function, language, memory and visuospatial function impairment in sub-acute stroke. From the sub-acute to the chronic timepoint, longitudinal structural co-varying patterns mirrored the baseline structural covariance networks, suggesting synchronized grey-matter volume decline occurred within established networks over time. The greatest changes, in terms of extent of distributed spatial co-varying patterns, were in the default mode and dorsal attention networks, whereas the rest were more focal. Importantly, faster degradation in these major cognitive structural covariance networks was associated with greater decline in attention, memory and language domains frequently impaired after stroke. Our findings suggest that sub-acute ischaemic stroke is associated with widespread degeneration of higher-order structural brain networks and degradation of these structural brain networks may contribute to longitudinal domain-specific cognitive dysfunction.
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Affiliation(s)
- Michele Veldsman
- Department of Experimental Psychology, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Hsiao-Ju Cheng
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fang Ji
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Kwun Kei Ng
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joseph K W Lim
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xing Qian
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Haoyong Yu
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Juan Helen Zhou
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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19
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Iadecola C, Buckwalter MS, Anrather J. Immune responses to stroke: mechanisms, modulation, and therapeutic potential. J Clin Invest 2020; 130:2777-2788. [PMID: 32391806 PMCID: PMC7260029 DOI: 10.1172/jci135530] [Citation(s) in RCA: 329] [Impact Index Per Article: 82.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Stroke is the second leading cause of death worldwide and a leading cause of disability. Most strokes are caused by occlusion of a major cerebral artery, and substantial advances have been made in elucidating how ischemia damages the brain. In particular, increasing evidence points to a double-edged role of the immune system in stroke pathophysiology. In the acute phase, innate immune cells invade brain and meninges and contribute to ischemic damage, but may also be protective. At the same time, danger signals released into the circulation by damaged brain cells lead to activation of systemic immunity, followed by profound immunodepression that promotes life-threatening infections. In the chronic phase, antigen presentation initiates an adaptive immune response targeted to the brain, which may underlie neuropsychiatric sequelae, a considerable cause of poststroke morbidity. Here, we briefly review these pathogenic processes and assess the potential therapeutic value of targeting immunity in human stroke.
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Affiliation(s)
- Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Marion S. Buckwalter
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, California, USA
| | - Josef Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
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20
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Sagnier S, Catheline G, Dilharreguy B, Linck PA, Coupé P, Munsch F, Bigourdan A, Debruxelles S, Poli M, Olindo S, Renou P, Rouanet F, Dousset V, Berthoz S, Tourdias T, Sibon I. Normal-Appearing White Matter Integrity Is a Predictor of Outcome After Ischemic Stroke. Stroke 2020; 51:449-456. [PMID: 31906830 DOI: 10.1161/strokeaha.119.026886] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The aim of the present study was to evaluate the relationship between normal-appearing white matter (NAWM) integrity and postischemic stroke recovery in 4 main domains including cognition, mood, gait, and dependency. Methods- A prospective study was conducted, including patients diagnosed for an ischemic supratentorial stroke on a 3T brain MRI performed 24 to 72 hours after symptom onset. Clinical assessment 1 year after stroke included a Montreal Cognitive Assessment, an Isaacs set test, a Zazzo cancelation task, a Hospital Anxiety and Depression scale, a 10-meter walking test, and a modified Rankin Scale (mRS). Diffusion tensor imaging parameters in the NAWM were computed using FMRIB (Functional Magnetic Resonance Imaging of the Brain) Diffusion Toolbox. The relationships between mean NAWM diffusion tensor imaging parameters and the clinical scores were assessed using linear and ordinal regression analyses, including the volumes of white matter hyperintensities, gray matter, and ischemic stroke as radiological covariates. Results- Two hundred seven subjects were included (66±13 years old; 67% men; median National Institutes of Health Stroke Scale score, 3; interquartile range, 2-6). In the models including only radiological variables, NAWM fractional anisotropy was associated with the mRS and the cognitive scores. After adjusting for demographic confounders, NAWM fractional anisotropy remained a significant predictor of mRS (β=-0.24; P=0.04). Additional path analysis showed that NAWM fractional anisotropy had a direct effect on mRS (β=-0.241; P=0.001) and a less important indirect effect mediating white matter hyperintensity burden. Similar results were found with mean diffusivity, axial diffusivity, and radial diffusivity. In further subgroup analyses, a relationship between NAWM integrity in widespread white matter tracts, mRS, and Isaacs set test was found in right hemispheric strokes. Conclusions- NAWM diffusion tensor imaging parameters measured early after an ischemic stroke are independent predictors of functional outcome and may be additional markers to include in studies evaluating poststroke recovery.
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Affiliation(s)
- Sharmila Sagnier
- From the UMR-5287-CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., S.B., I.S.).,CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Gwenaëlle Catheline
- From the UMR-5287-CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., S.B., I.S.)
| | - Bixente Dilharreguy
- From the UMR-5287-CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., S.B., I.S.)
| | | | - Pierrick Coupé
- UMR-5800-CNRS, Université de Bordeaux, LaBRI, Talence, France (P.C.)
| | - Fanny Munsch
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (F.M.)
| | - Antoine Bigourdan
- CHU de Bordeaux, Neuroradiologie, France (P.-A.L., A.B., V.D., T.T.)
| | - Sabrina Debruxelles
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Mathilde Poli
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Stéphane Olindo
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Pauline Renou
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - François Rouanet
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Vincent Dousset
- CHU de Bordeaux, Neuroradiologie, France (P.-A.L., A.B., V.D., T.T.).,INSERM-U862, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Sylvie Berthoz
- From the UMR-5287-CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., S.B., I.S.).,Département de Psychiatrie de l'Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris, Paris, France (S.B.)
| | - Thomas Tourdias
- CHU de Bordeaux, Neuroradiologie, France (P.-A.L., A.B., V.D., T.T.).,INSERM-U862, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Igor Sibon
- From the UMR-5287-CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., S.B., I.S.).,CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
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21
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Debette S, Schilling S, Duperron MG, Larsson SC, Markus HS. Clinical Significance of Magnetic Resonance Imaging Markers of Vascular Brain Injury: A Systematic Review and Meta-analysis. JAMA Neurol 2019; 76:81-94. [PMID: 30422209 DOI: 10.1001/jamaneurol.2018.3122] [Citation(s) in RCA: 344] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Covert vascular brain injury (VBI) is highly prevalent in community-dwelling older persons, but its clinical and therapeutic implications are debated. Objective To better understand the clinical significance of VBI to optimize prevention strategies for the most common age-related neurological diseases, stroke and dementia. Data Source We searched for articles in PubMed between 1966 and December 22, 2017, studying the association of 4 magnetic resonance imaging (MRI) markers of covert VBI (white matter hyperintensities [WMHs] of presumed vascular origin, MRI-defined covert brain infarcts [BIs], cerebral microbleeds [CMBs], and perivascular spaces [PVSs]) with incident stroke, dementia, or death. Study Selection Data were taken from prospective, longitudinal cohort studies including 50 or more adults. Data Extraction and Synthesis We performed inverse variance-weighted meta-analyses with random effects and z score-based meta-analyses for WMH burden. The significance threshold was P < .003 (17 independent tests). We complied with the Meta-analyses of Observational Studies in Epidemiology guidelines. Main Outcomes and Measures Stroke (hemorrhagic and ischemic), dementia (all and Alzheimer disease), and death. Results Of 2846 articles identified, 94 studies were eligible, with up to 14 529 participants for WMH, 16 012 participants for BI, 15 693 participants for CMB, and 4587 participants for PVS. Extensive WMH burden was associated with higher risk of incident stroke (hazard ratio [HR], 2.45; 95% CI, 1.93-3.12; P < .001), ischemic stroke (HR, 2.39; 95% CI, 1.65-3.47; P < .001), intracerebral hemorrhage (HR, 3.17; 95% CI, 1.54-6.52; P = .002), dementia (HR, 1.84; 95% CI, 1.40-2.43; P < .001), Alzheimer disease (HR, 1.50; 95% CI, 1.22-1.84; P < .001), and death (HR, 2.00; 95% CI, 1.69-2.36; P < .001). Presence of MRI-defined BIs was associated with higher risk of incident stroke (HR, 2.38; 95% CI, 1.87-3.04; P < .001), ischemic stroke (HR, 2.18; 95% CI, 1.67-2.85; P < .001), intracerebral hemorrhage (HR, 3.81; 95% CI, 1.75-8.27; P < .001), and death (HR, 1.64; 95% CI, 1.40-1.91; P < .001). Presence of CMBs was associated with increased risk of stroke (HR, 1.98; 95% CI, 1.55-2.53; P < .001), ischemic stroke (HR, 1.92; 95% CI, 1.40-2.63; P < .001), intracerebral hemorrhage (HR, 3.82; 95% CI, 2.15-6.80; P < .001), and death (HR, 1.53; 95% CI, 1.31-1.80; P < .001). Data on PVS were limited and insufficient to conduct meta-analyses but suggested an association of high PVS burden with increased risk of stroke, dementia, and death; this requires confirmation. Conclusions and Relevance We report evidence that MRI markers of VBI have major clinical significance. This research prompts careful evaluation of the benefit-risk ratio for available prevention strategies in individuals with covert VBI.
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Affiliation(s)
- Stéphanie Debette
- University of Bordeaux, Inserm 1219, Bordeaux Population Health Research Center, Bordeaux, France.,Department of Neurology, Memory Clinic, Bordeaux University Hospital, Bordeaux, France
| | - Sabrina Schilling
- University of Bordeaux, Inserm 1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Marie-Gabrielle Duperron
- University of Bordeaux, Inserm 1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Susanna C Larsson
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.,Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
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22
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Qu JF, Chen YK, Zhong HH, Li W, Lu ZH. Preexisting Cerebral Abnormalities and Functional Outcomes After Acute Ischemic Stroke. J Geriatr Psychiatry Neurol 2019; 32:327-335. [PMID: 31480988 DOI: 10.1177/0891988719862631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to investigate the association between preexisting cerebral abnormalities in patients with acute ischemic stroke upon their functional outcomes. METHODS We recruited 272 patients with first-ever acute ischemic stroke. Cerebral abnormalities on magnetic resonance imaging included infarction, silent brain infarcts (SBI), enlarged perivascular spaces, white matter lesions (WMLs), global brain atrophy, and medial temporal lobe atrophy (MTLA). Functional outcomes were assessed using the instrumental activities of daily living (IADL) scale and basic activities of daily living (BADL) scale, at 3 and 6 months after the index stroke. RESULTS Two hundred and fifty patients completed the 3-month follow-up and 246 patients completed the 6-month follow-up. Univariate analyses showed that patients with poor IADL and BADL were older, more likely to be men, had higher National Institutes of Health Stroke Scale (NIHSS) score on admission, more frequent atrial fibrillation, and large artery atherosclerosis subtypes. They also had more frequent cortical infarcts, subcortical infarcts, infratentorial infarcts, larger infarct volume, more frequent presence of SBI, severe WMLs, and MTLA. In multiple regression analyses, NIHSS on admission, subcortical region infarct and MTLA were significant predictors of poor IADL at 3 months. National Institutes of Health Stroke Scale on admission, SBI and MTLA were significant predictors of poor IADL at 6 months. National Institutes of Health Stroke Scale on admission and MTLA were significant predictors of poor BADL at 3 months. National Institutes of Health Stroke Scale on admission and SBI were significant predictors of poor BADL at 6 months. CONCLUSIONS In patients with acute ischemic stroke, the presence of SBI, and severe MTLA represent significant predictors of poorer functional outcomes, thus highlighting the importance of preexisting cerebral abnormalities.
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Affiliation(s)
- Jian-Feng Qu
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Yang-Kun Chen
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Huo-Hua Zhong
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China.,2 Faculty of Neurology, Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Wei Li
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Zhi-Hao Lu
- 1 Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China.,2 Faculty of Neurology, Guangdong Medical University, Zhanjiang, Guangdong Province, China
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23
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Sagnier S, Sibon I. The new insights into human brain imaging after stroke. J Neurosci Res 2019; 100:1171-1181. [PMID: 31498491 DOI: 10.1002/jnr.24525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 12/16/2022]
Abstract
Over the last two decades, developments of human brain stroke imaging have raised several questions about the place of new MRI biomarkers in the acute management of stroke and the prediction of poststroke outcome. Recent studies have demonstrated the main role of perfusion-weighted imaging in the identification of the best cerebral perfusion profile for a better response after reperfusion therapies in acute ischemic stroke. A major issue remains the early prediction of stroke outcome. While voxel-based lesion-symptom mapping emphasized the influence of stroke location, the analysis of the brain parenchyma underpinning the stroke lesion showed the relevance of prestroke cerebral status, including cortical atrophy, white matter integrity, or presence of chronic cortical cerebral microinfarcts. Moreover, besides the evaluation of the visually abnormal brain tissue, the analysis of normal-appearing brain parenchyma using diffusion tensor imaging and magnetization transfer imaging or spectroscopy offered new biomarkers to improve the prediction of the prognosis and new targets to follow in therapeutic trials. The aim of this review was to depict the main new radiological biomarkers reported in the last two decades that will provide a more thorough prediction of functional, motor, and neuropsychological outcome following the stroke. These new developments in neuroimaging might be a cornerstone in the emerging personalized medicine for stroke patients.
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Affiliation(s)
- Sharmila Sagnier
- UMR-5287 CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France.,CHU de Bordeaux, Unité Neuro-vasculaire, Bordeaux, France
| | - Igor Sibon
- UMR-5287 CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France.,CHU de Bordeaux, Unité Neuro-vasculaire, Bordeaux, France
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24
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Zamboni G, Griffanti L, Mazzucco S, Pendlebury ST, Rothwell PM. Age-dependent association of white matter abnormality with cognition after TIA or minor stroke. Neurology 2019; 93:e272-e282. [PMID: 31201296 PMCID: PMC6656647 DOI: 10.1212/wnl.0000000000007772] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/04/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate if the association between MRI-detectable white matter hyperintensity (WMH) and cognitive status reported in previous studies persists at older ages (>80 years), when some white matter abnormality is almost universally reported in clinical practice. METHODS Consecutive eligible patients from a population-based cohort of all TIA/nondisabling stroke (Oxford Vascular Study) underwent multimodal MRI, including fluid-attenuated inversion recovery and diffusion-weighted imaging, allowing automated measurement of WMH volume, mean diffusivity (MD), and fractional anisotropy (FA) in normal-appearing white matter using FSL tools. These measures were related to cognitive status (Montreal Cognitive Assessment) at age ≤80 vs >80 years. RESULTS Of 566 patients (mean [range] age 66.7 [20-102] years), 107 were aged >80 years. WMH volumes and MD/FA were strongly associated with cognitive status in patients aged ≤80 years (all p < 0.001 for WMH, MD, and FA) but not in patients aged >80 years (not significant for WMH, MD, and FA), with age interactions for WMH volume (p interaction = 0.016) and MD (p interaction = 0.037). Voxel-wise analyses also showed that lower Montreal Cognitive Assessment scores were associated with frontal WMH in patients ≤80 years, but not >80 years. CONCLUSION MRI markers of white matter damage are strongly related to cognition in patients with TIA/minor stroke at younger ages, but not at age >80 years. Clinicians and patients should not overinterpret the significance of these abnormalities at older ages.
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Affiliation(s)
- Giovanna Zamboni
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy.
| | - Ludovica Griffanti
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
| | - Sara Mazzucco
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
| | - Sarah T Pendlebury
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
| | - Peter M Rothwell
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
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25
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Munir M, Ursenbach J, Reid M, Gupta Sah R, Wang M, Sitaram A, Aftab A, Tariq S, Zamboni G, Griffanti L, Smith EE, Frayne R, Sajobi TT, Coutts SB, d'Esterre CD, Barber PA. Longitudinal Brain Atrophy Rates in Transient Ischemic Attack and Minor Ischemic Stroke Patients and Cognitive Profiles. Front Neurol 2019; 10:18. [PMID: 30837927 PMCID: PMC6389669 DOI: 10.3389/fneur.2019.00018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/07/2019] [Indexed: 02/04/2023] Open
Abstract
Introduction: Patients with transient ischemic attack (TIA) and minor stroke demonstrate cognitive impairment, and a four-fold risk of late-life dementia. Aim: To study the extent to which the rates of brain volume loss in TIA patients differ from healthy controls and how they are correlated with cognitive impairment. Methods: TIA or minor stroke patients were tested with a neuropsychological battery and underwent T1 weighted volumetric magnetic resonance imaging scans at fixed intervals over a 3 years period. Linear mixed effects regression models were used to compare brain atrophy rates between groups, and to determine the relationship between atrophy rates and cognitive function in TIA and minor stroke patients. Results: Whole brain atrophy rates were calculated for the TIA and minor stroke patients; n = 38 between 24 h and 18 months, and n = 68 participants between 18 and 36 months, and were compared to healthy controls. TIA and minor stroke patients demonstrated a significantly higher whole brain atrophy rate than healthy controls over a 3 years interval (p = 0.043). Diabetes (p = 0.012) independently predicted higher atrophy rate across groups. There was a relationship between higher rates of brain atrophy and processing speed (composite P = 0.047 and digit symbol coding P = 0.02), but there was no relationship with brain atrophy rates and memory or executive composite scores or individual cognitive tests for language (Boston naming, memory recall, verbal fluency or Trails A or B score). Conclusion: TIA and minor stroke patients experience a significantly higher rate of whole brain atrophy. In this cohort of TIA and minor stroke patients changes in brain volume over time precede cognitive decline.
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Affiliation(s)
- Muhammad Munir
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Jake Ursenbach
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Meaghan Reid
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Rani Gupta Sah
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Amith Sitaram
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Arooj Aftab
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
| | - Sana Tariq
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Giovanna Zamboni
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ludovica Griffanti
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Richard Frayne
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tolulope T Sajobi
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Shelagh B Coutts
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Christopher D d'Esterre
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Philip A Barber
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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26
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Xiong L, Boulouis G, Charidimou A, Roongpiboonsopit D, Jessel MJ, Pasi M, Reijmer YD, Fotiadis P, Ayres A, Merrill E, Schwab K, Blacker D, Gurol ME, Greenberg SM, Viswanathan A. Dementia incidence and predictors in cerebral amyloid angiopathy patients without intracerebral hemorrhage. J Cereb Blood Flow Metab 2018; 38:241-249. [PMID: 28318355 PMCID: PMC5951014 DOI: 10.1177/0271678x17700435] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is a common cause of cognitive impairment in older individuals. This study aimed to investigate predictors of dementia in CAA patients without intracerebral hemorrhage (ICH). A total of 158 non-demented patients from the Stroke Service or the Memory Clinic who met the modified Boston Criteria for probable CAA were included. At baseline, neuroimaging markers, including lobar microbleeds (cerebral microbleeds (CMBs)), white matter hyperintensities (WMH), cortical superficial siderosis (cSS), magnetic resonance imaging (MRI)-visible centrum semiovale perivascular spaces (CSO-PVS), lacunes, and medial temporal atrophy (MTA) were assessed. The overall burden of small vessel disease (SVD) for CAA was calculated by a cumulative score based on CMB number, WMH severity, cSS presence and extent and CSO-PVS severity. The estimated cumulative dementia incidence at 1 year was 14% (95% confidence interval (CI): 5%-23%), and 5 years 73% (95% CI: 55%, 84%). Age (hazard ratio (HR) 1.05 per year, 95% CI: 1.01-1.08, p = 0.007), presence of MCI status (HR 3.40, 95% CI: 1.97-6.92, p < 0.001), MTA (HR 1.71 per point, 95% CI: 1.26-2.32, p = 0.001), and SVD score (HR 1.23 per point, 95% CI: 1.20-1.48, p = 0.030) at baseline were independent predictors for dementia conversion in these patients. Cognitive deterioration of CAA patients appears attributable to cumulative changes, from both vasculopathic and neurodegenerative lesions.
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Affiliation(s)
- Li Xiong
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | | | | | - Duangnapa Roongpiboonsopit
- 1 Department of Neurology, Harvard Medical School, Boston, USA.,2 Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Marco Pasi
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | - Yael D Reijmer
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | | | - Alison Ayres
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | - Emily Merrill
- 3 MIND Informatics, Harvard Medical School, Boston, USA
| | - Kristin Schwab
- 1 Department of Neurology, Harvard Medical School, Boston, USA
| | - Deborah Blacker
- 4 Department of Psychiatry, Harvard Medical School, Boston, USA
| | - M Edip Gurol
- 1 Department of Neurology, Harvard Medical School, Boston, USA
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27
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Akinyemi RO, Allan LM, Oakley A, Kalaria RN. Hippocampal Neurodegenerative Pathology in Post-stroke Dementia Compared to Other Dementias and Aging Controls. Front Neurosci 2017; 11:717. [PMID: 29311794 PMCID: PMC5742173 DOI: 10.3389/fnins.2017.00717] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 12/08/2017] [Indexed: 12/14/2022] Open
Abstract
Neuroimaging evidence from older stroke survivors in Nigeria and Northeast England showed medial temporal lobe atrophy (MTLA) to be independently associated with post-stroke cognitive impairment and dementia. Given the hypothesis ascribing MTLA to neurodegenerative processes, we assessed Alzheimer pathology in the hippocampal formation and entorhinal cortex of autopsied brains from of post-stroke demented and non-demented subjects in comparison with controls and other dementias. We quantified markers of amyloid β (total Aβ, Aβ-40, Aβ-42, and soluble Aβ) and hyperphosphorylated tau in the hippocampal formation and entorhinal cortex of 94 subjects consisting of normal controls (n = 12), vascular dementia, VaD (17), post-stroke demented, PSD (n = 15), and post-stroke non-demented, PSND (n = 23), Alzheimer's disease, AD (n = 14), and mixed AD and vascular dementia, AD_VAD (n = 13) using immunohistochemical techniques. We found differential expression of amyloid and tau across the disease groups, and across hippocampal sub-regions. Among amyloid markers, the pattern of Aβ-42 immunoreactivity was similar to that of total Aβ. Tau immunoreactivity showed highest expression in the AD and mixed AD and vascular dementia, AD_VaD, which was higher than in control, post - stroke and VaD groups (p < 0.05). APOE ε4 allele positivity was associated with higher expression of amyloid and tau pathology in the subiculum and entorhinal cortex of post-stroke cases (p < 0.05). Comparison between PSND and PSD revealed higher total Aβ immunoreactivity in PSND compared to PSD in the CA1, subiculum and entorhinal cortex (p < 0.05) but no differences between PSND and PSD in Aβ-42, Aβ-40, soluble Aβ or tau immunoreactivities (p > 0.05). Correlation of MMSE and CAMCOG scores with AD pathological measures showed lack of correlation with amyloid species although tau immunoreactivity demonstrated correlation with memory scores (p < 0.05). Our findings suggest hippocampal AD pathology does not necessarily differ between demented and non-demented post-stroke subjects. The dissociation of cognitive performance with hippocampal AD pathological burden suggests more dominant roles for non-Alzheimer neurodegenerative and / or other non-neurodegenerative substrates for dementia following stroke.
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Affiliation(s)
- Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Oyo, Nigeria.,Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Louise M Allan
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Arthur Oakley
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rajesh N Kalaria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
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28
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Sagnier S, Catheline G, Dilharreguy B, Munsch F, Bigourdan A, Poli M, Debruxelles S, Olindo S, Renou P, Rouanet F, Dousset V, Tourdias T, Sibon I. Admission Brain Cortical Volume. Stroke 2017. [DOI: 10.1161/strokeaha.117.017646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sharmila Sagnier
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Gwenaëlle Catheline
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Bixente Dilharreguy
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Fanny Munsch
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Antoine Bigourdan
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Mathilde Poli
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Sabrina Debruxelles
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Stéphane Olindo
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Pauline Renou
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - François Rouanet
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Vincent Dousset
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Thomas Tourdias
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Igor Sibon
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
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Sarfo FS, Akassi J, Adamu S, Obese V, Ovbiagele B. Burden and Predictors of Poststroke Cognitive Impairment in a Sample of Ghanaian Stroke Survivors. J Stroke Cerebrovasc Dis 2017; 26:2553-2562. [PMID: 28652059 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.041] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 05/30/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE There are limited data on vascular cognitive impairment (VCI) from low- and middle-income countries where the stroke burden is burgeoning. The aim of this study was to characterize the burden, determinants, and effects of VCI on health-related quality of life in sub-Saharan Africa (SSA). METHODS From January 2015 to February 2016, we collected information on 147 consecutive stroke survivors (>45 years) seen at a tertiary hospital in Ghana and 49 demographically matched stroke-free controls. Data collected included demographics, clinical factors, health-related quality of life, and presence of depression. Cognitive status was evaluated using a standard Vascular Neuropsychological Battery that assessed memory, executive function and mental speed, language, and visuospatial-visuoconstructive functioning. Expert VCI guideline and Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria were used to classify stroke patients into no VCI, VCI but no dementia, and vascular dementia (VD). RESULTS The mean age ± standard deviation of the stroke survivors was 59.9 ± 13.7 years, of which 47.6% were women. Among the cohort, 77 out of 147 (52.3%) had no VCI, 50 of the 147 (34.0%) had VCI without dementia, and 20 of the 147 (13.6%) had VD. Three factors remained significantly associated with VCI: increasing age for each successive 10-year rise (odds ratio [OR] 1.44, 95% confidence interval [CI]: 1.03-2.02), lack of formal education (OR 5.26, 95% CI: 1.01-27.52), and worse functional disability on the modified Rankin scale (OR 2.46, 95% CI: 1.61-3.75). Patients with VD had the poorest health-related quality of life. CONCLUSIONS Half of the Ghanaian stroke survivors encountered in this cross-sectional study had evidence of cognitive dysfunction. Future studies in SSA will need to identify strategies to address this immense burden.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Neurology Division, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Neurology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - John Akassi
- Department of Medicine, Neurology Division, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Neurology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sheila Adamu
- Neurology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Vida Obese
- Neurology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Neurology Department, Medical University of South Carolina, South Carolina
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Risk Prediction Models for Post-Stroke Dementia. Geriatrics (Basel) 2017; 2:geriatrics2030019. [PMID: 31011029 PMCID: PMC6371182 DOI: 10.3390/geriatrics2030019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/08/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022] Open
Abstract
A strong association exists between stroke and dementia with both diseases linked to ageing. Survival rates from stroke are improving which would equate to an ever-expanding population of patients at risk of future dementia. Early or timelier identification of dementia has become a priority in many countries, including the UK. Although screening for dementia is not advocated, targeting at risk populations could be used to reduce an individual's risk via intervention (i.e., personalised medicine), where available. One approach to improving identification of high-risk dementia individuals is using risk prediction models. Such models could be applied to stroke survivors. Dementia risk prediction models specific to stroke survivors have recently been developed and will be discussed here.
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Teng Z, Dong Y, Zhang D, An J, Lv P. Cerebral small vessel disease and post-stroke cognitive impairment. Int J Neurosci 2016; 127:824-830. [PMID: 27838946 DOI: 10.1080/00207454.2016.1261291] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cerebral small vessel disease (CSVD) refers to a group of pathological processes with multifarious etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. Features seen on neuroimaging include white matter hyperintensities, lacunar infarction, cerebral microbleeds, brain atrophy, microinfarcts and enlarged perivascular spaces (EPVS). CSVD gives rise to one in five strokes worldwide and is a leading cause of cognitive impairment and dementia, especially in the elderly. Post-stroke cognitive impairment (PSCI) is one of the most common subtypes of cognitive impairment. The underlying mechanisms of PSCI are not known in detail. A growing body of evidence has been suggesting that CSVD plays an important role in the pathogenesis of PSCI. This article reviews the advances in research on the relationship between CSVD and PSCI.
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Affiliation(s)
- Zhenjie Teng
- a Department of Neurology , Hebei General Hospital , Shijiazhuang , P. R. China.,b Graduate School , Hebei Medical University , Shijiazhuang , P. R. China
| | - Yanhong Dong
- a Department of Neurology , Hebei General Hospital , Shijiazhuang , P. R. China
| | - Dandan Zhang
- a Department of Neurology , Hebei General Hospital , Shijiazhuang , P. R. China.,b Graduate School , Hebei Medical University , Shijiazhuang , P. R. China
| | - Jin An
- a Department of Neurology , Hebei General Hospital , Shijiazhuang , P. R. China
| | - Peiyuan Lv
- a Department of Neurology , Hebei General Hospital , Shijiazhuang , P. R. China.,b Graduate School , Hebei Medical University , Shijiazhuang , P. R. China
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Arba F, Quinn T, Hankey GJ, Ali M, Lees KR, Inzitari D. Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack. Eur J Neurol 2016; 24:276-282. [PMID: 27862654 DOI: 10.1111/ene.13191] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Small vessel disease (SVD) and Alzheimer's disease (AD) are two common causes of cognitive impairment and dementia, traditionally considered as distinct processes. The relationship between radiological features suggestive of AD and SVD was explored, and the association of each of these features with cognitive status at 1 year was investigated in patients with stroke or transient ischaemic attack. METHODS Anonymized data were accessed from the Virtual International Stroke Trials Archive (VISTA). Medial temporal lobe atrophy (MTA; a marker of AD) and markers of SVD were rated using validated ordinal visual scales. Cognitive status was evaluated with the Mini Mental State Examination (MMSE) 1 year after the index stroke. Logistic regression models were used to investigate independent associations between (i) baseline SVD features and MTA and (ii) all baseline neuroimaging features and cognitive status 1 year post-stroke. RESULTS In all, 234 patients were included, mean (±SD) age 65.7 ± 13.1 years, 145 (62%) male. Moderate to severe MTA was present in 104 (44%) patients. SVD features were independently associated with MTA (P < 0.001). After adjusting for age, sex, disability after stroke, hypertension and diabetes mellitus, MTA was the only radiological feature independently associated with cognitive impairment, defined using thresholds of MMSE ≤ 26 (odds ratio 1.94; 95% confidence interval 1.28-2.94) and MMSE ≤ 23 (odds ratio 2.31; 95% confidence interval 1.48-3.62). CONCLUSION In patients with ischaemic cerebrovascular disease, SVD features are associated with MTA, which is a common finding in stroke survivors. SVD and AD type neurodegeneration coexist, but the AD marker MTA, rather than SVD markers, is associated with post-stroke cognitive impairment.
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Affiliation(s)
- F Arba
- NEUROFARBA Department, University of Florence, Florence, Italy.,Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - T Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - G J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, QEII Medical Centre, Perth, Australia
| | - M Ali
- Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - K R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Inzitari
- NEUROFARBA Department, University of Florence, Florence, Italy
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Mok VCT, Lam BYK, Wang Z, Liu W, Au L, Leung EYL, Chen S, Yang J, Chu WCW, Lau AYL, Chan AYY, Shi L, Fan F, Ma SH, Ip V, Soo YOY, Leung TWH, Kwok TCY, Ho CL, Wong LKS, Wong A. Delayed-onset dementia after stroke or transient ischemic attack. Alzheimers Dement 2016; 12:1167-1176. [PMID: 27327542 DOI: 10.1016/j.jalz.2016.05.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/11/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Patients surviving stroke without immediate dementia are at high risk of delayed-onset dementia. Mechanisms underlying delayed-onset dementia are complex and may involve vascular and/or neurodegenerative diseases. METHODS Dementia-free patients with stroke and/or transient ischemic attack (TIA; n = 919) were studied for 3 years prospectively, excluding those who developed dementia 3 to 6 months after stroke and/or TIA. RESULTS Forty subjects (4.4%) developed dementia during the study period. Imaging markers of severe small vessel disease (SVD), namely presence of ≥3 lacunes and confluent white matter changes; history of hypertension and diabetes mellitus independently predicted delayed-onset dementia after adjustment for age, gender, and education. Only 6 of 31 (19.4%) subjects with delayed cognitive decline harbored Alzheimer's disease-like Pittsburg compound B (PiB) retention. Most PiB cases (16/25, 64%) had evidence of severe SVD. DISCUSSION Severe SVD contributes importantly to delayed-onset dementia after stroke and/or TIA. Future clinical trials aiming to prevent delayed-onset dementia after stroke and/or TIA should target this high-risk group.
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Affiliation(s)
- Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Bonnie Y K Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eric Y L Leung
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Sirong Chen
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Jie Yang
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alexander Y L Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Florence Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sze H Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yannie O Y Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas W H Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi L Ho
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China.
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Tuladhar AM, van Uden IWM, Rutten-Jacobs LCA, Lawrence A, van der Holst H, van Norden A, de Laat K, van Dijk E, Claassen JAHR, Kessels RPC, Markus HS, Norris DG, de Leeuw FE. Structural network efficiency predicts conversion to dementia. Neurology 2016; 86:1112-9. [PMID: 26888983 DOI: 10.1212/wnl.0000000000002502] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/16/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To examine whether structural network connectivity at baseline predicts incident all-cause dementia in a prospective hospital-based cohort of elderly participants with MRI evidence of small vessel disease (SVD). METHODS A total of 436 participants from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC), a prospective hospital-based cohort of elderly without dementia with cerebral SVD, were included in 2006. During follow-up (2011-2012), dementia was diagnosed. The structural network was constructed from baseline diffusion tensor imaging followed by deterministic tractography and measures of efficiency using graph theory were calculated. Cox proportional regression analyses were conducted. RESULTS During 5 years of follow-up, 32 patients developed dementia. MRI markers for SVD were strongly associated with network measures. Patients with dementia showed lower total network strength and global and local efficiency at baseline as compared with the group without dementia. Lower global network efficiency was independently associated with increased risk of incident all-cause dementia (hazard ratio 0.63, 95% confidence interval 0.42-0.96, p = 0.032); in contrast, individual SVD markers including lacunes, white matter hyperintensities volume, and atrophy were not independently associated. CONCLUSIONS These results support a role of network disruption playing a pivotal role in the genesis of dementia in SVD, and suggest network analysis of the connectivity of white matter has potential as a predictive marker in the disease.
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Affiliation(s)
- Anil M Tuladhar
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Ingeborg W M van Uden
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Loes C A Rutten-Jacobs
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Andrew Lawrence
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Helena van der Holst
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Anouk van Norden
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Karlijn de Laat
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Ewoud van Dijk
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Jurgen A H R Claassen
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Roy P C Kessels
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Hugh S Markus
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - David G Norris
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands
| | - Frank-Erik de Leeuw
- From the Departments of Neurology (A.M.T., I.W.M.v.U., H.v.d.H., E.v.D., F.-E.d.L.), Geriatrics (J.A.H.R.C., R.P.C.K.), and Medical Psychology (R.P.C.K.), Radboudumc, and Centre for Cognitive Neuroimaging, Radboud University Nijmegen (A.M.T., D.G.N.), Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J., A.L., H.S.M.), University of Cambridge, UK; Department of Neurology (A.v.N.), Amphia ziekenhuis Breda; Department of Neurology (K.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany; and MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands.
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Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta Mol Basis Dis 2016; 1862:915-25. [PMID: 26806700 PMCID: PMC4827373 DOI: 10.1016/j.bbadis.2016.01.015] [Citation(s) in RCA: 288] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 12/13/2022]
Abstract
The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. Ischaemic injury is common among long-term stroke survivors About 25% stroke survivors develop dementia with a much greater proportion developing cognitive impairment Risk factors of dementia after stroke include older age, vascular comorbidities, prior stroke and pre-stroke impairment Current imaging and pathological studies suggest 70% of dementia after stroke is vascular dementia Severe white matter changes and medial temporal lobe atrophy as sequelae after ischaemic injury are substrates of dementia Controlling vascular risk factors and prevention strategies related to lifestyle factors would reduce dementia after stroke
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Affiliation(s)
- Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
| | - Rufus Akinyemi
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Masafumi Ihara
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
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Akinyemi RO, Firbank M, Ogbole GI, Allan LM, Owolabi MO, Akinyemi JO, Yusuf BP, Ogunseyinde O, Ogunniyi A, Kalaria RN. Medial temporal lobe atrophy, white matter hyperintensities and cognitive impairment among Nigerian African stroke survivors. BMC Res Notes 2015; 8:625. [PMID: 26519155 PMCID: PMC4628353 DOI: 10.1186/s13104-015-1552-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuroimaging features associated with vascular cognitive impairment have not been examined in sub-Saharan Africans. We determined magnetic resonance imaging (MRI) features associated with cognitive impairment in a sample of Nigerian stroke survivors. METHODS Stroke survivors underwent brain MRI with standardized assessment of brain volumes and visual rating of medial temporal lobe atrophy (MTA), and white matter hyperintensities (WMH) at 3 months post-stroke. Demographic, clinical and psychometric assessments of global cognitive function, executive function, mental speed and memory were related to changes in structural MRI. RESULTS In our pilot sample of 58 stroke survivors (60.1 ± 10.7 years old) MTA correlated significantly with age (r = 0.525), WMH (r = 0.461), memory (r = -0.702), executive function (r = -0.369) and general cognitive performance (r = -0.378). On univariate analysis, age >60 years (p = 0.016), low educational attainment (p < 0.001 to p < 0.003), total brain volume (p < 0.024 and p < 0.025) and MTA (p < 0.003 to p < 0.007) but not total WMH (p < 0.073, p = 0.610) were associated with cognitive outcome. In a two-step multivariate regression analysis, MTA (p < 0.035 and p < 0.016) and low educational attainment (p < 0.012 and p < 0.019) were sustained as independent statistical predictors of cognitive outcome. CONCLUSIONS Medial temporal lobe atrophy was a significant neuroimaging predictor of early post-stroke cognitive dysfunction in the Nigerian African stroke survivors. These observations have implications for a vascular basis of MTA in older stroke survivors among sub-Saharan Africans.
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Affiliation(s)
- Rufus O Akinyemi
- Division of Neurology, Department of Medicine, Federal Medical Centre Abeokuta, Abeokuta, Nigeria. .,Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
| | - Michael Firbank
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
| | - Godwin I Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria.
| | - Louise M Allan
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
| | | | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria.
| | | | | | | | - Raj N Kalaria
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
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Atangana EN, Homburg D, Vajkoczy P, Schneider UC. Mouse cerebral magnetic resonance imaging fails to visualize brain volume changes after experimental subarachnoid hemorrhage. Acta Neurochir (Wien) 2015; 157:37-42. [PMID: 25398554 DOI: 10.1007/s00701-014-2276-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/04/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Brain atrophy after subarachnoid hemorrhage (SAH) has been detected in humans and might serve as a functional read-out parameter for neuropsychological deficits. To determine whether serial magnetic resonance imaging (MRI) can provide information on brain atrophy in animals as well, mice that had undergone experimental SAH were scanned repeatedly after the bleeding. METHODS Using a 7-T rodent MRI, six mice were evaluated for total hemispheric, cerebrospinal fluid (CSF) and hippocampal volumes on days 1, 2, 4, 21, 28, 42 and 60 after experimental SAH or sham operation, respectively. RESULTS Repeated MRI scanning demonstrated a very high reproducibility with minimum standard deviation. Nevertheless, no significant differences were found between the two groups concerning hemispherical volumes or hippocampal volumes. A transient but significant increase in CSF volume was detected on days 2 and 60 after SAH. Compared with the existing method, no MRI data on brain atrophy in mice after experimental SAH have been published. CONCLUSION Repeated brain MRI in mice after experimental SAH did not provide additional information on brain atrophy. Our data suggest that this is not due to a lack of sensitivity of the method. Despite all promising details about MRI, our results should initiate careful consideration (additional sequences/other questions) before its further use in this certain area, especially since it is expensive and associated with demanding logistics.
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Affiliation(s)
- Etienne N Atangana
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Mehrabian S, Raycheva M, Petrova N, Janyan A, Petrova M, Traykov L. Neuropsychological and neuroimaging markers in prediction of cognitive impairment after ischemic stroke: a prospective follow-up study. Neuropsychiatr Dis Treat 2015; 11:2711-9. [PMID: 26527875 PMCID: PMC4621206 DOI: 10.2147/ndt.s86366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are few longitudinal studies with controversial results examining delayed changes in cognition after ischemic stroke and predictive values of neuropsychological and neuroimaging markers. OBJECTIVE The objectives of this study were to evaluate the delayed changes in cognition in poststroke patients and their relationship to the neuropsychological and neuroimaging markers measured during the acute poststroke phase. METHODS Eighty-five first-ever stroke inpatients (mean age 65.6±5.6 years) without previous cognitive complaints were prospectively evaluated with a comprehensive neuropsychological battery at the 5th day and the 1st, 6th, and 12th months. A wide range of clinical, radiological, and neuropsychological variables were examined. RESULTS Our results showed significantly poorer performance on mini-mental state examination, memory, attention/executive functions, and processing speed in patients with stroke in comparison with stroke-free cognitively intact controls. Multiple regression analysis revealed that hippocampal atrophy is the strongest predictor of delayed cognitive impairment. Secondary divided subgroups according to Isaacs Set Test (IST) score showed that patients with IST score ≤28 had different patterns of cognitive and neurological impairment after 1 year. Baseline impairments in attention/executive functions and memory were associated with development of dementia in poststroke patients. CONCLUSION Executive functioning deficit appears to have a predictive power for cognitive impairment progression. The study suggests that IST as a screening test has a potential to be a reliable and quick tool for poststroke cognitive impairment evaluation and delayed cognitive and neurological outcome. Hippocampal atrophy was the strongest predictor for cognitive impairment outcome, even in poststroke cognitive impairment. The findings may set the stage for better poststroke management.
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Affiliation(s)
- Shima Mehrabian
- Clinic of Neurology, University Hospital Alexandrovska, Sofia, Bulgaria
| | | | - Neli Petrova
- Clinic of Neurology, MHAT "Ruse", Ruse, Bulgaria
| | - Armina Janyan
- Research Center for Cognitive Science, Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria ; Laboratory for Cognitive Studies in Language, National Research Tomsk State University, Tomsk, Russia
| | - Mariya Petrova
- Clinic of Neurology, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Latchezar Traykov
- Clinic of Neurology, University Hospital Alexandrovska, Sofia, Bulgaria
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Burke MJC, Nelson L, Slade JY, Oakley AE, Khundakar AA, Kalaria RN. Morphometry of the hippocampal microvasculature in post-stroke and age-related dementias. Neuropathol Appl Neurobiol 2014; 40:284-95. [PMID: 24003901 PMCID: PMC4282329 DOI: 10.1111/nan.12085] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/29/2013] [Indexed: 12/31/2022]
Abstract
Background Optimal vascular function is vital for prevention of dementia. We hypothesized that elderly post-stroke survivors who preserve cognitive function show unperturbed cerebral microvasculature compared with those who develop dementia. Methods Using stereological spherical probe software, we compared the length density (Lv, cumulative vessel length per unit tissue volume) of hippocampal microvessels in post mortem brain tissue from post-stroke survivors, Alzheimer's disease (AD), vascular dementia (VaD) and normal ageing control subjects. We also assessed microvessel diameters in the same subjects. Microvessels were identified by markers of endothelial cells (glucose transporter 1; GLUT1), basement membrane (collagen IV; COL4) and smooth muscle cell α-actin (SMA). Results We found increased Lv of both GLUT1 and COL4 immunostained microvessels (P < 0.05) in the hippocampal CA1 region of post-stroke demented (PSD) and AD cases compared with post-stroke nondemented (PSND), control and VaD subjects. However, no changes were apparent in the CA2 region. We also noted significant increase in Lv in the entorhinal cortex of AD compared with PSND and PSD subjects. The mean diameter of microvessels was decreased in PSD, compared with PSND, as well as in AD and VaD compared with controls. Cumulative frequency analysis showed PSND subjects to have significantly greater proportion of microvessels with diameters, ranging from 7 to 12 μm. Conclusions An increase in microvascular Lv in AD and PSD suggests either an increase in angiogenesis or the formation of newer microvessel loops in response to cerebral hypoperfusion. The decreased vessel diameters found in AD and VaD suggests increased vasoconstriction in dementia.
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Affiliation(s)
- M J C Burke
- Centre for Brain Ageing and Vitality, Institute for Ageing and Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
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Akinyemi RO, Allan L, Owolabi MO, Akinyemi JO, Ogbole G, Ajani A, Firbank M, Ogunniyi A, Kalaria RN. Profile and determinants of vascular cognitive impairment in African stroke survivors: the CogFAST Nigeria Study. J Neurol Sci 2014; 346:241-9. [PMID: 25238666 DOI: 10.1016/j.jns.2014.08.042] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/25/2014] [Accepted: 08/28/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Sub-Saharan Africa faces a potential epidemic of non-communicable diseases including stroke and dementia but little is known about the burden of stroke-related cognitive dysfunction. We assessed the baseline profile and factors associated with vascular cognitive impairment (VCI) in stroke survivors participating in the Cognitive Function After STroke (CogFAST) Nigeria Study. METHODS We recruited 217 subjects (>45 years old) comprising 143 stroke survivors and 74 demographically matched stroke-free healthy controls. We obtained demographic, clinical and lifestyle information and assessed the cognitive status of the subjects at baseline three months after stroke. Standard neuropsychological tests included the Vascular Neuropsychological Battery, which assessed executive function/mental speed, memory, language, and visuospatial/visuoconstructive functioning. Cognitive impairment and dementia were defined based on the AHA/ASA VCI guidelines and the DSM IV criteria. RESULTS Among the stroke survivors (mean ag e= 60.4+9.5 years, 43.4% female, mean number of years of education = 9.4+5.6 years, median modified Rankin score = 2), 57 (39.9%) had cognitive impairment no dementia while 12 (8.4%) were demented at baseline. Multivariate analysis revealed that older age [OR = 1.05 (1.00-1.09)], low education [OR = 5.09 (2.17-11.95)], pre-stroke cognitive decline [OR = 4.51 (1.20-16.88)] and medial temporal lobe atrophy [OR = 2.25 (1.16-4.35)] were independently associated with cognitive dysfunction whereas pre-stroke daily intake of fish [p = 0.022, OR = 0.39 (0.15-0.89)] was inversely associated. CONCLUSIONS These results suggest a high frequency of early VCI in older Nigerian stroke survivors. Apart from aging, associated neurodegeneration and cognitive decline, educational level and pre-stroke diet particularly fish consumption were identified as modifiable factors. This emphasizes the vital role of education and healthy nutrition in building reserves to ameliorate cognitive dysfunction after stroke.
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Affiliation(s)
- Rufus O Akinyemi
- Division of Neurology, Department of Medicine, Federal Medical Center Abeokuta, Nigeria; Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Louise Allan
- Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mayowa O Owolabi
- Department of Medicine, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Godwin Ogbole
- Department of Radiology, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Akinlolu Ajani
- Division of Neurology, Department of Medicine, Federal Medical Center Abeokuta, Nigeria
| | - Michael Firbank
- Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Adesola Ogunniyi
- Department of Medicine, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Raj N Kalaria
- Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Ihara M, Kalaria RN. Understanding and preventing the development of post-stroke dementia. Expert Rev Neurother 2014; 14:1067-77. [PMID: 25105544 DOI: 10.1586/14737175.2014.947276] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Post-stroke dementia (PSD) is a clinical entity but it now appears that most of PSD may be categorized as vascular dementia. The well-established relationship between vascular factors and dementia provides a rationale for the implementation of intervention and prevention efforts. Larger primary prevention trials related to lifestyle factors are warranted in association with dementia. Published clinical trials have not been promising and there is meager information on whether PSD can be prevented through the use of pharmacological agents. Control of vascular disease risk and prevention of recurrent strokes are obviously key to reducing the burden of cognitive decline and dementia after stroke. However, modern imaging and analysis techniques will help to elucidate the mechanism of PSD and establish better treatment.
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Affiliation(s)
- Masafumi Ihara
- Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
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Foster V, Oakley AE, Slade JY, Hall R, Polvikoski TM, Burke M, Thomas AJ, Khundakar A, Allan LM, Kalaria RN. Pyramidal neurons of the prefrontal cortex in post-stroke, vascular and other ageing-related dementias. ACTA ACUST UNITED AC 2014; 137:2509-21. [PMID: 24974383 DOI: 10.1093/brain/awu172] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Dementia associated with cerebrovascular disease is common. It has been reported that ∼30% of elderly patients who survive stroke develop delayed dementia (post-stroke dementia), with most cases being diagnosed as vascular dementia. The pathological substrates associated with post-stroke or vascular dementia are poorly understood, particularly those associated with executive dysfunction. Three separate yet interconnecting circuits control executive function within the frontal lobe involving the dorsolateral prefrontal cortex, anterior cingulate cortex and the orbitofrontal cortex. We used stereological methods, along with immunohistological and related cell morphometric analysis, to examine densities and volumes of pyramidal neurons of the dorsolateral prefrontal cortex, anterior cingulate cortex and orbitofrontal cortex in the frontal lobe from a total of 90 elderly subjects (age range 71-98 years). Post-mortem brain tissues from post-stroke dementia and post-stroke patients with no dementia were derived from our prospective Cognitive Function After Stroke study. We also examined, in parallel, samples from ageing controls and similar age subjects pathologically diagnosed with Alzheimer's disease, mixed Alzheimer's disease and vascular dementia, and vascular dementia. We found pyramidal cell volumes in layers III and V in the dorsolateral prefrontal cortex of post-stroke and vascular dementia and, of mixed and Alzheimer's disease subjects to be reduced by 30-40% compared to post-stroke patients with no dementia and controls. There were no significant changes in neuronal volumes in either the anterior cingulate or orbitofrontal cortices. Remarkably, pyramidal neurons within the orbitofrontal cortex were also found to be smaller in size when compared to those in the other two neocortical regions. To relate the cell changes to cognitive function, we noted significant correlations between neuronal volumes and total CAMCOG, orientation and memory scores and clinical dementia ratings. Total estimated neuronal densities were not significantly changed between patients with post-stroke dementia and post-stroke patients with no dementia groups or ageing controls in any of the three frontal regions. In further morphometric analysis of the dorsolateral prefrontal cortex, we showed that neither diffuse cerebral atrophy nor neocortical thickness explained the selective neuronal volume effects. We also noted that neurofilament protein SMI31 immunoreactivity was increased in post-stroke and vascular dementia compared with post-stroke patients with no dementia and correlated with decreased neuronal volumes in subjects with post-stroke dementia and vascular dementia. Our findings suggest selective regional pyramidal cell atrophy in the dorsolateral prefrontal cortex-rather than neuronal density changes per se-are associated with dementia and executive dysfunction in post-stroke dementia and vascular dementia. The changes in dorsolateral prefrontal cortex pyramidal cells were not associated with neurofibrillary pathology suggesting there is a vascular basis for the observed highly selective neuronal atrophy.
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Affiliation(s)
- Vincent Foster
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Arthur E Oakley
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Janet Y Slade
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Roslyn Hall
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Tuomo M Polvikoski
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Matthew Burke
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Ahmad Khundakar
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise M Allan
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Raj N Kalaria
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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43
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Neuron Volumes in Hippocampal Subfields in Delayed Poststroke and Aging-Related Dementias. J Neuropathol Exp Neurol 2014; 73:305-11. [DOI: 10.1097/nen.0000000000000054] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Yin X, Liu C, Gui L, Zhao L, Zhang J, Wei L, Xie B, Zhou D, Li C, Wang J. Comparison of medial temporal measures between Binswanger's disease and Alzheimer's disease. PLoS One 2014; 9:e86423. [PMID: 24466084 PMCID: PMC3900523 DOI: 10.1371/journal.pone.0086423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/10/2013] [Indexed: 01/23/2023] Open
Abstract
Binswanger's disease (BD) is a common cause of vascular dementia in elderly patients; however, few studies have investigated the medial temporal lobe (MTL) atrophy in BD, and the differences in the atrophic patterns between BD and Alzheimer's disease (AD) remain largely unknown. Such knowledge is essential for understanding the pathologic basis of dementia. In this study, we collected structural magnetic resonance imaging (MRI) data from 16 normal controls, 14 patients with AD and 14 patients with BD. The volumes of the hippocampus and amygdala, and morphologic parameters (volume, surface area, cortical thickness and mean curvature) of the entorhinal cortex (ERC) and perirhinal cortex (PRC) were calculated using an automated approach. Volume reduction of the hippocampus, amygdala and ERC, and disturbance of the PRC curvature was found in both AD and BD patients compared with the controls (p<0.05, uncorrected). There were no significant differences among all the structural measures between the AD and BD patients. Finally, partial correlation analyses revealed that cognitive decline could be attributed to ERC thinning in AD and volume reduction of PRC in BD. We conclude that AD and BD exhibit similar atrophy patterns in the medial temporal cortices and deep gray matter but have distinct pathologic bases for cognitive impairments. Although atrophy of the MTL structures is a sensitive biomarker for AD, it is not superior for discrimination between AD and BD.
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Affiliation(s)
- Xuntao Yin
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Chen Liu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Li Gui
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Lu Zhao
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jiuquan Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Luqing Wei
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bing Xie
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Daiquan Zhou
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Chuanming Li
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
- * E-mail: (JW); (CL)
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
- * E-mail: (JW); (CL)
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45
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Qiu C. Epidemiological findings of vascular risk factors in Alzheimer’s disease: implications for therapeutic and preventive intervention. Expert Rev Neurother 2014; 11:1593-607. [DOI: 10.1586/ern.11.146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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46
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Al-Qazzaz NK, Ali SH, Ahmad SA, Islam S. Cognitive assessments for the early diagnosis of dementia after stroke. Neuropsychiatr Dis Treat 2014; 10:1743-51. [PMID: 25246795 PMCID: PMC4168871 DOI: 10.2147/ndt.s68443] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The early detection of poststroke dementia (PSD) is important for medical practitioners to customize patient treatment programs based on cognitive consequences and disease severity progression. The aim is to diagnose and detect brain degenerative disorders as early as possible to help stroke survivors obtain early treatment benefits before significant mental impairment occurs. Neuropsychological assessments are widely used to assess cognitive decline following a stroke diagnosis. This study reviews the function of the available neuropsychological assessments in the early detection of PSD, particularly vascular dementia (VaD). The review starts from cognitive impairment and dementia prevalence, followed by PSD types and the cognitive spectrum. Finally, the most usable neuropsychological assessments to detect VaD were identified. This study was performed through a PubMed and ScienceDirect database search spanning the last 10 years with the following keywords: "post-stroke"; "dementia"; "neuro-psychological"; and "assessments". This study focuses on assessing VaD patients on the basis of their stroke risk factors and cognitive function within the first 3 months after stroke onset. The search strategy yielded 535 articles. After application of inclusion and exclusion criteria, only five articles were considered. A manual search was performed and yielded 14 articles. Twelve articles were included in the study design and seven articles were associated with early dementia detection. This review may provide a means to identify the role of neuropsychological assessments as early PSD detection tests.
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Affiliation(s)
- Noor Kamal Al-Qazzaz
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi, Selangor, Malaysia ; Department of Biomedical Engineering, Al-Khwarizmi College of Engineering, Baghdad University, Baghdad, Iraq
| | - Sawal Hamid Ali
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi, Selangor, Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Shabiul Islam
- Institute of Microengineering and Nanoelectronics (IMEN), UKM, Bangi, Selangor, Malaysia
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47
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Ihle-Hansen H, Thommessen B, Fagerland MW, Øksengård AR, Wyller TB, Engedal K, Fure B. Multifactorial Vascular Risk Factor Intervention to Prevent Cognitive Impairment after Stroke and TIA: A 12-month Randomized Controlled Trial. Int J Stroke 2012. [DOI: 10.1111/j.1747-4949.2012.00928.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives Vascular risk factor control may not only prevent stroke but also reduce the risk of dementia. We investigated whether a multifactorial intervention program reduces the incidence of cognitive symptoms one-year after stroke and transient ischemic attack in first ever stroke patients without cognitive decline prior to the stroke. Materials and methods Patients suffering their first ever stroke were included in this randomized, evaluator-blinded, controlled trial with two parallel groups. Baseline examination included extensive assessment of exposure to vascular risk factors and cognitive assessments regarding memory, attention, and executive function. After discharge, patients were allocated to either intensive vascular risk factor intervention or care as usual. The primary end points were changes in trail-making test A and 10-word test from baseline to 12 months follow-up. Results One hundred ninety-five patients were randomized. The difference between groups in trail-making test A, adjusted for baseline measurements, was 3·8 s (95% confidence interval: −4·2 to 11·9; P = 0·35) in favor of the intervention group. The difference between groups in the 10-word recall test was 1·1 words (95% confidence interval: −0·5 to 2·7; P = 0·17) in favor of the intervention group. We did not observe any differences in the secondary outcomes of incident dementia or mild cognitive impairment. Conclusions We could not demonstrate cognitive effects of an intensive risk factor intervention at one-year poststroke. Longer follow-up and a more heterogeneous study sample might have lead to larger effects. More effective methods for managing the risk of further cognitive decline after stroke are needed.
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Affiliation(s)
- Hege Ihle-Hansen
- Department of Geriatric Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Oslo, Norway
| | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Oslo, Norway
| | - Morten W. Fagerland
- Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Anne R. Øksengård
- Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Torgeir B. Wyller
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Engedal
- Norwegian Centre for Dementia Research, Oslo University Hospital, Oslo, Norway
| | - Brynjar Fure
- Norwegian Knowledge Centre for the Health Services, Specialist Health Section, Oslo, Norway
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48
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Kalaria RN, Akinyemi R, Ihara M. Does vascular pathology contribute to Alzheimer changes? J Neurol Sci 2012; 322:141-7. [PMID: 22884479 DOI: 10.1016/j.jns.2012.07.032] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 07/10/2012] [Accepted: 07/11/2012] [Indexed: 12/21/2022]
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Pendlebury ST. Dementia in Patients Hospitalized with Stroke: Rates, Time Course, and Clinico-Pathologic Factors. Int J Stroke 2012; 7:570-81. [DOI: 10.1111/j.1747-4949.2012.00837.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke is a risk factor for dementia and dementia predisposes to stroke. Dementia prevalence in subjects with stroke is comparable with that seen in stroke-free subjects who are 10 years older. Although overall there is heterogeneity between studies of prestroke and poststroke dementia, stratifying by study method and clinical criteria (e.g. inclusion/exclusion of prestroke dementia, first ever vs. any vs. recurrent stroke) results in reasonably consistent estimates. Pooled dementia rates from studies of consecutive patients hospitalized with stroke indicate that around 10% have dementia prior to first stroke and 10% have new dementia in the first year after first-ever stroke with highest rates (over 30%) seen after recurrent stroke. After the immediate high-risk poststroke period, rates of new incident dementia are lower but remain elevated at around four times the background risk. Factors associated with prestroke and poststroke dementia are broadly similar but age, medial temporal lobe atrophy, female sex, and family history are more strongly associated with prestroke dementia suggesting a greater role for degenerative pathology. Poststroke dementia is associated with factors indicating a reduced cognitive reserve (prestroke cognitive decline, premorbid disability, low education, white matter disease, and atrophy) and is also strongly associated with stroke factors (lesion size, multiple lesions, and stroke recurrence) and complications of stroke (delirium, seizures, hypotension, systemic illness and incontinence) indicating the likely impact of optimal acute stroke care and secondary prevention in reducing the burden of dementia. Future studies are needed to clarify the interaction between degenerative, vascular, and systemic processes in the development of stroke-associated dementia.
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Affiliation(s)
- Sarah T. Pendlebury
- Nuffield Department of Clinical Neurosciences, Stroke Prevention Research Unit, University of Oxford, Oxford, UK and NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
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50
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Korczyn AD, Vakhapova V, Grinberg LT. Vascular dementia. J Neurol Sci 2012; 322:2-10. [PMID: 22575403 DOI: 10.1016/j.jns.2012.03.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 12/22/2022]
Abstract
The epidemic growth of dementia causes great concern for the society. It is customary to consider Alzheimer's disease (AD) as the most common cause of dementia, followed by vascular dementia (VaD). This dichotomous view of a neurodegenerative disease as opposed to brain damage caused by extrinsic factors led to separate lines of research in these two entities. Indeed, accumulated data suggest that the two disorders have additive effects and probably interact; however it is still unknown to what degree. Furthermore, epidemiological studies have shown "vascular" risk factors to be associated with AD. Therefore, a clear distinction between AD and VaD cannot be made in most cases, and is furthermore unhelpful. In the absence of efficacious treatment for the neurodegenerative process, special attention must be given to the vascular component, even in patients with presumed mixed pathology. Symptomatic treatment of VaD and AD is similar, although the former is less effective. For prevention of dementia it is important to treat all factors aggressively, even in stroke survivors who do not show evidence of cognitive decline. In this review, we will give a clinical and pathological picture of the processes leading to VaD and discuss its interaction with AD.
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Affiliation(s)
- Amos D Korczyn
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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