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Hong H, Tozer DJ, Markus HS. Relationship of Perivascular Space Markers With Incident Dementia in Cerebral Small Vessel Disease. Stroke 2024; 55:1032-1040. [PMID: 38465597 PMCID: PMC10962441 DOI: 10.1161/strokeaha.123.045857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Recent studies, using diffusion tensor image analysis along the perivascular space (DTI-ALPS), suggest impaired perivascular space (PVS) function in cerebral small vessel disease, but they were cross-sectional, making inferences on causality difficult. We determined associations between impaired PVS, measured using DTI-ALPS and PVS volume, and cognition and incident dementia. METHODS In patients with lacunar stroke and confluent white matter hyperintensities, without dementia at baseline, recruited prospectively in a single center, magnetic resonance imaging was performed annually for 3 years, and cognitive assessments, including global, memory, executive function, and processing speed, were performed annually for 5 years. We determined associations between DTI-ALPS and PVS volume with cerebral small vessel disease imaging markers (white matter hyperintensity volume, lacunes, and microbleeds) at baseline and with changes in imaging markers. We determined whether DTI-ALPS and PVS volume at baseline and change over 3 years predicted incident dementia. Analyses were controlled for conventional diffusion tensor image metrics using 2 markers (median mean diffusivity [MD] and peak width of skeletonized MD) and adjusted for age, sex, and vascular risk factors. RESULTS A total of 120 patients, mean age 70.0 years and 65.0% male, were included. DTI-ALPS declined over 3 years, while no change in PVS volume was found. Neither DTI-ALPS nor PVS volume was associated with cerebral small vessel disease imaging marker progression. Baseline DTI-ALPS was associated with changes in global cognition (β=0.142, P=0.032), executive function (β=0.287, P=0.027), and long-term memory (β=0.228, P=0.027). Higher DTI-ALPS at baseline predicted a lower risk of dementia (hazard ratio, 0.328 [0.183-0.588]; P<0.001), and this remained significant after including median MD as a covariate (hazard ratio, 0.290 [0.139-0.602]; P<0.001). Change in DTI-ALPS predicted dementia conversion (hazard ratio, 0.630 [0.428-0.964]; P=0.048), but when peak width of skeletonized MD and median MD were entered as covariates, the association was not significant. There was no association between baseline PVS volume, or PVS change over 3 years, and conversion to dementia. CONCLUSIONS DTI-ALPS predicts future dementia risk in patients with lacunar strokes and confluent white matter hyperintensities. However, the weakening of the association between change in DTI-ALPS and incident dementia after controlling for peak width of skeletonized MD and median MD suggests part of the signal may represent conventional diffusion tensor image metrics. PVS volume is not a predictor of future dementia risk.
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Affiliation(s)
- Hui Hong
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom (H.H., D.J.T., H.S.M.)
- Department of Radiology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (H.H.)
| | - Daniel J. Tozer
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom (H.H., D.J.T., H.S.M.)
| | - Hugh S. Markus
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom (H.H., D.J.T., H.S.M.)
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Reiländer A, Engel M, Nöth U, Deichmann R, Shrestha M, Wagner M, Gracien RM, Seiler A. Cortical microstructural involvement in cerebral small vessel disease. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100218. [PMID: 38510580 PMCID: PMC10951897 DOI: 10.1016/j.cccb.2024.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background In cerebral small vessel disease (CSVD), cortical atrophy occurs at a later stage compared to microstructural abnormalities and therefore cannot be used for monitoring short-term disease progression. We aimed to investigate whether cortical diffusion tensor imaging (DTI) and quantitative (q) magnetic resonance imaging (MRI) are able to detect early microstructural involvement of the cerebral cortex in CSVD. Materials and Methods 33 CSVD patients without significant cortical or whole-brain atrophy and 16 healthy control subjects were included and underwent structural MRI, DTI and high-resolution qMRI with T2, T2* and T2' mapping at 3 T as well as comprehensive cognitive assessment. After tissue segmentation and reconstruction of the cortical boundaries with the Freesurfer software, DTI and qMRI parameters were saved as surface datasets and averaged across all vertices. Results Cortical diffusivity and quantitative T2 values were significantly increased in patients compared to controls (p < 0.05). T2 values correlated significantly positively with white matter hyperintensity (WMH) volume (p < 0.01). Both cortical diffusivity and T2 showed significant negative associations with axonal damage to the white matter fiber tracts (p < 0.05). Conclusions Cortical diffusivity and quantitative T2 mapping are suitable to detect microstructural involvement of the cerebral cortex in CSVD and represent promising imaging biomarkers for monitoring disease progression and effects of therapeutical interventions in clinical studies.
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Affiliation(s)
- Annemarie Reiländer
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Marlene Engel
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Manoj Shrestha
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Marlies Wagner
- Brain Imaging Center, Goethe University, Frankfurt, Germany
- Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Alexander Seiler
- Brain Imaging Center, Goethe University, Frankfurt, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
- Neurovascular Center, University Hospital Schleswig-Holstein, Kiel, Germany
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Mu S, Lu W, Yu G, Zheng L, Qiu J. Deep learning-based grading of white matter hyperintensities enables identification of potential markers in multi-sequence MRI data. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107904. [PMID: 37924768 DOI: 10.1016/j.cmpb.2023.107904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND White matter hyperintensities (WMHs) are widely-seen in the aging population, which are associated with cerebrovascular risk factors and age-related cognitive decline. At present, structural atrophy and functional alterations coexisted with WMHs lacks comprehensive investigation. This study developed a WMHs risk prediction model to evaluate WHMs according to Fazekas scales, and to locate potential regions with high risks across the entire brain. METHODS We developed a WMHs risk prediction model, which consisted of the following steps: T2 fluid attenuated inversion recovery (T2-FLAIR) image of each participant was firstly segmented into 1000 tiles with the size of 32 × 32 × 1, features from the tiles were extracted using the ResNet18-based feature extractor, and then a 1D convolutional neural network (CNN) was used to score all tiles based on the extracted features. Finally, a multi-layer perceptron (MLP) was constructed to predict the Fazekas scales based on the tile scores. The proposed model was trained using T2-FLAIR images, we selected tiles with abnormal scores in the test set after prediction, and evaluated their corresponding gray matter (GM) volume, white matter (WM) volume, fractional anisotropy (FA), mean diffusivity (MD), and cerebral blood flow (CBF) via longitudinal and multi-sequence Magnetic Resonance Imaging (MRI) data analysis. RESULTS The proposed WMHs risk prediction model could accurately predict the Fazekas ratings based on the tile scores from T2-FLAIR MRI images with accuracy of 0.656, 0.621 in training data set and test set, respectively. The longitudinal MRI validation revealed that most of the high-risk tiles predicted by the WMHs risk prediction model in the baseline images had WMHs in the corresponding positions in the longitudinal images. The validation on multi-sequence MRI demonstrated that WMHs were associated with GM and WM atrophies, WM micro-structural and perfusion alterations in high-risk tiles, and multi-modal MRI measures of most high-risk tiles showed significant associations with Mini Mental State Examination (MMSE) score. CONCLUSION Our proposed WMHs risk prediction model can not only accurately evaluate WMH severities according to Fazekas scales, but can also uncover potential markers of WMHs across modalities. The WMHs risk prediction model has the potential to be used for the early detection of WMH-related alterations in the entire brain and WMH-induced cognitive decline.
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Affiliation(s)
- Si Mu
- College of Mechanical and Electronic Engineering, Shandong Agricultural University, Tai'an, Shandong, 271000, China
| | - Weizhao Lu
- Department of Radiology, the Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong, 271000, China
| | - Guanghui Yu
- Department of Radiology, the Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong, 271000, China
| | - Lei Zheng
- Department of Radiology, Rushan Hospital of Chinese Medicine, Rushan, Shandong, 264500, China.
| | - Jianfeng Qiu
- School of Radiology, Shandong First Medical University & Shandong Academy of Medicine Sciences, Tai'an, Shandong, 271000, China; Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250000, China.
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4
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Li H, Jacob MA, Cai M, Duering M, Chamberland M, Norris DG, Kessels RPC, de Leeuw FE, Marques JP, Tuladhar AM. Regional cortical thinning, demyelination and iron loss in cerebral small vessel disease. Brain 2023; 146:4659-4673. [PMID: 37366338 PMCID: PMC10629800 DOI: 10.1093/brain/awad220] [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: 03/20/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023] Open
Abstract
The link between white matter hyperintensities (WMH) and cortical thinning is thought to be an important pathway by which WMH contributes to cognitive deficits in cerebral small vessel disease (SVD). However, the mechanism behind this association and the underlying tissue composition abnormalities are unclear. The objective of this study is to determine the association between WMH and cortical thickness, and the in vivo tissue composition abnormalities in the WMH-connected cortical regions. In this cross-sectional study, we included 213 participants with SVD who underwent standardized protocol including multimodal neuroimaging scans and cognitive assessment (i.e. processing speed, executive function and memory). We identified the cortex connected to WMH using probabilistic tractography starting from the WMH and defined the WMH-connected regions at three connectivity levels (low, medium and high connectivity level). We calculated the cortical thickness, myelin and iron of the cortex based on T1-weighted, quantitative R1, R2* and susceptibility maps. We used diffusion-weighted imaging to estimate the mean diffusivity of the connecting white matter tracts. We found that cortical thickness, R1, R2* and susceptibility values in the WMH-connected regions were significantly lower than in the WMH-unconnected regions (all Pcorrected < 0.001). Linear regression analyses showed that higher mean diffusivity of the connecting white matter tracts were related to lower thickness (β = -0.30, Pcorrected < 0.001), lower R1 (β = -0.26, Pcorrected = 0.001), lower R2* (β = -0.32, Pcorrected < 0.001) and lower susceptibility values (β = -0.39, Pcorrected < 0.001) of WMH-connected cortical regions at high connectivity level. In addition, lower scores on processing speed were significantly related to lower cortical thickness (β = 0.20, Pcorrected = 0.030), lower R1 values (β = 0.20, Pcorrected = 0.006), lower R2* values (β = 0.29, Pcorrected = 0.006) and lower susceptibility values (β = 0.19, Pcorrected = 0.024) of the WMH-connected regions at high connectivity level, independent of WMH volumes and the cortical measures of WMH-unconnected regions. Together, our study demonstrated that the microstructural integrity of white matter tracts passing through WMH is related to the regional cortical abnormalities as measured by thickness, R1, R2* and susceptibility values in the connected cortical regions. These findings are indicative of cortical thinning, demyelination and iron loss in the cortex, which is most likely through the disruption of the connecting white matter tracts and may contribute to processing speed impairment in SVD, a key clinical feature of SVD. These findings may have implications for finding intervention targets for the treatment of cognitive impairment in SVD by preventing secondary degeneration.
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Affiliation(s)
- Hao Li
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Mina A Jacob
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Mengfei Cai
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 510080 Guangzhou, China
| | - Marco Duering
- Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering, University of Basel, 4051 Basel, Switzerland
- LMU Munich, University Hospital, Institute for Stroke and Dementia Research (ISD), 81377 Munich, Germany
| | - Maxime Chamberland
- Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, 6525 EN Nijmegen, The Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, 6525 EN Nijmegen, The Netherlands
| | - Roy P C Kessels
- Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Center, 6525 GC, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 EN Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, 5803 AC Venray, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - José P Marques
- Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, 6525 EN Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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Marzi C, Scheda R, Salvadori E, Giorgio A, De Stefano N, Poggesi A, Inzitari D, Pantoni L, Mascalchi M, Diciotti S. Fractal dimension of the cortical gray matter outweighs other brain MRI features as a predictor of transition to dementia in patients with mild cognitive impairment and leukoaraiosis. Front Hum Neurosci 2023; 17:1231513. [PMID: 37822707 PMCID: PMC10562576 DOI: 10.3389/fnhum.2023.1231513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023] Open
Abstract
Background The relative contribution of changes in the cerebral white matter (WM) and cortical gray matter (GM) to the transition to dementia in patients with mild cognitive impairment (MCI) is not yet established. In this longitudinal study, we aimed to analyze MRI features that may predict the transition to dementia in patients with MCI and T2 hyperintensities in the cerebral WM, also known as leukoaraiosis. Methods Sixty-four participants with MCI and moderate to severe leukoaraiosis underwent baseline MRI examinations and annual neuropsychological testing over a 2 year period. The diagnosis of dementia was based on established criteria. We evaluated demographic, neuropsychological, and several MRI features at baseline as predictors of the clinical transition. The MRI features included visually assessed MRI features, such as the number of lacunes, microbleeds, and dilated perivascular spaces, and quantitative MRI features, such as volumes of the cortical GM, hippocampus, T2 hyperintensities, and diffusion indices of the cerebral WM. Additionally, we examined advanced quantitative features such as the fractal dimension (FD) of cortical GM and WM, which represents an index of tissue structural complexity derived from 3D-T1 weighted images. To assess the prediction of transition to dementia, we employed an XGBoost-based machine learning system using SHapley Additive exPlanations (SHAP) values to provide explainability to the machine learning model. Results After 2 years, 18 (28.1%) participants had transitioned from MCI to dementia. The area under the receiving operator characteristic curve was 0.69 (0.53, 0.85) [mean (90% confidence interval)]. The cortical GM-FD emerged as the top-ranking predictive feature of transition. Furthermore, aggregated quantitative neuroimaging features outperformed visually assessed MRI features in predicting conversion to dementia. Discussion Our findings confirm the complementary roles of cortical GM and WM changes as underlying factors in the development of dementia in subjects with MCI and leukoaraiosis. FD appears to be a biomarker potentially more sensitive than other brain features.
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Affiliation(s)
- Chiara Marzi
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti, " University of Florence, Florence, Italy
| | - Riccardo Scheda
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi, " University of Bologna, Cesena, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio, " University of Florence, Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and Network in Oncology (ISPRO), Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi, " University of Bologna, Cesena, Italy
- Alma Mater Research Institute for Human-Centered Artificial Intelligence, University of Bologna, Bologna, Italy
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Chen H, Xu J, Lv W, Hu Z, Ke Z, Qin R, Xu Y. Altered static and dynamic functional network connectivity related to cognitive decline in individuals with white matter hyperintensities. Behav Brain Res 2023; 451:114506. [PMID: 37230298 DOI: 10.1016/j.bbr.2023.114506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023]
Abstract
White matter hyperintensities (WMH) of assumed vascular origin are common in elderly individuals and are closely associated with cognitive decline. However, the underlying neural mechanisms of WMH-related cognitive impairment remain unclear. After strict screening, 59 healthy controls (HC, n = 59), 51 patients with WMH and normal cognition (WMH-NC, n = 51) and 68 patients with WMH and mild cognitive impairment (WMH-MCI, n = 68) were included in the final analyses. All individuals underwent multimodal magnetic resonance imaging (MRI) and cognitive evaluations. We investigated the neural mechanism underlying WMH-related cognitive impairment based on static and dynamic functional network connectivity (sFNC and dFNC) approaches. Finally, the support vector machine (SVM) method was performed to identify WMH-MCI individuals. The sFNC analysis indicated that functional connectivity within the visual network (VN) could mediate the impairment of information processing speed related to WMH (indirect effect: 0.24; 95% CI: 0.03, 0.88 and indirect effect: 0.05; 95% CI: 0.001, 0.14). WMH may regulate the dFNC between the higher-order cognitive network and other networks and enhance the dynamic variability between the left frontoparietal network (lFPN) and the VN to compensate for the decline in high-level cognitive functions. The SVM model achieved good prediction ability for WMH-MCI patients based on the above characteristic connectivity patterns. Our findings shed light on the dynamic regulation of brain network resources to maintain cognitive processing in individuals with WMH. Crucially, dynamic reorganization of brain networks could be regarded as a potential neuroimaging biomarker for identifying WMH-related cognitive impairment.
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Affiliation(s)
- Haifeng Chen
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China; Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China; Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Jingxian Xu
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Weiping Lv
- Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China
| | - Zheqi Hu
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhihong Ke
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Ruomeng Qin
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China; Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China; Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China; Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China; Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China; Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China.
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da Silva PHR, de Leeuw FE, Zotin MCZ, Neto OMP, Leoni RF, Tuladhar AM. Cortical Thickness and Brain Connectivity Mediate the Relation Between White Matter Hyperintensity and Information Processing Speed in Cerebral Small Vessel Disease. Brain Topogr 2023:10.1007/s10548-023-00973-w. [PMID: 37273021 DOI: 10.1007/s10548-023-00973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
White matter hyperintensities of presumed vascular origin (WMH) are the most common imaging feature of cerebral small vessel disease (cSVD) and are associated with cognitive impairment, especially information processing speed (IPS) deficits. However, it is unclear how WMH can directly impact IPS or whether the cortical thickness and brain connectivity mediate such association. In this study, it was evaluated the possible mediating roles of cortical thickness and brain (structural and functional) connectivity on the relationship between WMH (also considering its topography distribution) and IPS in 389 patients with cSVD from the RUN-DMC (Radboud University Nijmegen Diffusion tensor and Magnetic resonance imaging Cohort) database. Significant (p < 0.05 after multiple comparisons correction) associations of WMH volume and topography with cortical thickness, brain connectivity, and IPS performance in cSVD individuals were found. Additionally, cortical thickness and brain structural and functional connectivity were shown to mediate the association of WMH volume and location with IPS scores. More specifically, frontal cortical thickness, functional sensorimotor network, and posterior thalamic radiation tract were the essential mediators of WMH and IPS in this clinical group. This study provided insight into the mechanisms underlying the clinical relevance of white matter hyperintensities in information processing speed deficits in cSVD through cortical thinning and network disruptions.
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Affiliation(s)
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Maria Clara Zanon Zotin
- Department of Neurology, J. Philip Kistler Stroke Research Center, MGH, Boston, MA, USA
- Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Octavio Marques Pontes Neto
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Anil M Tuladhar
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Miceli G, Basso MG, Rizzo G, Pintus C, Cocciola E, Pennacchio AR, Tuttolomondo A. Artificial Intelligence in Acute Ischemic Stroke Subtypes According to Toast Classification: A Comprehensive Narrative Review. Biomedicines 2023; 11:biomedicines11041138. [PMID: 37189756 DOI: 10.3390/biomedicines11041138] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
The correct recognition of the etiology of ischemic stroke (IS) allows tempestive interventions in therapy with the aim of treating the cause and preventing a new cerebral ischemic event. Nevertheless, the identification of the cause is often challenging and is based on clinical features and data obtained by imaging techniques and other diagnostic exams. TOAST classification system describes the different etiologies of ischemic stroke and includes five subtypes: LAAS (large-artery atherosclerosis), CEI (cardio embolism), SVD (small vessel disease), ODE (stroke of other determined etiology), and UDE (stroke of undetermined etiology). AI models, providing computational methodologies for quantitative and objective evaluations, seem to increase the sensitivity of main IS causes, such as tomographic diagnosis of carotid stenosis, electrocardiographic recognition of atrial fibrillation, and identification of small vessel disease in magnetic resonance images. The aim of this review is to provide overall knowledge about the most effective AI models used in the differential diagnosis of ischemic stroke etiology according to the TOAST classification. According to our results, AI has proven to be a useful tool for identifying predictive factors capable of subtyping acute stroke patients in large heterogeneous populations and, in particular, clarifying the etiology of UDE IS especially detecting cardioembolic sources.
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Affiliation(s)
- Giuseppe Miceli
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Maria Grazia Basso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Giuliana Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Chiara Pintus
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Elena Cocciola
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Andrea Roberta Pennacchio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Antonino Tuttolomondo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
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Wang M, Zhao G, Jiang Y, Lu T, Wang Y, Zhu Y, Zhang Z, Xie C, Wang Z, Ren Q. Disconnection of Network Hubs Underlying the Executive Function Deficit in Patients with Ischemic Leukoaraiosis. J Alzheimers Dis 2023; 94:1577-1586. [PMID: 37458032 DOI: 10.3233/jad-230048] [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] [Indexed: 07/18/2023]
Abstract
BACKGROUND Cognitive impairment is the most common clinical manifestation of ischemic leukoaraiosis (ILA), but the underlying neurobiological pathways have not been well elucidated. Recently, it was thought that ILA is a "disconnection syndrome". Disorganized brain connectome were considered the key neuropathology underlying cognitive deficits in ILA patients. OBJECTIVE We aimed to detect the disruption of network hubs in ILA patients using a new analytical method called voxel-based eigenvector centrality (EC) mapping. METHODS Subjects with moderate to severe white matters hyperintensities (Fazekas score ≥3) and healthy controls (HCs) (Fazekas score = 0) were included in the study. The resting-state functional magnetic resonance imaging and the EC mapping approach were performed to explore the alteration of whole-brain network connectivity in ILA patients. RESULTS Relative to the HCs, the ILA patients exhibited poorer cognitive performance in episodic memory, information processing speed, and executive function (all ps < 0.0125). Additionally, compared with HCs, the ILA patients had lower functional connectivity (i.e., EC values) in the medial parts of default-mode network (i.e., bilateral posterior cingulate gyrus and ventral medial prefrontal cortex [vMPFC]). Intriguingly, the functional connectivity strength at the right vMPFC was positively correlated with executive function deficit in the ILA patients. CONCLUSION The findings suggested disorganization of the hierarchy of the default-mode regions within the whole-brain network in patients with ILA and advanced our understanding of the neurobiological mechanism underlying executive function deficit in ILA.
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Affiliation(s)
- Mengxue Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Guofeng Zhao
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou, China
| | - Ying Jiang
- Department of Neurology, The 962nd Hospital of the PLA Joint Logistic Support Force, Harbin, China
| | - Tong Lu
- Department of Radiology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yanjuan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yixin Zhu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhengsheng Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Chunming Xie
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qingguo Ren
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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10
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Marshall RS, Liebeskind DS, III JH, Edwards LJ, Howard G, Meschia JF, Brott TG, Lal BK, Heck D, Lanzino G, Sangha N, Kashyap VS, Morales CD, Cotton-Samuel D, Rivera AM, Brickman AM, Lazar RM. Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis. J Stroke 2023; 25:92-100. [PMID: 36592969 PMCID: PMC9911846 DOI: 10.5853/jos.2022.02285] [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] [Received: 07/13/2022] [Accepted: 10/17/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. METHODS We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis-Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. RESULTS Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). CONCLUSIONS Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.
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Affiliation(s)
- Randolph S. Marshall
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA,Correspondence: Randolph S. Marshall Department of Neurology, Columbia University Irving Medical Center, 710 W 168th St, New York, NY 10032, USA Tel: +1-212-305-8389 Fax: +1-212-305-3741 E-mail:
| | - David S. Liebeskind
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Lloyd J. Edwards
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Brajesh K. Lal
- Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Donald Heck
- Department of Radiology, Novant Health Clinical Research, Winston-Salem, NC, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Navdeep Sangha
- Department of Neurology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Vikram S. Kashyap
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Clarissa D. Morales
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Dejania Cotton-Samuel
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Andres M. Rivera
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam M. Brickman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ronald M. Lazar
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Austin TR, Jensen PN, Nasrallah IM, Habes M, Rashid T, Ware JB, Chen LY, Greenland P, Hughes TM, Post WS, Shea SJ, Watson KE, Sitlani CM, Floyd JS, Kronmal RA, Longstreth WT, Bertoni AG, Shah SJ, Bryan RN, Heckbert SR. Left Atrial Function and Arrhythmias in Relation to Small Vessel Disease on Brain MRI: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2022; 11:e026460. [PMID: 36250665 PMCID: PMC9673671 DOI: 10.1161/jaha.122.026460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Atrial fibrillation (AF) is associated with increased stroke risk and accelerated cognitive decline, but the association of early manifestations of left atrial (LA) impairment with subclinical changes in brain structure is unclear. We investigated whether abnormal LA structure and function, greater supraventricular ectopy, and intermittent AF are associated with small vessel disease on magnetic resonance imaging of the brain. Methods and Results In the Multi‐Ethnic Study of Atherosclerosis, 967 participants completed 14‐day ambulatory electrocardiographic monitoring, speckle tracking echocardiography and, a median 17 months later, magnetic resonance imaging of the brain. We assessed associations of LA volume index and reservoir strain, supraventricular ectopy, and prevalent AF with brain magnetic resonance imaging measures of small vessel disease and atrophy. The mean age of participants was 72 years; 53% were women. In multivariable models, LA enlargement was associated with lower white matter fractional anisotropy and greater prevalence of microbleeds; reduced LA strain, indicating worse LA function, was associated with more microbleeds. More premature atrial contractions were associated with lower total gray matter volume. Compared with no AF, intermittent AF (prevalent AF with <100% AF during electrocardiographic monitoring) was associated with lower white matter fractional anisotropy (−0.25 SDs [95% CI, −0.44 to −0.07]) and greater prevalence of microbleeds (prevalence ratio: 1.42 [95% CI, 1.12–1.79]). Conclusions In individuals without a history of stroke or transient ischemic attack, alterations of LA structure and function, including enlargement, reduced strain, frequent premature atrial contractions, and intermittent AF, were associated with increased markers of small vessel disease. Detailed assessment of LA structure and function and extended ECG monitoring may enable early identification of individuals at greater risk of small vessel disease.
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Affiliation(s)
- Thomas R Austin
- Department of Epidemiology University of Washington Seattle WA
| | - Paul N Jensen
- Department of Medicine University of Washington Seattle WA
| | - Ilya M Nasrallah
- Center for Biomedical Image Computing and Analytics, Department of Radiology University of Pennsylvania Philadelphia PA
| | - Mohamad Habes
- Neuroimage Analytics Laboratory and the Biggs Institute Neuroimaging Core Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio TX
| | - Tanweer Rashid
- Neuroimage Analytics Laboratory and the Biggs Institute Neuroimaging Core Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio TX
| | - Jeffrey B Ware
- Department of Radiology University of Pennsylvania Philadelphia PA
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Philip Greenland
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Timothy M Hughes
- Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC
| | - Wendy S Post
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Steven J Shea
- Departments of Medicine and Epidemiology Columbia University New York NY
| | - Karol E Watson
- Department of Medicine, David Geffen School of Medicine University of California Los Angeles CA
| | | | - James S Floyd
- Department of Epidemiology University of Washington Seattle WA.,Department of Medicine University of Washington Seattle WA
| | | | - W T Longstreth
- Department of Epidemiology University of Washington Seattle WA.,Department of Neurology University of Washington Seattle WA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention Wake Forest School of Medicine Winston-Salem NC
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - R Nick Bryan
- Department of Radiology University of Pennsylvania Philadelphia PA
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12
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Safri AA, Nassir CMNCM, Iman IN, Mohd Taib NH, Achuthan A, Mustapha M. Diffusion tensor imaging pipeline measures of cerebral white matter integrity: An overview of recent advances and prospects. World J Clin Cases 2022; 10:8450-8462. [PMID: 36157806 PMCID: PMC9453345 DOI: 10.12998/wjcc.v10.i24.8450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/20/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is a leading cause of age-related microvascular cognitive decline, resulting in significant morbidity and decreased quality of life. Despite a progress on its key pathophysiological bases and general acceptance of key terms from neuroimaging findings as observed on the magnetic resonance imaging (MRI), key questions on CSVD remain elusive. Enhanced relationships and reliable lesion studies, such as white matter tractography using diffusion-based MRI (dMRI) are necessary in order to improve the assessment of white matter architecture and connectivity in CSVD. Diffusion tensor imaging (DTI) and tractography is an application of dMRI that provides data that can be used to non-invasively appraise the brain white matter connections via fiber tracking and enable visualization of individual patient-specific white matter fiber tracts to reflect the extent of CSVD-associated white matter damage. However, due to a lack of standardization on various sets of software or image pipeline processing utilized in this technique that driven mostly from research setting, interpreting the findings remain contentious, especially to inform an improved diagnosis and/or prognosis of CSVD for routine clinical use. In this minireview, we highlight the advances in DTI pipeline processing and the prospect of this DTI metrics as potential imaging biomarker for CSVD, even for subclinical CSVD in at-risk individuals.
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Affiliation(s)
- Amanina Ahmad Safri
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
| | - Che Mohd Nasril Che Mohd Nassir
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ismail Nurul Iman
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
| | - Nur Hartini Mohd Taib
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
| | - Anusha Achuthan
- School of Computer Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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13
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Binnie LR, Pauls MMH, Benjamin P, Dhillon MPK, Betteridge S, Clarke B, Ghatala R, Hainsworth FAH, Howe FA, Khan U, Kruuse C, Madigan JB, Moynihan B, Patel B, Pereira AC, Rostrup E, Shtaya ABY, Spilling CA, Trippier S, Williams R, Isaacs JD, Barrick TR, Hainsworth AH. Test-retest reliability of arterial spin labelling for cerebral blood flow in older adults with small vessel disease. Transl Stroke Res 2022; 13:583-594. [PMID: 35080734 PMCID: PMC9232403 DOI: 10.1007/s12975-021-00983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022]
Abstract
Cerebral small vessel disease (SVD) is common in older people and is associated with lacunar stroke, white matter hyperintensities (WMH) and vascular cognitive impairment. Cerebral blood flow (CBF) is reduced in SVD, particularly within white matter.Here we quantified test-retest reliability in CBF measurements using pseudo-continuous arterial spin labelling (pCASL) in older adults with clinical and radiological evidence of SVD (N=54, mean (SD): 66.9 (8.7) years, 15 females/39 males). We generated whole-brain CBF maps on two visits at least 7 days apart (mean (SD): 20 (19), range 7-117 days).Test-retest reliability for CBF was high in all tissue types, with intra-class correlation coefficient [95%CI]: 0.758 [0.616, 0.852] for whole brain, 0.842 [0.743, 0.905] for total grey matter, 0.771 [0.636, 0.861] for deep grey matter (caudate-putamen and thalamus), 0.872 [0.790, 0.923] for normal-appearing white matter (NAWM) and 0.780 [0.650, 0.866] for WMH (all p<0.001). ANCOVA models indicated significant decline in CBF in total grey matter, deep grey matter and NAWM with increasing age and diastolic blood pressure (all p<0.001). CBF was lower in males relative to females (p=0.013 for total grey matter, p=0.004 for NAWM).We conclude that pCASL has high test-retest reliability as a quantitative measure of CBF in older adults with SVD. These findings support the use of pCASL in routine clinical imaging and as a clinical trial endpoint.All data come from the PASTIS trial, prospectively registered at: https://eudract.ema.europa.eu (2015-001235-20, registered 13/05/2015), http://www.clinicaltrials.gov (NCT02450253, registered 21/05/2015).
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Affiliation(s)
- Lauren R Binnie
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Mathilde M H Pauls
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
- Department of Neurology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Philip Benjamin
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
- Department of Neuroradiology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Mohani-Preet K Dhillon
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Shai Betteridge
- Department of Neuropsychology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Brian Clarke
- Department of Neurology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Rita Ghatala
- Department of Neurology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Fearghal A H Hainsworth
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Franklyn A Howe
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Usman Khan
- Department of Neurology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Christina Kruuse
- Department of Neurology and Neurovascular Research Unit, Herlev Gentofte Hospital, Herlev, Denmark
| | - Jeremy B Madigan
- Department of Neuroradiology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Barry Moynihan
- Department of Neurology, St George's University Hospitals NHS Foundation Trust London, London, UK
- Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Bhavini Patel
- Department of Neurology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Anthony C Pereira
- Department of Neurology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Egill Rostrup
- Mental Health Centre, University of Copenhagen, Glostrup, Denmark
| | - Anan B Y Shtaya
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Catherine A Spilling
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Sarah Trippier
- South London Stroke Research Network, St George's Hospital, London, UK
| | - Rebecca Williams
- South London Stroke Research Network, St George's Hospital, London, UK
| | - Jeremy D Isaacs
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
- Department of Neurology, St George's University Hospitals NHS Foundation Trust London, London, UK
| | - Thomas R Barrick
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Atticus H Hainsworth
- Molecular & Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
- Department of Neurology, St George's University Hospitals NHS Foundation Trust London, London, UK.
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14
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Jansen MG, Griffanti L, Mackay CE, Anatürk M, Melazzini L, Lange AMGD, Filippini N, Zsoldos E, Wiegertjes K, Leeuw FED, Singh-Manoux A, Kivimäki M, Ebmeier KP, Suri S. Association of cerebral small vessel disease burden with brain structure and cognitive and vascular risk trajectories in mid-to-late life. J Cereb Blood Flow Metab 2022; 42:600-612. [PMID: 34610763 PMCID: PMC8943617 DOI: 10.1177/0271678x211048411] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We characterize the associations of total cerebral small vessel disease (SVD) burden with brain structure, trajectories of vascular risk factors, and cognitive functions in mid-to-late life. Participants were 623 community-dwelling adults from the Whitehall II Imaging Sub-study with multi-modal MRI (mean age 69.96, SD = 5.18, 79% men). We used linear mixed-effects models to investigate associations of SVD burden with up to 25-year retrospective trajectories of vascular risk and cognitive performance. General linear modelling was used to investigate concurrent associations with grey matter (GM) density and white matter (WM) microstructure, and whether these associations were modified by cognitive status (Montreal Cognitive Asessment [MoCA] scores of < 26 vs. ≥ 26). Severe SVD burden in older age was associated with higher mean arterial pressure throughout midlife (β = 3.36, 95% CI [0.42-6.30]), and faster cognitive decline in letter fluency (β = -0.07, 95% CI [-0.13--0.01]), and verbal reasoning (β = -0.05, 95% CI [-0.11--0.001]). Moreover, SVD burden was related to lower GM volumes in 9.7% of total GM, and widespread WM microstructural decline (FWE-corrected p < 0.05). The latter association was most pronounced in individuals who demonstrated cognitive impairments on MoCA (MoCA < 26; F3,608 = 2.14, p = 0.007). These findings highlight the importance of managing midlife vascular health to preserve brain structure and cognitive function in old age.
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Affiliation(s)
- Michelle G Jansen
- Donders Centre for Cognition, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ludovica Griffanti
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
| | - Clare E Mackay
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
| | - Melis Anatürk
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Centre for Medical Image Computing, Department of Computer Science, 4919University College London, University College London, London, UK
| | - Luca Melazzini
- Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ann-Marie G de Lange
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Department of Psychology, 6305University of Oslo, University of Oslo, Oslo, Norway
| | | | - Enikő Zsoldos
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, 4919University College London, University College London, London, UK.,INSERM, Epidemiology of Ageing and Neurogenerative Diseases, Université de Paris, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, 4919University College London, University College London, London, UK
| | - Klaus P Ebmeier
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK
| | - Sana Suri
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
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15
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Saridin FN, Chew KA, Reilhac A, Giyanwali B, Villaraza SG, Tanaka T, Scheltens P, van der Flier WM, Chen CLH, Hilal S. Cerebrovascular disease in Suspected Non-Alzheimer's Pathophysiology and cognitive decline over time. Eur J Neurol 2022; 29:1922-1929. [PMID: 35340085 DOI: 10.1111/ene.15337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The underlying cause of cognitive decline in individuals who are positive for biomarkers of neurodegeneration (N) but negative for biomarkers of amyloid-beta (A), designated as Suspected Non-Alzheimer's Pathophysiology (SNAP), remains unclear. We evaluate whether cerebrovascular disease (CeVD) is more prevalent in those with SNAP compared to A-N- and A+N+ individuals and whether CeVD is associated with cognitive decline over time in SNAP patients. METHODS A total of 216 individuals from a prospective memory clinic cohort [mean (SD) age, 72.7(7.3) years, 100 women (56.5%)] were included and were diagnosed as no cognitive impairment (NCI), cognitive impairment no dementia (CIND), Alzheimer's dementia (AD) or Vascular dementia (VaD). All individuals underwent clinical evaluation and neuropsychological assessment annually for up to 5 years. [11 C]-PiB or [18 F]-Flutafuranol-PET imaging was performed to ascertain amyloid-beta status. MRI was performed to assess neurodegeneration as measured by medial temporal atrophy≥2, as well as significant CeVD (sCeVD) burden, defined by cortical infarct count≥1, Fazekas-score≥2, lacune count≥2 or cerebral microbleed count≥2. RESULTS Of the 216 individuals, 50(23.1%) A-N+ were (SNAP), 93(43.1%) A-N-, 36(16.7%) A+N- and 37(17.1%) A+N+. A+N+ individuals were significantly older, while A+N+ and SNAP individuals were more likely to have dementia. The SNAP group had a higher prevalence of sCeVD (90.0%) compared to A-N-. Moreover, SNAP individuals with sCeVD had significantly steeper decline in global cognition compared to A-N- over 5 years (P=0.042). CONCLUSIONS These findings suggest that CeVD is a contributing factor to cognitive decline in SNAP. Therefore, SNAP-individuals should be carefully assessed and treated for CeVD.
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Affiliation(s)
- Francis Nicole Saridin
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory Aging & Cognition Centre, National University Health System, Singapore
| | - Kimberly Ann Chew
- Memory Aging & Cognition Centre, National University Health System, Singapore
| | - Anthonin Reilhac
- Clinical Imaging Research Centre, National University of Singapore, Singapore
| | - Bibek Giyanwali
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Tomotaka Tanaka
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phillip Scheltens
- Department of Neurology & Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Christopher Li Hsian Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory Aging & Cognition Centre, National University Health System, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore
| | - Saima Hilal
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory Aging & Cognition Centre, National University Health System, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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16
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Li J, Wen H, Wang S, Che Y, Zhang N, Guo L. Altered Brain Morphometry in Cerebral Small Vessel Disease With Cerebral Microbleeds: An Investigation Combining Univariate and Multivariate Pattern Analyses. Front Neurol 2022; 13:819055. [PMID: 35280297 PMCID: PMC8904567 DOI: 10.3389/fneur.2022.819055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The objective of this study was to evaluate whether altered gray matter volume (GMV) and white matter volume (WMV) are associated with the presence of cerebral microbleeds (CMBs) in cerebral small vessel disease (CSVD). Materials and Methods In this study, we included 26 CSVD patients with CMBs (CSVD-c), 43 CSVD patients without CMBs (CSVD-n) and 39 healthy controls. All participants underwent cognitive assessment testing. Both univariate analysis and multivariate pattern analysis (MVPA) approaches were applied to investigate differences in brain morphometry among groups. Results In univariate analysis, GMV and WMV differences were compared among groups using voxel-based morphometry (VBM) with diffeomorphic anatomical registration through exponentiated lie algebra (DARTEL). Compared to healthy controls, the CSVD-c group and CSVD-n group showed significantly lower GMV than the control group in similar brain clusters, mainly including the right superior frontal gyrus (medial orbital), left anterior cingulate gyrus, right inferior frontal gyrus (triangular part) and left superior frontal gyrus (medial), while the CSVD-n group also showed significantly lower WMV in the cluster of the left superior frontal gyrus (medial). No significant GMV or WMV differences were found between the CSVD-c group and the CSVD-n group. Specifically, we applied the multiple kernel learning (MKL) technique in MVPA to combine GMV and WMV features, yielding an average of >80% accuracy for three binary classification problems, which was a considerable improvement over the individual modality approach. Consistent with the univariate analysis, the MKL weight maps revealed default mode network and subcortical region damage associated with CSVD compared to controls. On the other hand, when classifying the CSVD-c group and CSVD-n group in the MVPA analysis, we found that some WMVs were highly weighted regions (left olfactory cortex and right middle frontal gyrus), which hinted at the presence of different white matter alterations in the CSVD-c group. Conclusion Our findings not only suggested that the localized alterations in GMV and WMV appeared to be associated with the pathophysiology of CSVD but also indicated that altered brain morphometry could be a potential discriminative pattern to detect CSVD at the individual level.
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Affiliation(s)
- Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongwei Wen
- Key Laboratory of Cognition and Personality (Ministry of Education), Chongqing, China.,School of Psychology, Southwest University, Chongqing, China
| | - Shengpei Wang
- Research Center for Brain-Inspired Intelligence, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yena Che
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Nan Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lingfei Guo
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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17
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Silva‐Candal A, Custodia A, López‐Dequidt I, Rodríguez‐Yáñez M, Alonso‐Alonso ML, Ávila‐Gómez P, Pumar JM, Castillo J, Sobrino T, Campos F, Iglesias‐Rey R, Hervella P. sTWEAK
is a leukoaraiosis biomarker associated with neurovascular angiopathy. Ann Clin Transl Neurol 2022; 9:171-180. [PMID: 35060359 PMCID: PMC8862435 DOI: 10.1002/acn3.51502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Leukoaraiosis (LA) refers to white matter lesions of undetermined etiology associated with the appearance and worsening of vascular pathologies. The aim is to confirm an increased frequency and intensity of LA in symptomatic patients with neurovascular pathology compared with asymptomatic subjects, and its association with circulating serum levels of soluble tumor necrosis factor‐like weak inducer of apoptosis (sTWEAK). Methods An observational study was conducted in which two groups of patients were compared. Group I (N = 242) comprised of asymptomatic subjects with arterial hypertension and/or diabetes or with a history of transient ischemic attacks, and Group II (N = 382) comprised patients with lacunar stroke or deep hemispheric intracerebral hemorrhage (ICH) of hypertensive origin. Serum levels of sTWEAK were analyzed and correlated with prevalence and intensity of LA according to the Fazekas scale. Results The prevalence of LA was higher in symptomatic (85.1%) versus asymptomatic patients (62.0%). Logistic regression model showed a significant relation of LA with neurovascular pathologies (OR: 2.69, IC 95%: 1.10–6.59, p = 0.003). When stratified according to the Fazekas scale, LA of grade II (OR: 3.53, IC 95%: 1.10–6.59, p = 0.003) and specially grade III (OR: 4.66, 95% CI: 1.09–19.84, p = 0.037) showed correlation with neurovascular pathologies. Increased sTWEAK levels were found in the symptomatic group in all LA grades (p < 0.0001), and associated with 5.06 times more risk of presenting clinical symptoms (OR: 5.06, 95% CI: 2.66–9.75, p < 0.0001). Interpretation LA showed a higher prevalence in patients with symptomatic lacunar stroke or deep hemispheric ICH. There is an association between sTWEAK levels and LA degree.
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Affiliation(s)
- Andrés Silva‐Candal
- Clinical Neurosciences Research Laboratories (LINC) Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
- Neurovascular Diseases Laboratory Neurology Service University Hospital Complex of A Coruña Biomedical Research Institute (INIBIC) A Coruña Spain
| | - Antia Custodia
- Clinical Neurosciences Research Laboratories (LINC) Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Iria López‐Dequidt
- Stroke Unit Department of Neurology Hospital Clínico Universitario Santiago de Compostela Spain
| | - Manuel Rodríguez‐Yáñez
- Stroke Unit Department of Neurology Hospital Clínico Universitario Santiago de Compostela Spain
| | - Maria Luz Alonso‐Alonso
- Clinical Neurosciences Research Laboratories (LINC) Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Paulo Ávila‐Gómez
- Clinical Neurosciences Research Laboratories (LINC) Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - José M. Pumar
- Department of Neuroradiology Hospital Clínico Universitario Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratories (LINC) Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratories (LINC) Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratories (LINC) Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Ramón Iglesias‐Rey
- Clinical Neurosciences Research Laboratories (LINC) Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Pablo Hervella
- Clinical Neurosciences Research Laboratories (LINC) Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
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18
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Celle S, Boutet C, Annweiler C, Ceresetti R, Pichot V, Barthélémy JC, Roche F. Leukoaraiosis and Gray Matter Volume Alteration in Older Adults: The PROOF Study. Front Neurosci 2022; 15:747569. [PMID: 35095388 PMCID: PMC8793339 DOI: 10.3389/fnins.2021.747569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose: Leukoaraiosis, also called white matter hyperintensities (WMH), is frequently encountered in the brain of older adults. During aging, gray matter structure is also highly affected. WMH or gray matter defects are commonly associated with a higher prevalence of mild cognitive impairment. However, little is known about the relationship between WMH and gray matter. Our aim was thus to explore the relationship between leukoaraiosis severity and gray matter volume in a cohort of healthy older adults. Methods: Leukoaraiosis was rated in participants from the PROOF cohort using the Fazekas scale. Voxel-based morphometry was performed on brain scans to examine the potential link between WMH and changes of local brain volume. A neuropsychological evaluation including attentional, executive, and memory tests was also performed to explore cognition. Results: Out of 315 75-year-old subjects, 228 had punctuate foci of leukoaraiosis and 62 had begun the confluence of foci. Leukoaraiosis was associated with a decrease of gray matter in the middle temporal gyrus, in the right medial frontal gyrus, and in the left parahippocampal gyrus. It was also associated with decreased performances in memory recall, executive functioning, and depression. Conclusion: In a population of healthy older adults, leukoaraiosis was associated with gray matter defects and reduced cognitive performance. Controlling vascular risk factors and detecting early cerebrovascular disease may prevent, at least in part, dementia onset and progression.
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Affiliation(s)
- Sébastien Celle
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
- *Correspondence: Sébastien Celle,
| | - Claire Boutet
- Department of Radiology, University Hospital, Saint Etienne, France
- EA7423 TAPE, UJM, Saint-Étienne, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
- UPRES EA4638, University of Angers, Angers, France
| | - Romain Ceresetti
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
| | - Vincent Pichot
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
| | - Jean-Claude Barthélémy
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
| | - Frédéric Roche
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
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19
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Feng M, Wen H, Xin H, Zhang N, Liang C, Guo L. Altered Spontaneous Brain Activity Related to Neurologic Dysfunction in Patients With Cerebral Small Vessel Disease. Front Aging Neurosci 2022; 13:731585. [PMID: 34975450 PMCID: PMC8718906 DOI: 10.3389/fnagi.2021.731585] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/30/2021] [Indexed: 12/04/2022] Open
Abstract
Cerebral small vessel disease (CSVD) encompasses several diseases affecting the small arteries, arterioles, venules, and capillaries of the brain and refers to several pathological processes and etiologies. Neuroimaging is considered the gold standard for detecting CSVD, which can present diverse features on MRI. Cerebral microbleeds (CMBs) in CSVD have been demonstrated to play a synergistic role in both cerebrovascular and neurodegenerative pathology. Considering previous studies on brain structural abnormalities in CSVD, in the present study, we aimed to explore altered spontaneous brain activity among CSVD patients using amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF) and regional homogeneity (ReHo) methods based on resting-state functional MRI. In this study, we recruited 24 CSVD patients with CMBs (CSVD-c), 42 CSVD patients without CMBs (CSVD-n) and 36 healthy controls from outpatient clinics in Shandong Provincial Hospital affiliated to Shandong First Medical University between September 2018 and June 2019. All subjects underwent 3-T MRI, including blood oxygen level-dependent (BOLD) and susceptibility-weighted imaging (SWI). Anatomic structures were segmented, ALFF/fALFF values were calculated, and ReHo maps were generated. Further statistical analysis was applied to study the difference in ALFF/fALFF/ReHo among the three groups and the association between ALFF/fALFF/ReHo changes in different brain regions and clinical characteristics. Twenty-four CSVD-c patients (age: 67.54 ± 6.00 years, 10 females), 42 CSVD-n patients (age: 66.33 ± 5.25 years, 22 females) and 36 healthy subjects (age: 64.14 ± 8.57 years, 19 females) were evaluated. Compared with controls, the CSVD-c group showed significantly increased ALFF values in the right insula, putamen and left precuneus; decreased fALFF values in the right precentral gyrus and postcentral gyrus; and increased ReHo values in the left precuneus, fusiform gyrus, right supplementary motor area (SMA), and superior frontal gyrus. Notably, the mean ALFF values of the right insula and putamen were not only significantly related to all clinical parameters but also demonstrated the best performance in Receiver Operating Characteristic (ROC) curve analysis. These findings reveal CSVD-c patients have dysfunctions in the default mode network, sensorimotor network and frontoparietal network, which may implicate the underlying neurophysiological mechanisms of intrinsic brain activity. The correlation between altered spontaneous neuronal activity and clinical parameters provides early useful diagnostic biomarkers for CSVD.
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Affiliation(s)
- Mengmeng Feng
- Department of Radiology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Hongwei Wen
- Key Laboratory of Cognition and Personality, Ministry of Education, Chongqing, China.,School of Psychology, Southwest University, Chongqing, China
| | - Haotian Xin
- Department of Radiology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Nan Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Changhu Liang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lingfei Guo
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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20
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Morys F, Dadar M, Dagher A. Association Between Midlife Obesity and Its Metabolic Consequences, Cerebrovascular Disease, and Cognitive Decline. J Clin Endocrinol Metab 2021; 106:e4260-e4274. [PMID: 33677592 PMCID: PMC8475210 DOI: 10.1210/clinem/dgab135] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Indexed: 01/08/2023]
Abstract
CONTEXT Chronic obesity is associated with several complications, including cognitive impairment and dementia. However, we have only piecemeal knowledge of the mechanisms linking obesity to central nervous system damage. Among candidate mechanisms are other elements of obesity-associated metabolic syndrome, such as hypertension, dyslipidemia, and diabetes, but also systemic inflammation. While there have been several neuroimaging studies linking adiposity to changes in brain morphometry, a comprehensive investigation of the relationship has so far not been done. OBJECTIVE To identify links between adiposity and cognitive dysfunction. METHODS This observational cohort study (UK Biobank), with an 8-year follow-up, included more than 20 000 participants from the general community, with a mean age of 63 years. Only participants with data available on both baseline and follow-up timepoints were included. The main outcome measures were cognitive performance and mediator variables: hypertension, diabetes, systemic inflammation, dyslipidemia, gray matter measures, and cerebrovascular disease (volume of white matter hyperintensities on magnetic resonance imaging). RESULTS Using structural equation modeling, we found that body mass index, waist-to-hip ratio, and body fat percentage were positively related to higher plasma C-reactive protein, dyslipidemia, hypertension, and diabetes. In turn, hypertension and diabetes were related to cerebrovascular disease. Finally, cerebrovascular disease was associated with lower cortical thickness and volume and higher subcortical volumes, but also cognitive deficits (largest significant pcorrected = 0.02). CONCLUSIONS We show that adiposity is related to poor cognition, with metabolic consequences of obesity and cerebrovascular disease as potential mediators. The outcomes have clinical implications, supporting a role for the management of adiposity in the prevention of late-life dementia and cognitive decline.
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Affiliation(s)
- Filip Morys
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
- Correspondence: Filip Morys, Ph.D., Université McGill, 3801 University Street, H3A 2B4 Montreal, Canada.
| | - Mahsa Dadar
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Québec, Canada
| | - Alain Dagher
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
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21
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Guan S, Kong X, Duan S, Ren Q, Huang Z, Li Y, Wang W, Gong G, Meng X, Ma X. Neuroimaging Anomalies in Community-Dwelling Asymptomatic Adults With Very Early-Stage White Matter Hyperintensity. Front Aging Neurosci 2021; 13:715434. [PMID: 34483884 PMCID: PMC8415566 DOI: 10.3389/fnagi.2021.715434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022] Open
Abstract
White matter hyperintensity (WMH) is common in healthy adults in their 60s and can be seen as early as in their 30s and 40s. Alterations in the brain structural and functional profiles in adults with WMH have been repeatedly studied but with a focus on late-stage WMH. To date, structural and functional MRI profiles during the very early stage of WMH remain largely unexplored. To address this, we investigated multimodal MRI (structural, diffusion, and resting-state functional MRI) profiles of community-dwelling asymptomatic adults with very early-stage WMH relative to age-, sex-, and education-matched non-WMH controls. The comparative results showed significant age-related and age-independent changes in structural MRI-based morphometric measures and resting-state fMRI-based measures in a set of specific gray matter (GM) regions but no global white matter changes. The observed structural and functional anomalies in specific GM regions in community-dwelling asymptomatic adults with very early-stage WMH provide novel data regarding very early-stage WMH and enhance understanding of the pathogenesis of WMH.
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Affiliation(s)
- Shuai Guan
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Xiangyu Kong
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Shifei Duan
- Department of Radiology, Qingdao Central Hospital, Qingdao University, Qingdao, China
| | - Qingguo Ren
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Zhaodi Huang
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Ye Li
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Wei Wang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Gaolang Gong
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xiangshui Meng
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Xiangxing Ma
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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22
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Liu Y, Hu A, Chen L, Li B, Zhang M, Xi P, Yang Q, Tang R, Huang Q, He J, Lang Y, Zhang Y. Association between cortical thickness and distinct vascular cognitive impairment and dementia in patients with white matter lesions. Exp Physiol 2021; 106:1612-1620. [PMID: 33866642 DOI: 10.1113/ep089419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/08/2021] [Indexed: 12/29/2022]
Abstract
NEW FINDINGS What is the central question of this study? White matter lesions (WMLs) are a brain disease characterized by altered brain structural and functional connectivity, but findings have shown an inconsistent pattern: are there distinct cortical thickness changes in patients with WMLs subtypes? What is the main finding and its importance? Patients with WMLs with non-dementia vascular cognitive impairment and WMLs with vascular dementia showed distinct pathophysiology in cortical thickness. These neural correlates of WMLs should be considered in future treatment. ABSTRACT The effect of cortical thickness on white matter lesions (WMLs) in patients with distinct vascular cognitive impairments is relatively unknown. This study investigated the correlation between cortical thickness and vascular cognitive manifestations. WML patients and healthy controls from Beijing Tiantan Hospital between 2014 and 2018 were included. The patients were further divided into two subgroups, namely WMLs with non-dementia vascular cognitive impairment (WML-VCIND) and WMLs with vascular dementia (WML-VaD) according to the Clinical Dementia Rating (CDR) scale and the Beijing version of the Montreal Cognitive Assessment (MoCA). Changes in cortical thickness were calculated using FreeSurfer. Pearson's correlation analysis was performed to explore the relationship between cognitive manifestations and cortical thickness in WML patients. Forty-five WML patients and 23 healthy controls were recruited. The WML group exhibited significant difference in cortical thickness compared to the control group. Significantly decreased cortical thickness in the middle and superior frontal gyri, middle temporal gyrus, angular gyrus and insula was found in the WML-VaD versus WML-VCIND subgroup. Cortical thickness deficits of the left caudal middle frontal gyrus (r = 0.451, P = 0.002), left rostral middle frontal gyrus (r = 0.514, P < 0.001), left superior frontal gyrus (r = 0.410, P = 0.006), right middle temporal gyrus (r = 0.440, P = 0.003), right pars triangularis (r = 0.462, P = 0.002), right superior frontal gyrus (r = 0.434, P = 0.004) and right insula (r = 0.499, P = 0.001) were positively correlated with the MoCA score in WML patients. The specific pattern of cortical thickness deficits in the WML-VaD subgroup revealed the pathophysiology of WMLs, which should be considered in future treatment of WMLs.
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Affiliation(s)
- Yafei Liu
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Anming Hu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Luyao Chen
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing, China
| | - Bo Li
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Minjian Zhang
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Pengcheng Xi
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Qinghu Yang
- College of Life Sciences & Research Center for Resource Peptide Drugs, Shaanxi Engineering & Technological Research Center for Conversation & Utilization of Regional Biological Resources, Yanan University, Yanan, China
| | - Rongyu Tang
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing, China
| | - Qiang Huang
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing, China
| | - Jiping He
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China.,Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing, China
| | - Yiran Lang
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing, China
| | - Yumei Zhang
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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23
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Jang H, Kim HJ, Choe YS, Kim SJ, Park S, Kim Y, Kim KW, Lyoo CH, Cho H, Ryu YH, Choi JY, DeCarli C, Na DL, Seo SW. The Impact of Amyloid-β or Tau on Cognitive Change in the Presence of Severe Cerebrovascular Disease. J Alzheimers Dis 2021; 78:573-585. [PMID: 33016911 DOI: 10.3233/jad-200680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND As Alzheimer's disease (AD) and cerebral small vessel disease (CSVD) commonly coexist, the interaction between two has been of the considerable interest. OBJECTIVE We determined whether the association of Aβ and tau with cognitive decline differs by the presence of significant CSVD. METHODS We included 60 subcortical vascular cognitive impairment (SVCI) from Samsung Medical Center and 82 Alzheimer's disease-related cognitive impairment (ADCI) from ADNI, who underwent Aβ (florbetaben or florbetapir) and tau (flortaucipir, FTP) PET imaging. They were retrospectively assessed for 5.0±3.9 and 5.6±1.9 years with Clinical Dementia Rating-sum of boxes (CDR-SB)/Mini-Mental State Examination (MMSE). Mixed effects models were used to investigate the interaction between Aβ/tau and group on CDR-SB/MMSE changes. RESULTS The frequency of Aβ positivity (45% versus 54.9%, p = 0.556) and mean global FTP SUVR (1.17±0.21 versus 1.16±0.17, p = 0.702) were not different between the two groups. We found a significant interaction effect of Aβ positivity and SVCI group on CDR-SB increase/MMSE decrease (p = 0.013/p < 0.001), and a significant interaction effect of global FTP uptake and SVCI group on CDR-SB increase/MMSE decrease (p < 0.001 and p = 0.030). Finally, the interaction effects of regional tau and group were prominent in the Braak III/IV (p = 0.001) and V/VI (p = 0.003) not in Braak I/II region (p = 0.398). CONCLUSION The association between Aβ/tau and cognitive decline is stronger in SVCI than in ADCI. Therefore, our findings suggested that Aβ positivity or tau burden (particularly in the Braak III/IV or V/VI regions) and CSVD might synergistically affect cognitive decline.
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Affiliation(s)
- Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Yeong Sim Choe
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Soo-Jong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Seongbeom Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Ko Woon Kim
- Department of Neurology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Yong Choi
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California, Davis, Davis, CA, USA
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.,Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Chen L, Song J, Cheng R, Wang K, Liu X, He M, Luo T. Cortical Thinning in the Medial Temporal Lobe and Precuneus Is Related to Cognitive Deficits in Patients With Subcortical Ischemic Vascular Disease. Front Aging Neurosci 2021; 12:614833. [PMID: 33679368 PMCID: PMC7925832 DOI: 10.3389/fnagi.2020.614833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022] Open
Abstract
Subcortical ischemic vascular disease (SIVD) is a major cause of vascular cognitive impairment (CI) and features extensive atrophy in the cerebral cortex. We aimed to test the hypothesis that cognitive deficits in SIVD are linked to decreased cortical thickness in specific brain regions, which may constitute neuroimaging biomarkers of CI. Sixty-seven SIVD patients without (SIVD-NC, n = 35) and with (SIVD-CI, n = 32) CI and a group of healthy controls (HCs, n = 36) underwent structural magnetic resonance imaging (MRI) and cognitive functional assessments. FreeSurfer was used to preprocess structural MRI data and to calculate and compare cortical thickness. The correlation between cortical thickness and cognitive scores was examined in SIVD patients. Significantly altered cortical thickness in the bilateral insula, middle and inferior temporal lobes, precuneus, and medial temporal lobe (MTL) was identified among the three groups (p < 0.05, Monte Carlo simulation corrected). Post hoc results showed significantly decreased thickness in the bilateral insula and temporal lobe in SIVD-NC and SIVD-CI patients compared with HCs. However, the areas with reduced cortical thickness were larger in SIVD-CI than SIVD-NC patients. SIVD-CI patients had significantly reduced thickness in the bilateral precuneus and left MTL (Bonferroni corrected) compared with SIVD-NC patients when we extracted the mean thickness for each region of interest. In SIVD patients, the thicknesses of the left MTL and bilateral precuneus were positively correlated with immediate recall in the memory test. SIVD might lead to extensive cerebral cortical atrophy, while atrophy in the MTL and precuneus might be associated with memory deficits.
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Affiliation(s)
- Li Chen
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jiarui Song
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Runtian Cheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kangcheng Wang
- School of Psychology, Shandong Normal University, Jinan, China
| | - Xiaoshuang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Miao He
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Camarda C, Torelli P, Pipia C, Sottile G, Cilluffo G, Camarda R. APOE Genotypes and Brain Imaging Classes in Normal Cognition, Mild Cognitive Impairment, and Alzheimer's Disease: A Longitudinal Study. Curr Alzheimer Res 2020; 17:766-780. [PMID: 33167837 DOI: 10.2174/1567205017666201109093314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 08/20/2020] [Accepted: 10/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate in 419 stroke-free cognitively normal subjects (CN) aged 45-82 years covering during a long prospective study (11.54 ± 1.47 years) the preclinical to dementia spectrum: 1) the distribution of small vessel disease (V) and brain atrophy (A) aggregated as following: V-/A-, V-/A+, V+/A-, V+/A+; 2) the relationship of these imaging classes with individual apolipoprotein E (APOE) genotypes; 3) the risk of progression to Alzheimer Disease (AD) of the individual APOE genotypes. METHODS Participants underwent one baseline (t0), and 4 clinical and neuropsychological assessments (t1,t2,t3, and t4). Brain MRI was performed in all subjects at t0, t2, t3 and t4.. White matter hyperintensities were assessed through two visual rating scales. Lacunes were also rated. Subcortical and global brain atrophy were determined through the bicaudate ratio and the lateral ventricle to brain ratio, respectively. APOE genotypes were determined at t0 in all subjects. Cox proportional hazard model was used to evaluate the risk of progression to AD. RESULTS The imaging class of mixed type was very common in AD, and in non amnestic mild cognitive impaired APOE ε4 non carriers. In these subjects, frontal and parieto-occipital regions were most affected by small vessel disease. CONCLUSION Our findings suggest that the APOE ε3 allele is probably linked to the brain vascular pathology.
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Affiliation(s)
- Cecilia Camarda
- Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Paola Torelli
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | | | - Gianluca Sottile
- Department of Economics, Business, and Statistics, University of Palermo, Palermo, Italy,Institute for Research and Biomedical Innovation (IRIB), National Research Council, Palermo, Italy
| | - Giovanna Cilluffo
- Institute for Research and Biomedical Innovation (IRIB), National Research Council, Palermo, Italy
| | - Rosolino Camarda
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
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Wang Y, Yang Y, Wang T, Nie S, Yin H, Liu J. Correlation between White Matter Hyperintensities Related Gray Matter Volume and Cognition in Cerebral Small Vessel Disease. J Stroke Cerebrovasc Dis 2020; 29:105275. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/22/2020] [Indexed: 12/14/2022] Open
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Heinen R, Groeneveld ON, Barkhof F, de Bresser J, Exalto LG, Kuijf HJ, Prins ND, Scheltens P, van der Flier WM, Biessels GJ. Small vessel disease lesion type and brain atrophy: The role of co-occurring amyloid. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12060. [PMID: 32695872 PMCID: PMC7364862 DOI: 10.1002/dad2.12060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/05/2022]
Abstract
INTRODUCTION It is unknown whether different types of small vessel disease (SVD), differentially relate to brain atrophy and if co-occurring Alzheimer's disease pathology affects this relation. METHODS In 725 memory clinic patients with SVD (mean age 67 ± 8 years, 48% female) we compared brain volumes of those with moderate/severe white matter hyperintensities (WMHs; n = 326), lacunes (n = 132) and cerebral microbleeds (n = 321) to a reference group with mild WMHs (n = 197), also considering cerebrospinal fluid (CSF) amyloid status in a subset of patients (n = 488). RESULTS WMHs and lacunes, but not cerebral microbleeds, were associated with smaller gray matter (GM) volumes. In analyses stratified by CSF amyloid status, WMHs and lacunes were associated with smaller total brain and GM volumes only in amyloid-negative patients. SVD-related atrophy was most evident in frontal (cortical) GM, again predominantly in amyloid-negative patients. DISCUSSION Amyloid status modifies the differential relation between SVD lesion type and brain atrophy in memory clinic patients.
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Affiliation(s)
- Rutger Heinen
- Department of Neurology and NeurosurgeryUMC Utrecht Brain CenterUtrecht UniversityUtrechtthe Netherlands
| | - Onno N. Groeneveld
- Department of Neurology and NeurosurgeryUMC Utrecht Brain CenterUtrecht UniversityUtrechtthe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear MedicineAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Institutes of Neurology & Healthcare EngineeringUniversity College London (UCL)LondonUK
| | - Jeroen de Bresser
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Lieza G. Exalto
- Department of Neurology and NeurosurgeryUMC Utrecht Brain CenterUtrecht UniversityUtrechtthe Netherlands
| | - Hugo J. Kuijf
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Niels D. Prins
- Alzheimer Center & Department of NeurologyVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Brain Research CenterAmsterdamthe Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of NeurologyVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Brain Research CenterAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center & Department of NeurologyVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Geert Jan Biessels
- Department of Neurology and NeurosurgeryUMC Utrecht Brain CenterUtrecht UniversityUtrechtthe Netherlands
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Zhu Y, Lu T, Xie C, Wang Q, Wang Y, Cao X, Su Y, Wang Z, Zhang Z. Functional Disorganization of Small-World Brain Networks in Patients With Ischemic Leukoaraiosis. Front Aging Neurosci 2020; 12:203. [PMID: 32719596 PMCID: PMC7348592 DOI: 10.3389/fnagi.2020.00203] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/11/2020] [Indexed: 01/15/2023] Open
Abstract
Cognitive impairment is a key clinical feature of ischemic leukoaraiosis (ILA); however, the underlying neurobiological mechanism is still unclear. ILA has been associated with widespread gray and white matter (WM) damage mainly located in cortical-cortical and cortico-subcortical pathways. A total of 36 patients with ILA (Fazekas rating score ≥2) and 31 healthy controls (HCs) underwent comprehensive neuropsychological assessments (covering four cognitive domains, i.e., information processing speed, episodic memory, executive and visuospatial function) and resting-state functional MRI scans. Graph theory-based analyses were employed to explore the topological organization of the brain connectome in ILA patients, and we further sought to explore the associations of connectome-based metrics and neuropsychological performances. An efficient small-world architecture in the functional brain connectome was observed in the ILA and control groups. Moreover, compared with the HCs, the ILA patients showed increased path length and decreased network efficiency (i.e., global and local efficiency) in their functional brain networks. Further network-based statistic (NBS) analysis revealed a functional-disconnected network in ILA, which is comprised of functional connections linking different brain modules (i.e., default mode, frontoparietal, ventral attention and limbic systems) and connections within single modules (i.e., ventral attention and limbic systems). Intriguingly, the abnormal network metrics correlated with cognitive deficits in ILA patients. Therefore, our findings provide further evidence to support the concept that ILA pathologies could disrupt brain connections, impairing network functioning, and cognition via a “disconnection syndrome.”
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Affiliation(s)
- Yixin Zhu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Tong Lu
- Department of Radiology, ZhongDa Hospital Affiliated to Southeast University, Nanjing, China
| | - Chunming Xie
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qing Wang
- Department of Radiology, ZhongDa Hospital Affiliated to Southeast University, Nanjing, China
| | - Yanjuan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xuejin Cao
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yuting Su
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhijun Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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Goto M, Hagiwara A, Fujita S, Hori M, Kamagata K, Aoki S, Abe O, Sakamoto H, Sakano Y, Kyogoku S, Daida H. Influence of Mild White Matter Lesions on Voxel-based Morphometry. Magn Reson Med Sci 2020; 20:40-46. [PMID: 32074592 PMCID: PMC7952207 DOI: 10.2463/mrms.mp.2019-0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose: The aim of this study was to investigate whether the detectability of brain volume change in voxel-based morphometry (VBM) with gray matter images is affected by mild white matter lesions (MWLs). Methods: Three-dimensional T1-weighted images (3D-T1WIs) of 11 healthy subjects were obtained using a 3T MR scanner. We initially created 3D-T1WIs with focal cortical atrophy simulated cortical atrophy in left amygdala (type A) and the left medial frontal lobe (type B) from control 3D-T1WIs. Next, the following three types of MWL images were created: type A + 1L and type B + 1L images, only one white matter lesion; type A + 4L and type B + 4L images, four white matter lesions at distant positions; and type A + 4L* and type B + 4L* images, four white matter lesions at clustered positions. Comparisons between the control group and the other groups were performed with VBM using segmented gray matter images. Results: The gray matter volume was significantly lower in the type A group than in the control group, and similar results were observed in the type A + 1L, type A + 4L, and type A + 4L* groups. Additionally, the gray matter volume was significantly lower in the type B group than in the control group, and similar results were observed in the type B + 1L, type B + 4L, and type B + 4L* groups, but the cluster size in type B + 4L* was smaller than that in type B. Conclusion: Our study showed that the detectability of brain volume change in VBM with gray matter images was not decreased by MWLs as lacunar infarctions. Therefore, we think that group comparisons with VBM should be analyzed by groups including and excluding subjects with MWLs, respectively.
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Affiliation(s)
- Masami Goto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | | | - Shohei Fujita
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, The University of Tokyo Hospital
| | - Masaaki Hori
- Department of Radiology, Toho University Omori Medical Center
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine
| | - Osamu Abe
- Department of Radiology, The University of Tokyo Hospital
| | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | - Yasuaki Sakano
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | - Shinsuke Kyogoku
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | - Hiroyuki Daida
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
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30
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Perosa V, Priester A, Ziegler G, Cardenas-Blanco A, Dobisch L, Spallazzi M, Assmann A, Maass A, Speck O, Oltmer J, Heinze HJ, Schreiber S, Düzel E. Hippocampal vascular reserve associated with cognitive performance and hippocampal volume. Brain 2020; 143:622-634. [PMID: 31994699 PMCID: PMC7009470 DOI: 10.1093/brain/awz383] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/12/2019] [Accepted: 10/07/2019] [Indexed: 01/14/2023] Open
Abstract
Medial temporal lobe dependent cognitive functions are highly vulnerable to hypoxia in the hippocampal region, yet little is known about the relationship between the richness of hippocampal vascular supply and cognition. Hippocampal vascularization patterns have been categorized into a mixed supply from both the posterior cerebral artery and the anterior choroidal artery or a single supply by the posterior cerebral artery only. Hippocampal arteries are small and affected by pathological changes when cerebral small vessel disease is present. We hypothesized, that hippocampal vascularization patterns may be important trait markers for vascular reserve and modulate (i) cognitive performance; (ii) structural hippocampal integrity; and (iii) the effect of cerebral small vessel disease on cognition. Using high-resolution 7 T time-of-flight angiography we manually classified hippocampal vascularization patterns in older adults with and without cerebral small vessel disease in vivo. The presence of a mixed supplied hippocampus was an advantage in several cognitive domains, including verbal list learning and global cognition. A mixed supplied hippocampus also was an advantage for verbal memory performance in cerebral small vessel disease. Voxel-based morphometry showed higher anterior hippocampal grey matter volume in mixed, compared to single supply. We discuss that a mixed hippocampal supply, as opposed to a single one, may increase the reliability of hippocampal blood supply and thereby provide a hippocampal vascular reserve that protects against cognitive impairment.
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Affiliation(s)
- Valentina Perosa
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Anastasia Priester
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Gabriel Ziegler
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Arturo Cardenas-Blanco
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Laura Dobisch
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Marco Spallazzi
- Department of Neurology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Anne Assmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Anne Maass
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Oliver Speck
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Leibniz-Institute for Neurobiology (LIN), Magdeburg, Germany
- Institute of Physics, Otto-von-Guericke University, Magdeburg, Germany
| | - Jan Oltmer
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Leibniz-Institute for Neurobiology (LIN), Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Emrah Düzel
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, UK
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Wang B, Zhang J, Pan W, Cao S, Li B, Bai L, Hu P, Tian Y, Jiang D, Wang K. Differential Influence of Location-Specific White-Matter Hyperintensities on Attention Subdomains Measured Using the Attention Network Test. Med Sci Monit 2020; 26:e921874. [PMID: 31940305 PMCID: PMC6983326 DOI: 10.12659/msm.921874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Elderly people with white-matter hyperintensities (WMHs) typically show cognitive impairment. Attention, consisting of 3 independent component processes (alerting, orienting, and executive control), is crucial for cognitive functioning. Little is known about how WMHs interfere with these attention subdomains. In the present study, we sought to describe characteristics of attention deficits in patients with age-related WMHs and to assess whether the severity and location of lesions differentially affect specific attention subdomains using the attention network test (ANT), which is a computer-based paradigm tailored to accurately provide behavioral measures of the aforementioned subdomains. MATERIAL AND METHODS A total of 39 WMH patients and 39 age-, sex-, and education-matched controls underwent comprehensive neuropsychological and ANT evaluation. Brain magnetic resonance imaging (MRI) was performed to visualize severity of total and location-specific WMH lesions. Multiple linear regression analyses adjusted for possible confounders were performed. RESULTS Compared with controls, WMH patients showed pronounced deficits in orienting and executive control efficiencies (P<0.050), but not alerting efficiency (P=0.642). As total WMH severity increased, efficiencies in the impaired subdomains significantly declined (P<0.050). In terms of lesion location, fronto-parietal type of periventricular WMH (PWMH) and deep WMH (DWMH) in the parietal lobe affected orienting efficiency, while all PWMH types and DWMH in the frontal, parietal, and temporal lobes affected executive control efficiency (P<0.050). Additional adjustment for other MRI lesions significantly changed the impact on orienting, but not on executive control efficiency. CONCLUSIONS Our results reveal specific attention deficits in patients with age-related WMH and may help clarify how the location of lesions influences their effects on attention subdomains.
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Affiliation(s)
- Bing Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Department of Neurology, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland)
| | - Jun Zhang
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland).,Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Wen Pan
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
| | - Shanshan Cao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
| | - Bin Li
- Department of Neurology, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China (mainland)
| | - Lu Bai
- Department of Neurology, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China (mainland)
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
| | - Dan Jiang
- Department of Neurology, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China (mainland)
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
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Wouts L, van Kessel M, Beekman AT, Marijnissen RM, Oude Voshaar RC. Empirical support for the vascular apathy hypothesis: A structured review. Int J Geriatr Psychiatry 2020; 35:3-11. [PMID: 31617249 PMCID: PMC6916153 DOI: 10.1002/gps.5217] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/15/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES A systematic review of the relationship between subclinical small vessel disease (SSVD) in the general population and apathy to examine the hypothesis that apathy has a vascular basis. METHODS We searched for studies on associations between apathy and SSVD, operationalized as white matter hyperintensities (WMH) or white matter diffusivity changes, lacunar infarcts, cerebral microbleeds, decreasing cortical thickness, and perivascular spaces, while also peripheral proxies for SSVD were considered, operationalized as ankle brachial pressure index (ABI), intima media thickness, arterial stiffness, cardio-femoral pulse wave velocity, hypertension, or cardiovascular disease. Only eligible retrospective and prospective observational studies conducted in the general population were included. RESULTS The 14 studies eligible for review examined the associations between apathy and hypertension (3), ABI (1), arterial stiffness (1), cardiovascular disease (2), WMH (3), white matter diffusivity (2), cerebral microbleeds (1), or cortical thickness (3). Arterial stiffness and white matter diffusivity were not related to apathy, while the associations with cortical thickness were contradictory. Cross-sectional studies in the general population did find evidence of apathy being associated with WMH, CM, cardiovascular disease, hypertension, and ABI, and cardiovascular disease was prospectively associated with apathy. The methodologies of the studies reviewed were too heterogeneous to perform meta-analyses. CONCLUSIONS Although more prospective evidence is needed and vascular depression needs to be controlled for, cardiovascular disease, hypertension, and ABI as proxies for SSVD, and WMH and cerebral microbleeds as direct measures of SSVD have been found to be associated with apathy in the general population, supporting the hypothesis of vascular apathy.
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Affiliation(s)
- Lonneke Wouts
- Pro PersonaMental Health InstituteThe Netherlands,Department of PsychiatryUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
| | | | - Aartjan T.F. Beekman
- GGZinGeestMental Health InstituteAmsterdamThe Netherlands,Department of PsychiatryAmsterdam University Medical CentreAmsterdamThe Netherlands
| | - Radboud M. Marijnissen
- Pro PersonaMental Health InstituteThe Netherlands,Department of PsychiatryUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
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Mustapha M, Nassir CMNCM, Aminuddin N, Safri AA, Ghazali MM. Cerebral Small Vessel Disease (CSVD) - Lessons From the Animal Models. Front Physiol 2019; 10:1317. [PMID: 31708793 PMCID: PMC6822570 DOI: 10.3389/fphys.2019.01317] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 09/30/2019] [Indexed: 12/28/2022] Open
Abstract
Cerebral small vessel disease (CSVD) refers to a spectrum of clinical and imaging findings resulting from pathological processes of various etiologies affecting cerebral arterioles, perforating arteries, capillaries, and venules. Unlike large vessels, it is a challenge to visualize small vessels in vivo, hence the difficulty to directly monitor the natural progression of the disease. CSVD might progress for many years during the early stage of the disease as it remains asymptomatic. Prevalent among elderly individuals, CSVD has been alarmingly reported as an important precursor of full-blown stroke and vascular dementia. Growing evidence has also shown a significant association between CSVD's radiological manifestation with dementia and Alzheimer's disease (AD) pathology. Although it remains contentious as to whether CSVD is a cause or sequelae of AD, it is not far-fetched to posit that effective therapeutic measures of CSVD would mitigate the overall burden of dementia. Nevertheless, the unifying theory on the pathomechanism of the disease remains elusive, hence the lack of effective therapeutic approaches. Thus, this chapter consolidates the contemporary insights from numerous experimental animal models of CSVD, to date: from the available experimental animal models of CSVD and its translational research value; the pathomechanical aspects of the disease; relevant aspects on systems biology; opportunities for early disease biomarkers; and finally, converging approaches for future therapeutic directions of CSVD.
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Affiliation(s)
- Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | | | - Niferiti Aminuddin
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Department of Basic Medical Sciences, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
| | - Amanina Ahmad Safri
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Mazira Mohamad Ghazali
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Vipin A, Foo HJL, Lim JKW, Chander RJ, Yong TT, Ng ASL, Hameed S, Ting SKS, Zhou J, Kandiah N. Regional White Matter Hyperintensity Influences Grey Matter Atrophy in Mild Cognitive Impairment. J Alzheimers Dis 2019; 66:533-549. [PMID: 30320575 DOI: 10.3233/jad-180280] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The association between cerebrovascular disease pathology (measured by white matter hyperintensities, WMH) and brain atrophy in early Alzheimer's disease (AD) remain to be elucidated. Thus, we investigated how WMH influence neurodegeneration and cognition in prodromal and clinical AD. We examined 51 healthy controls, 35 subjects with mild cognitive impairment (MCI), and 30 AD patients. We tested how total and regional WMH is related to specific grey matter volume (GMV) reductions in MCI and AD compared to controls. Stepwise regression analysis was further performed to investigate the association of GMV and regional WMH volume with global cognition. We found that total WMH volume was highest in AD but showed the strongest association with lower GMV in MCI. Frontal and parietal WMH had the most extensive influence on GMV loss in MCI. Additionally, parietal lobe WMH volume (but not hippocampal atrophy) was significantly associated with global cognition in MCI while smaller hippocampal volume (but not WMH volume) was associated with lower global cognition in AD. Thus, although WMH volume was highest in AD subjects, it had a more pervasive influence on brain structure and cognitive impairment in MCI. Our study thus highlights the importance of early detection of cerebrovascular disease, as its intervention at the MCI stage might potentially slow down neurodegeneration.
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Affiliation(s)
- Ashwati Vipin
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
| | - Heidi Jing Ling Foo
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Joseph Kai Wei Lim
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
| | - Russell Jude Chander
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Ting Ting Yong
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Adeline Su Lyn Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Shahul Hameed
- Department of Neurology, Singapore General Hospital, Singapore
| | | | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore.,Clinical Imaging Research Centre, The Agency for Science, Technology and Research and National University of Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
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Spilling CA, Jones PW, Dodd JW, Barrick TR. Disruption of white matter connectivity in chronic obstructive pulmonary disease. PLoS One 2019; 14:e0223297. [PMID: 31581226 PMCID: PMC6776415 DOI: 10.1371/journal.pone.0223297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022] Open
Abstract
Background Mild cognitive impairment is a common systemic manifestation of chronic obstructive pulmonary disease (COPD). However, its pathophysiological origins are not understood. Since, cognitive function relies on efficient communication between distributed cortical and subcortical regions, we investigated whether people with COPD have disruption in white matter connectivity. Methods Structural networks were constructed for 30 COPD patients (aged 54–84 years, 57% male, FEV1 52.5% pred.) and 23 controls (aged 51–81 years, 48% Male). Networks comprised 90 grey matter regions (nodes) interconnected by white mater fibre tracts traced using deterministic tractography (edges). Edges were weighted by the number of streamlines adjusted for a) streamline length and b) end-node volume. White matter connectivity was quantified using global and nodal graph metrics which characterised the networks connection density, connection strength, segregation, integration, nodal influence and small-worldness. Between-group differences in white matter connectivity and within-group associations with cognitive function and disease severity were tested. Results COPD patients’ brain networks had significantly lower global connection strength (p = 0.03) and connection density (p = 0.04). There was a trend towards COPD patients having a reduction in nodal connection density and connection strength across the majority of network nodes but this only reached significance for connection density in the right superior temporal gyrus (p = 0.02) and did not survive correction for end-node volume. There were no other significant global or nodal network differences or within-group associations with disease severity or cognitive function. Conclusion COPD brain networks show evidence of damage compared to controls with a reduced number and strength of connections. This loss of connectivity was not sufficient to disrupt the overall efficiency of network organisation, suggesting that it has redundant capacity that makes it resilient to damage, which may explain why cognitive dysfunction is not severe. This might also explain why no direct relationships could be found with cognitive measures. Smoking and hypertension are known to have deleterious effects on the brain. These confounding effects could not be excluded.
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Affiliation(s)
- Catherine A. Spilling
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Paul W. Jones
- Institute of Infection and Immunity, St George's, University of London, Tooting, London, United Kingdom
| | - James W. Dodd
- Academic Respiratory Unit, Second Floor, Learning and Research, Southmead Hospital, University of Bristol, Westbury-on-Trym, Bristol, United Kingdom
| | - Thomas R. Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Tooting, London, United Kingdom
- * E-mail:
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Abstract
BACKGROUND Isolated, subtle neurological abnormalities (ISNA) are commonly seen in aging and have been related to cerebral small vessel disease (SVD) and subcortical atrophy in neurologically and cognitively healthy aging subjects. OBJECTIVE To investigate the frequency of ISNA in different mild cognitive impairment (MCI) types and to evaluate for each MCI type, the cross-sectional relation between ISNA and white matter hyperintensities (WMH), lacunes, caudate atrophy, and ventricular enlargement. METHODS One thousand two hundred fifty subjects with different MCI types were included in the analysis and underwent brain magnetic resonance imaging. WMHs were assessed through two visual rating scales. Lacunes were also rated. Atrophy of the caudate nuclei and ventricular enlargement were assessed through the bicaudate ratio (BCr) and the lateral ventricles to brain ratio (LVBr), respectively. Apolipoprotein E (APOE) genotypes were also assessed. The routine neurological examination was used to evaluate ISNAs that were clustered as central-based signs, cerebellar-based signs, and primitive reflexes. The items of Part-III of the Unified Parkinson's Disease Rating Scale were used to evaluate ISNAs that were clustered as mild parkinsonian signs. Associations of ISNAs with imaging findings were determined through logistic regression analysis. RESULTS The ISNAs increase with the age and are present in all MCI types, particularly in those multiple domains, and carrying the APOE ϵ4 allele, and are associated with WMH, lacunes, BCr, and LVBr. CONCLUSION This study demonstrates that cortical and subcortical vascular and atrophic processes contribute to ISNAs. Long prospective population-based studies are needed to disentangle the role of ISNAs in the conversion from MCI to dementia.
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Camarda C, Torelli P, Pipia C, Battaglini I, Azzarello D, Rosano R, Ventimiglia CC, Sottile G, Cilluffo G, Camarda R. Mild Parkinsonian Signs in a Hospital-based Cohort of Mild Cognitive Impairment Types: A Cross-sectional Study. Curr Alzheimer Res 2019; 16:633-649. [DOI: 10.2174/1567205016666190726100744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/24/2019] [Accepted: 06/17/2019] [Indexed: 12/27/2022]
Abstract
Background:Mild Parkinsonian Signs (MPS) have been associated with Mild Cognitive Impairment (MCI) types with conflicting results.Objective:To investigate the association of individual MPS with different MCI types using logistic ridge regression analysis, and to evaluate for each MCI type, the association of MPS with caudate atrophy, global cerebral atrophy, and the topographical location of White Matter Hyperintensities (WMH), and lacunes.Methods:A cross-sectional study was performed among 1,168 subjects with different types of MCI aged 45-97 (70,52 ± 9,41) years, who underwent brain MRI. WMH were assessed through two visual rating scales. The number and location of lacunes were also rated. Atrophy of the caudate nuclei and global cerebral atrophy were assessed through the bicaudate ratio, and the lateral ventricles to brain ratio, respectively. Apolipoprotein E (APOE) genotypes were also assessed. Using the items of the motor section of the Unified Parkinson’s Disease Rating Scale, tremor, rigidity, bradykinesia, and gait/balance/axial dysfunction were evaluated.Results:Bradykinesia, and gait/balance/axial dysfunction were the MPS more frequently encountered followed by rigidity, and tremor. MPS were present in both amnestic and non-amnestic MCI types, and were associated with WMH, lacunes, bicaudate ratio, and lateral ventricles to brain ratio.Conclusion:MPS are present in both amnestic and non-amnestic MCI types, particularly in those multiple domain, and carrying the APOE ε4 allele. Cortical and subcortical vascular and atrophic processes contribute to MPS. Long prospective studies are needed to disentangle the contribution of MPS to the conversion from MCI to dementia.
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Affiliation(s)
- Cecilia Camarda
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Paola Torelli
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | | | - Iacopo Battaglini
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Delia Azzarello
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Rosamaria Rosano
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | | | - Gianluca Sottile
- Department of Economics, Business, and Statistics Sciences, University of Palermo, Palermo, Italy
| | - Giovanna Cilluffo
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Rosolino Camarda
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
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Ter Telgte A, van Leijsen EMC, Wiegertjes K, Klijn CJM, Tuladhar AM, de Leeuw FE. Cerebral small vessel disease: from a focal to a global perspective. Nat Rev Neurol 2019; 14:387-398. [PMID: 29802354 DOI: 10.1038/s41582-018-0014-y] [Citation(s) in RCA: 273] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cerebral small vessel disease (SVD) is commonly observed on neuroimaging among elderly individuals and is recognized as a major vascular contributor to dementia, cognitive decline, gait impairment, mood disturbance and stroke. However, clinical symptoms are often highly inconsistent in nature and severity among patients with similar degrees of SVD on brain imaging. Here, we provide a new framework based on new advances in structural and functional neuroimaging that aims to explain the remarkable clinical variation in SVD. First, we discuss the heterogeneous pathology present in SVD lesions despite an identical appearance on imaging and the perilesional and remote effects of these lesions. We review effects of SVD on structural and functional connectivity in the brain, and we discuss how network disruption by SVD can lead to clinical deficits. We address reserve and compensatory mechanisms in SVD and discuss the part played by other age-related pathologies. Finally, we conclude that SVD should be considered a global rather than a focal disease, as the classically recognized focal lesions affect remote brain structures and structural and functional network connections. The large variability in clinical symptoms among patients with SVD can probably be understood by taking into account the heterogeneity of SVD lesions, the effects of SVD beyond the focal lesions, the contribution of neurodegenerative pathologies other than SVD, and the interaction with reserve mechanisms and compensatory mechanisms.
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Affiliation(s)
- Annemieke Ter Telgte
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Esther M C van Leijsen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands.
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Spilling CA, Bajaj MPK, Burrage DR, Ruickbie S, Thai NJ, Baker EH, Jones PW, Barrick TR, Dodd JW. Contributions of cardiovascular risk and smoking to chronic obstructive pulmonary disease (COPD)-related changes in brain structure and function. Int J Chron Obstruct Pulmon Dis 2019; 14:1855-1866. [PMID: 31686798 PMCID: PMC6709516 DOI: 10.2147/copd.s213607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022] Open
Abstract
Background Brain damage and cardiovascular disease are extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD). Cardiovascular risk factors and smoking are contributors to neurodegeneration. This study investigates whether there is a specific, COPD-related deterioration in brain structure and function independent of cardiovascular risk factors and smoking. Materials and methods Neuroimaging and clinical markers of brain structure (micro- and macro-) and function (cognitive function and mood) were compared between 27 stable COPD patients (age: 63.0±9.1 years, 59.3% male, forced expiratory volume in 1 second [FEV1]: 58.1±18.0% pred.) and 23 non-COPD controls with >10 pack years smoking (age: 66.6±7.5 years, 52.2% male, FEV1: 100.6±19.1% pred.). Clinical relationships and group interactions with brain structure were also tested. All statistical analyses included correction for cardiovascular risk factors, smoking, and aortic stiffness. Results COPD patients had significantly worse cognitive function (p=0.011), lower mood (p=0.046), and greater gray matter atrophy (p=0.020). In COPD patients, lower mood was associated with markers of white matter (WM) microstructural damage (p<0.001), and lower lung function (FEV1/forced vital capacity and FEV1) with markers of both WM macro (p=0.047) and microstructural damage (p=0.028). Conclusion COPD is associated with both structural (gray matter atrophy) and functional (worse cognitive function and mood) brain changes that cannot be explained by measures of cardiovascular risk, aortic stiffness, or smoking history alone. These results have important implications to guide the development of new interventions to prevent or delay progression of neuropsychiatric comorbidities in COPD. Relationships found between mood and microstructural abnormalities suggest that in COPD, anxiety, and depression may occur secondary to WM damage. This could be used to better understand disabling symptoms such as breathlessness, improve health status, and reduce hospital admissions.
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Affiliation(s)
- Catherine A Spilling
- Institute for Molecular and Clinical Sciences, St George’s University of London, LondonSW17 ORE, UK
| | - Mohani-Preet K Bajaj
- Institute for Molecular and Clinical Sciences, St George’s University of London, LondonSW17 ORE, UK
| | - Daniel R Burrage
- Institute for Infection and Immunity, St George’s University of London, LondonSW17 ORE, UK
| | - Sachelle Ruickbie
- Institute for Infection and Immunity, St George’s University of London, LondonSW17 ORE, UK
| | - N Jade Thai
- Clinical Research and Imaging Centre, University of Bristol, BristolBS2 8DX, UK
| | - Emma H Baker
- Institute for Infection and Immunity, St George’s University of London, LondonSW17 ORE, UK
| | - Paul W Jones
- Institute for Infection and Immunity, St George’s University of London, LondonSW17 ORE, UK
| | - Thomas R Barrick
- Institute for Molecular and Clinical Sciences, St George’s University of London, LondonSW17 ORE, UK
| | - James W Dodd
- Academic Respiratory Unit, University of Bristol, BristolBS10 5NB, UK
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Su N, Liang X, Yao M, Zhou LX, Wang Q, Jin ZY, Zhang SY, Cui LY, Gong G, Zhu YC, Ni J. Cerebral Microbleeds Correlated with White Matter and Hippocampal Volumes in Community-Dwelling Populations. J Alzheimers Dis 2019; 71:559-567. [PMID: 31424402 DOI: 10.3233/jad-190454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few studies have investigated the correlation between cerebral microbleeds (CMBs), a hemorrhagic imaging marker of cerebral small vessel disease (CSVD), and brain volume. OBJECTIVE We investigated the association between the burden and locations of CMBs and brain volume in community-dwelling populations. METHODS Data were obtained from 1,029 participants who underwent brain magnetic resonance imaging (MRI) and APOE genotyping. Volumes of the whole brain, subcortical white matter (WM), cortical gray matter (GM), and hippocampus were extracted. Linear regression models were used to investigate the relationship between the CMB burden and their location with structural changes. RESULTS Regarding burden, participants with≥3 CMBs had significantly lower whole brain (β= -1.124, p = 0.0133), subcortical WM (β= -1.020, p = 0.0043), and hippocampus (β= -0.015, p = 0.0088) volumes than those without CMBs. Regarding location and burden, the presence of≥3 strictly lobar CMBs was negatively associated with whole brain volume (β= -2.838, p = 0.0088). Additionally, higher CMB burdens in strictly lobar locations or deep/mixed locations were associated with lower subcortical WM volume (β= -1.689, p = 0.0482; β= -0.872, p = 0.0464, respectively). Finally, the presence of≥3 deep/mixed CMBs was associated with lower hippocampus volume (β= -0.018, p = 0.0088), and these associations were independent of other ischemic markers of CSVD. However, the CMB burden and distributional pattern did not correlate with cortical GM volumes. CONCLUSION A higher CMB burden, in specific locations, is associated with decreased brain volumes in community-dwelling populations.
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Affiliation(s)
- Ning Su
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Liang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Xin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quan Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gaolang Gong
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Basilakos A, Stark BC, Johnson L, Rorden C, Yourganov G, Bonilha L, Fridriksson J. Leukoaraiosis Is Associated With a Decline in Language Abilities in Chronic Aphasia. Neurorehabil Neural Repair 2019; 33:718-729. [PMID: 31315507 DOI: 10.1177/1545968319862561] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background. A fraction of stroke survivors with chronic aphasia experience declines in language abilities over time, but the reason for this remains unclear. Objective. To evaluate the effect of leukoaraiosis on baseline aphasia severity and long-term changes in aphasia severity. This study directly compares the predictive capacity of leukoaraiosis severity to that of lesion damage, a factor known to account for a substantial proportion of variance in the degree of language impairment and recovery. Methods. Using a longitudinal database of behavioral and neuroimaging data from 35 individuals in the chronic stage of recovery after a single-event left-hemisphere stroke (9 females, mean stroke age = 55.8 ± 9.1 years, mean months poststroke at initial evaluation = 36.3 ± 40.8), we examined 2 lines of inquiry: (1) to what extent does leukoaraiosis severity at initial evaluation predict aphasia severity and (2) to what extent does leukoaraiosis severity at initial evaluation predict longitudinal change in aphasia severity. Participants underwent high-resolution magnetic resonance imaging for the purpose of lesion volume analysis and leukoaraiosis severity rating. Biographical information was also considered. Results. Lesion volume and time poststroke at initial assessment best predicted initial aphasia severity (adjusted R2 = 0.37). Leukoaraiosis severity and initial aphasia severity significantly predicted decline in language abilities at follow-up, accounting for approximately one-third of the variance (adjusted R2 = 0.33). More severe leukoaraiosis was associated with a 4.3 odds increase of decline. Conclusions. Leukoaraiosis is a significant risk factor for declining language abilities in aphasia and should be considered for better identification of individuals at risk for long-term decline, which can guide clinical decision making.
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Affiliation(s)
| | - Brielle C Stark
- 1 University of South Carolina, Columbia, SC, USA.,2 Indiana University, Bloomington, IN, USA.,3 Medical University of South Carolina, Charleston, SC, USA
| | - Lisa Johnson
- 1 University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- 1 University of South Carolina, Columbia, SC, USA
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Relationship between stroke severity, extensity of leukoaraiosis, and brain atrophy in patients with ischaemic stroke. Pol J Radiol 2019; 84:e80-e85. [PMID: 31019599 PMCID: PMC6479140 DOI: 10.5114/pjr.2019.82917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/21/2018] [Indexed: 01/09/2023] Open
Abstract
Purpose Leukoaraiosis (LA), according to the latest classification, is white matter hyperintensity - morphological findings of small blood vessel disease of the brain. This radiological detection of small vessels disease is important because there are no technical possibilities to assess small vessels of the brain using computed tomography (CT) or magnetic resonance imaging (MRI) angiography. Our aim was to analysis the relationship between the extension of leukoaraiosis and severity of ischaemic stroke and brain atrophy. Material and methods We retrospectively analysed 77 head CT scans of patients admitted from the emergency room (ER) to the Radiology Department due to suspected stroke. We assessed the severity of leukoaraiosis using the van Swieten scale and brain atrophy by numerous linear measurements. Results Statistical analysis failed to demonstrate differences between LA1 and LA2 groups with regard to stroke severity in National Institutes of Health Stroke Scale (NIHSS) (p = 0.2159). There were no differences with regard to clinical severity of stroke between the study groups divided depending on the extent of brain atrophy. There were statistically significant differences with regard to the anterior horn width of the right and left lateral ventricle, posterior horn width of the right and left lateral ventricle, distance between occipital horn of the left lateral ventricle and internal surface of the cranium and third ventricle width depending on the severity of leukoaraiosis. Conclusions The results of our studies present an association between the degree leukoaraiosis extension and brain atrophy, but no association between central nervous system tissue atrophy of extent of leukoaraiosis and ischaemic stroke severity.
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Nociceptive Primitive Reflexes in Neurologically and Cognitively Healthy Aging Subjects. Can J Neurol Sci 2019; 46:199-208. [PMID: 30761966 DOI: 10.1017/cjn.2018.388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To assess the prevalence of three nociceptive primitive reflexes (nPR), i.e., glabellar tap, snout reflex, and palmomental reflex, in neurologically and cognitively healthy (NCH) aging subjects. OBJECTIVE To investigate whether nPR are cross-sectionally associated with white matter hyperintensities (WMH), lacunes, atrophy of the caudate nuclei, and global brain atrophy. METHODS A total of 1246 NCH subjects aged 45-91 years were included in the study and underwent standard brain MRI. Atrophy of the caudate nuclei and global brain atrophy were assessed through the bicaudate ratio (BCr) and lateral ventricles to brain ratio (LVBr), respectively. WMH were assessed through visual rating scales. Lacunes were also rated. Association of nPR with vascular risk factors/diseases and imaging findings was evaluated using logistic regression analysis. RESULTS nPR were exhibited by 33.1% of subjects and increased with age. Subjects with nPR performed less than subjects without nPR in tests evaluating global cognition, executive functions, attention, and language. Snout reflex was the most common nPR, followed by glabellar tap and palmomental reflex. Glabellar tap was associated with parieto-temporal WMH, BCr, and LVBr; snout reflex was associated with frontal lacunes, temporal WMH, BCr, and LVBr; palmomental reflex was associated with parieto-occipital WMH, basal ganglia lacunes, BCr, and LVBr. CONCLUSIONS This study demonstrates that in NCH aging individuals, nPR are associated with WMH, lacunes, BCr, and LVBr and are probably a warning sign of incipient cognitive decline. Therefore, NCH subjects presenting nPR should manage their vascular risk factors/vascular diseases rigorously in order to prevent or delay progression of small vessel disease, and future neurological and cognitive disabilities.
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Chung CP, Chou KH, Peng LN, Liu LK, Lee WJ, Chen LK, Lin CP, Wang PN. Associations between low circulatory low-density lipoprotein cholesterol level and brain health in non-stroke non-demented subjects. Neuroimage 2018; 181:627-634. [DOI: 10.1016/j.neuroimage.2018.07.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 07/20/2018] [Indexed: 01/24/2023] Open
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Shi Y, Li S, Li W, Zhang C, Guo L, Pan Y, Zhou X, Wang X, Niu S, Yu X, Tang H, Chen B, Zhang Z. MRI Lesion Load of Cerebral Small Vessel Disease and Cognitive Impairment in Patients With CADASIL. Front Neurol 2018; 9:862. [PMID: 30459701 PMCID: PMC6232772 DOI: 10.3389/fneur.2018.00862] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/25/2018] [Indexed: 11/13/2022] Open
Abstract
Background and objective: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the best known and the most common monogenic small vessel disease (SVD). Cognitive impairment is an inevitable feature of CADASIL. Total SVD score and global cortical atrophy (GCA) scale were found to be good predictors of poor cognitive performance in community-dwelling adults. We aimed to estimate the association between the total SVD score, GCA scale and the cognitive performance in patients with CADASIL. Methods: We enrolled 20 genetically confirmed CADASIL patients and 20 controls matched by age, gender, and years of education. All participants underwent cognitive assessments to rate the global cognition and individual domain of executive function, information processing speed, memory, language, and visuospatial function. The total SVD score and GCA scale were rated. Results: The CADASIL group performed worse than the controls on all cognition measures. Neither global cognition nor any separate domain of cognition was significantly different among patients grouped by total SVD score. Negative correlations between the GCA score and cognitive performance were observed. Approximately 40% of the variance was explained by the total GCA score in the domains of executive function, information processing speed, and language. The superficial atrophy score was associated with poor performance in most of the domains of cognition. Adding the superficial atrophy score decreased the prediction power of the deep atrophy score on cognitive impairment alone. Conclusions: The GCA score, not the total SVD score, was significantly associated with poor cognitive performance in patients with CADASIL. Adding the superficial atrophy score attenuated the prediction power of the deep atrophy score on cognitive impairment alone.
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Affiliation(s)
- YuZhi Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - ShaoWu Li
- Department of Functional Neuroimaging, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - LiYing Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - YunZhu Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - XueMei Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - XinGao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Songtao Niu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - XueYing Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - HeFei Tang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bin Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - ZaiQiang Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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46
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Jandke S, Garz C, Schwanke D, Sendtner M, Heinze HJ, Carare RO, Schreiber S. The association between hypertensive arteriopathy and cerebral amyloid angiopathy in spontaneously hypertensive stroke-prone rats. Brain Pathol 2018; 28:844-859. [PMID: 30062722 PMCID: PMC8028507 DOI: 10.1111/bpa.12629] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We aimed to test the hypothesis that in spontaneously hypertensive stroke‐prone rats (SHRSP), non‐amyloid cerebral small vessel disease/hypertensive arteriopathy (HA) results in vessel wall injury that may promote cerebral amyloid angiopathy (CAA). Our study comprised 21 male SHRSP (age 17–44 weeks) and 10 age‐ and sex‐matched Wistar control rats, that underwent two‐photon (2PM) imaging of the arterioles in the parietal cortex using Methoxy‐X04, Dextran and cerebral blood flow (CBF) measurements. Our data suggest that HA in SHRSP progresses in a temporal and age‐dependent manner, starting from small vessel wall damage (stage 1A), proceeding to CBF reduction (stage 1B), non‐occlusive (stage 2), and finally, occlusive thrombi (stage 3). Wistar animals also demonstrated small vessel wall damage, but were free of any of the later HA stages. Nearly half of all SHRSP additionally displayed vascular Methoxy‐X04 positivity indicative of cortical CAA. Vascular β‐amyloid deposits were found in small vessels characterized by thrombotic occlusions (stage 2 or 3). Post‐mortem analysis of the rat brains confirmed the findings derived from intravital 2PM microscopy. Our data thus overall suggest that advanced HA may play a role in CAA development with the two small vessel disease entities might be related to the same pathological spectrum of the aging brain.
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Affiliation(s)
- Solveig Jandke
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Cornelia Garz
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Daniel Schwanke
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Michael Sendtner
- Institute of Clinical Neurobiology, University of Würzburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | | | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
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47
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Cuadrado-Godia E, Dwivedi P, Sharma S, Ois Santiago A, Roquer Gonzalez J, Balcells M, Laird J, Turk M, Suri HS, Nicolaides A, Saba L, Khanna NN, Suri JS. Cerebral Small Vessel Disease: A Review Focusing on Pathophysiology, Biomarkers, and Machine Learning Strategies. J Stroke 2018; 20:302-320. [PMID: 30309226 PMCID: PMC6186915 DOI: 10.5853/jos.2017.02922] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/02/2018] [Indexed: 12/15/2022] Open
Abstract
Cerebral small vessel disease (cSVD) has a crucial role in lacunar stroke and brain hemorrhages and is a leading cause of cognitive decline and functional loss in elderly patients. Based on underlying pathophysiology, cSVD can be subdivided into amyloidal and non-amyloidal subtypes. Genetic factors of cSVD play a pivotal role in terms of unraveling molecular mechanism. An important pathophysiological mechanism of cSVD is blood-brain barrier leakage and endothelium dysfunction which gives a clue in identification of the disease through circulating biological markers. Detection of cSVD is routinely carried out by key neuroimaging markers including white matter hyperintensities, lacunes, small subcortical infarcts, perivascular spaces, cerebral microbleeds, and brain atrophy. Application of neural networking, machine learning and deep learning in image processing have increased significantly for correct severity of cSVD. A linkage between cSVD and other neurological disorder, such as Alzheimer's and Parkinson's disease and non-cerebral disease, has also been investigated recently. This review draws a broad picture of cSVD, aiming to inculcate new insights into its pathogenesis and biomarkers. It also focuses on the role of deep machine strategies and other dimensions of cSVD by linking it with several cerebral and non-cerebral diseases as well as recent advances in the field to achieve sensitive detection, effective prevention and disease management.
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Affiliation(s)
- Elisa Cuadrado-Godia
- Department of Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Sanjiv Sharma
- Department of Computer Science & Engineering and Information Technology, Madhav Institute of Technology and Science, Gwalior, India
| | - Angel Ois Santiago
- Department of Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Jaume Roquer Gonzalez
- Department of Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Mercedes Balcells
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Biological Engineering, IQS School of Engineering, Barcelona, Spain
| | - John Laird
- Department of Cardiology, St. Helena Hospital, St. Helena, CA, USA
| | - Monika Turk
- Deparment of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | | | | | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | | | - Jasjit S Suri
- Stroke Monitoring Division, AtheroPoint, Roseville, CA, USA
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48
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Lambert C, Zeestraten E, Williams O, Benjamin P, Lawrence AJ, Morris RG, Mackinnon AD, Barrick TR, Markus HS. Identifying preclinical vascular dementia in symptomatic small vessel disease using MRI. Neuroimage Clin 2018; 19:925-938. [PMID: 30003030 PMCID: PMC6039843 DOI: 10.1016/j.nicl.2018.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/23/2018] [Accepted: 06/17/2018] [Indexed: 11/21/2022]
Abstract
Sporadic cerebral small vessel disease is an important cause of vascular dementia, a syndrome of cognitive impairment together with vascular brain damage. At post-mortem pure vascular dementia is rare, with evidence of co-existing Alzheimer's disease pathology in 95% of cases. This work used MRI to characterize structural abnormalities during the preclinical phase of vascular dementia in symptomatic small vessel disease. 121 subjects were recruited into the St George's Cognition and Neuroimaging in Stroke study and followed up longitudinally for five years. Over this period 22 individuals converted to dementia. Using voxel-based morphometry, we found structural abnormalities present at baseline in those with preclinical dementia, with reduced grey matter density in the left striatum and hippocampus, and more white matter hyperintensities in the frontal white-matter. The lacunar data revealed that some of these abnormalities may be due to lesions within the striatum and centrum semiovale. Using support vector machines, future dementia could be best predicted using hippocampal and striatal Jacobian determinant data, achieving a balanced classification accuracy of 73%. Using cluster ward linkage we identified four anatomical subtypes. Successful predictions were restricted to groups with lower levels of vascular damage. The subgroup that could not be predicted were younger, further from conversion, had the highest levels of vascular damage, with milder cognitive impairment at baseline but more rapid deterioration in processing speed and executive function, consistent with a primary vascular dementia. In contrast, the remaining groups had decreasing levels of vascular damage and increasing memory impairment consistent with progressively more Alzheimer's-like pathology. Voxel-wise rates of hippocampal atrophy supported these distinctions, with the vascular group closely resembling the non-dementing cohort, whereas the Alzheimer's like group demonstrated global hippocampal atrophy. This work reveals distinct anatomical endophenotypes in preclinical vascular dementia, forming a spectrum between vascular and Alzheimer's like pathology. The latter group can be identified using baseline MRI, with 73% converting within 5 years. It was not possible to predict the vascular dominant dementia subgroup, however 19% of negative predictions with high levels of vascular disease would ultimately develop dementia. It may be that techniques more sensitive to white matter damage, such as diffusion weighted imaging, may prove more useful for this vascular dominant subgroup in the future. This work provides a way to accurately stratify patients using a baseline MRI scan, and has utility in future clinical trials designed to slow or prevent the onset of dementia in these high-risk cohorts.
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Affiliation(s)
- Christian Lambert
- Wellcome Centre for Human Neuroimaging, 12 Queen Square, WC1N 3BG London, UK; Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK.
| | - Eva Zeestraten
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Owen Williams
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Philip Benjamin
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Andrew J Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, CB2 0QQ, UK
| | - Robin G Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Andrew D Mackinnon
- St George's NHS Healthcare Trust, Atkinson Morley Regional Neuroscience Centre, London, UK
| | - Thomas R Barrick
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Hugh S Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, CB2 0QQ, UK
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49
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Banerjee G, Jang H, Kim HJ, Kim ST, Kim JS, Lee JH, Im K, Kwon H, Lee JM, Na DL, Seo SW, Werring DJ. Total MRI Small Vessel Disease Burden Correlates with Cognitive Performance, Cortical Atrophy, and Network Measures in a Memory Clinic Population. J Alzheimers Dis 2018; 63:1485-1497. [DOI: 10.3233/jad-170943] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Hyemin Jang
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Hong Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kiho Im
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hunki Kwon
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Jong Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Duk L. Na
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - David John Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
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50
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Benjamin P, Trippier S, Lawrence AJ, Lambert C, Zeestraten E, Williams OA, Patel B, Morris RG, Barrick TR, MacKinnon AD, Markus HS. Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease. Stroke 2018; 49:586-593. [PMID: 29438074 PMCID: PMC5832012 DOI: 10.1161/strokeaha.117.017526] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 12/11/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Cerebral small-vessel disease is a major cause of cognitive impairment. Perivascular spaces (PvS) occur in small-vessel disease, but their relationship to cognitive impairment remains uncertain. One reason may be difficulty in distinguishing between lacunes and PvS. We determined the relationship between baseline PvS score and PvS volume with change in cognition over a 5-year follow-up. We compared this to the relationship between baseline lacune count and total lacune volume with cognition. In addition, we examined change in PvS volume over time. Methods— Data from the prospective SCANS study (St Georges Cognition and Neuroimaging in Stroke) of patients with symptomatic lacunar stroke and confluent leukoaraiosis were used (n=121). Multimodal magnetic resonance imaging was performed annually for 3 years and neuropsychological testing annually for 5 years. Lacunes were manually identified and distinguished from PvS. PvS were rated using a validated visual rating scale, and PvS volumes calculated using T1-weighted images. Linear mixed-effect models were used to determine the impact of PvS and lacunes on cognition. Results— Baseline PvS scores or volumes showed no association with cognitive indices. No change was detectable in PvS volumes over the 3 years. In contrast, baseline lacunes associated with all cognitive indices and predicted cognitive decline over the 5-year follow-up. Conclusions— Although a feature of small-vessel disease, PvS are not a predictor of cognitive decline, in contrast to lacunes. This study highlights the importance of carefully differentiating between lacunes and PvS in studies investigating vascular cognitive impairment.
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Affiliation(s)
- Philip Benjamin
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M).
| | - Sarah Trippier
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Andrew J Lawrence
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Christian Lambert
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Eva Zeestraten
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Owen A Williams
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Bhavini Patel
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Robin G Morris
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Thomas R Barrick
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Andrew D MacKinnon
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Hugh S Markus
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
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