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Tu MC, Huang SM, Hsu YH, Yang JJ, Lin CY, Kuo LW. Joint diffusional kurtosis magnetic resonance imaging analysis of white matter and the thalamus to identify subcortical ischemic vascular disease. Sci Rep 2024; 14:2570. [PMID: 38297073 PMCID: PMC10830492 DOI: 10.1038/s41598-024-52910-x] [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: 09/12/2023] [Accepted: 01/25/2024] [Indexed: 02/02/2024] Open
Abstract
Identifying subcortical ischemic vascular disease (SIVD) in older adults is important but challenging. Growing evidence suggests that diffusional kurtosis imaging (DKI) can detect SIVD-relevant microstructural pathology, and a systematic assessment of the discriminant power of DKI metrics in various brain tissue microstructures is urgently needed. Therefore, the current study aimed to explore the value of DKI and diffusion tensor imaging (DTI) metrics in detecting early-stage SIVD by combining multiple diffusion metrics, analysis strategies, and clinical-radiological constraints. This prospective study compared DKI with diffusivity and macroscopic imaging evaluations across the aging spectrum including SIVD, Alzheimer's disease (AD), and cognitively normal (NC) groups. Using a white matter atlas and segregated thalamus analysis with considerations of the pre-identified macroscopic pathology, the most effective diffusion metrics were selected and then examined using multiple clinical-radiological constraints in a two-group or three-group paradigm. A total of 122 participants (mean age, 74.6 ± 7.38 years, 72 women) including 42 with SIVD, 50 with AD, and 30 NC were evaluated. Fractional anisotropy, mean kurtosis, and radial kurtosis were critical metrics in detecting early-stage SIVD. The optimal selection of diffusion metrics showed 84.4-100% correct classification of the results in a three-group paradigm, with an area under the curve of .909-.987 in a two-group paradigm related to SIVD detection (all P < .001). We therefore concluded that greatly resilient to the effect of pre-identified macroscopic pathology, the combination of DKI/DTI metrics showed preferable performance in identifying early-stage SIVD among adults across the aging spectrum.
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Affiliation(s)
- Min-Chien Tu
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Min Huang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
| | - Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi, Taiwan
| | - Jir-Jei Yang
- Department of Radiology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | | | - Li-Wei Kuo
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli, Taiwan.
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.
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Li R, Harshfield EL, Bell S, Burkhart M, Tuladhar AM, Hilal S, Tozer DJ, Chappell FM, Makin SD, Lo JW, Wardlaw JM, de Leeuw FE, Chen C, Kourtzi Z, Markus HS. Predicting incident dementia in cerebral small vessel disease: comparison of machine learning and traditional statistical models. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100179. [PMID: 37593075 PMCID: PMC10428032 DOI: 10.1016/j.cccb.2023.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/07/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
Background Cerebral small vessel disease (SVD) contributes to 45% of dementia cases worldwide, yet we lack a reliable model for predicting dementia in SVD. Past attempts largely relied on traditional statistical approaches. Here, we investigated whether machine learning (ML) methods improved prediction of incident dementia in SVD from baseline SVD-related features over traditional statistical methods. Methods We included three cohorts with varying SVD severity (RUN DMC, n = 503; SCANS, n = 121; HARMONISATION, n = 265). Baseline demographics, vascular risk factors, cognitive scores, and magnetic resonance imaging (MRI) features of SVD were used for prediction. We conducted both survival analysis and classification analysis predicting 3-year dementia risk. For each analysis, several ML methods were evaluated against standard Cox or logistic regression. Finally, we compared the feature importance ranked by different models. Results We included 789 participants without missing data in the survival analysis, amongst whom 108 (13.7%) developed dementia during a median follow-up of 5.4 years. Excluding those censored before three years, we included 750 participants in the classification analysis, amongst whom 48 (6.4%) developed dementia by year 3. Comparing statistical and ML models, only regularised Cox/logistic regression outperformed their statistical counterparts overall, but not significantly so in survival analysis. Baseline cognition was highly predictive, and global cognition was the most important feature. Conclusions When using baseline SVD-related features to predict dementia in SVD, the ML survival or classification models we evaluated brought little improvement over traditional statistical approaches. The benefits of ML should be evaluated with caution, especially given limited sample size and features.
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Affiliation(s)
- Rui Li
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Eric L. Harshfield
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
- Heart and Lung Research Institute, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Steven Bell
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
- Heart and Lung Research Institute, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
- Precision Breast Cancer Institute, Department of Oncology, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Michael Burkhart
- Adaptive Brain Lab, Department of Psychology, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Anil M. Tuladhar
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Saima Hilal
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Daniel J. Tozer
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Francesca M. Chappell
- Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Stephen D.J. Makin
- Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - Jessica W. Lo
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zoe Kourtzi
- Adaptive Brain Lab, Department of Psychology, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Hugh S. Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
- Heart and Lung Research Institute, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
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Price RS. Exploring what progress is being made in the development of health promotion material for vascular dementia: A systematic review of the evidence. Aging Med (Milton) 2023; 6:184-194. [PMID: 37287679 PMCID: PMC10242248 DOI: 10.1002/agm2.12253] [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: 02/01/2023] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 06/09/2023] Open
Abstract
A systematic review conducted by Price and Keady (Journal of Nursing and Healthcare of Chronic Illness, 2, 88 and 2010) demonstrated that there was a dearth of health-promoting literature available for people diagnosed with vascular dementia. The correlation between health behavior and the onset of cardiovascular change that can lead to vascular dementia had demonstrated a need for health education and health-promoting information to be made accessible to vulnerable populations to ameliorate the risk of cognitive decline because of cardiovascular disease. Dementia is a progressive and life-limiting condition and with limited treatment options and a lack of progress in identifying a way to delay onset or even cure the condition. Focus must be targeted towards risk reduction strategies that serve to reduce onset and decline and limit the global burden on not only the individual with the condition and their carers but also to the health and social care economy. To identify the progress that has been made in developing health-promoting literature and patient education guidance since 2010 a systematic literature review was undertaken. Using thematic analysis, CINAHL, MEDLINE, and psych INFO databases were accessed and following PRISMA guidelines an inclusion and exclusion criteria was developed in order to locate peer-reviewed articles. Titles and abstracts were reviewed to identify a match with key terms, and from 133 screened abstracts eight studies met the inclusion requirements. From the eight studies, thematic analysis was implemented to identify shared understanding of experiences relating to health promotion in vascular dementia. The methodology for the study was replicated from the authors' previous systematic review in 2010. Five key themes were identified in the literature (Healthy heart healthy brain; Risk factors; Risk reduction/modification; Interventions; Absence of targeted health promotion). From what little evidence was available to review the thematic analysis has demonstrated developments in knowledge into the link between the onset of cognitive impairment and vascular dementia because of compromised cardiovascular health. Modifying health behavior has become essential in ameliorating the risk of vascular cognitive decline. With these developments the synthesis of the literature demonstrates that even with these insights there continues to be a lack of targeted material that individuals can access to understand the link between cardiovascular health and cognitive decline. It is recognized that maximizing cardiovascular health has the potential to lessen the risk of vascular cognitive impairment and vascular dementia developing and progressing yet targeted health promoting material remains lacking. With the developments in understanding the causal links between poor cardiovascular health, vascular cognitive impairment, and vascular dementia progress now needs to be made in developing targeted health promotion material for individuals to access to share this knowledge to reduce the potential onset and subsequent burden of dementia.
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Rothstein A, Zhang Y, Briggs AQ, Bernard MA, Shao Y, Favilla C, Sloane K, Witsch J, Masurkar AV. Impact of white matter hyperintensities on subjective cognitive decline phenotype in a diverse cohort of cognitively normal older adults. Int J Geriatr Psychiatry 2023; 38:e5948. [PMID: 37291739 DOI: 10.1002/gps.5948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/20/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Subjective cognitive decline (SCD) is a preclinical stage of AD. White matter hyperintensities (WMH), an MRI marker of cerebral small vessel disease, associate with AD biomarkers and progression. The impact of WMH on SCD phenotype is unclear. METHODS/DESIGN A retrospective, cross-sectional analysis was conducted on a diverse cohort with SCD evaluated at the NYU Alzheimer's Disease Research Center between January 2017 and November 2021 (n = 234). The cohort was dichotomized into none-to-mild (n = 202) and moderate-to-severe (n = 32) WMH. Differences in SCD and neurocognitive assessments were evaluated via Wilcoxon or Fisher exact tests, with p-values adjusted for demographics using multivariable logistic regression. RESULTS Moderate-to-severe WMH participants reported more difficulty with decision making on the Cognitive Change Index (1.5 SD 0.7 vs. 1.2 SD 0.5, p = 0.0187) and worse short-term memory (2.2 SD 0.4 vs. 1.9 SD 0.3, p = 0.0049) and higher SCD burden (9.5 SD 1.6 vs. 8.7 SD 1.7, p = 0.0411) on the Brief Cognitive Rating Scale. Moderate-to-severe WMH participants scored lower on the Mini-Mental State Examination (28.0 SD 1.6 vs. 28.5 SD 1.9, p = 0.0491), and on delayed paragraph (7.2 SD 2.0 vs. 8.8 SD 2.9, p = 0.0222) and designs recall (4.5 SD 2.3 vs. 6.1 SD 2.5, p = 0.0373) of the Guild Memory Test. CONCLUSIONS In SCD, WMH impact overall symptom severity, specifically in executive and memory domains, as well as objective performance on global and domain-specific tests in verbal memory and visual working/associative memory.
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Affiliation(s)
- Aaron Rothstein
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yian Zhang
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Anthony Q Briggs
- Center for Cognitive Neurology, Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Mark A Bernard
- Center for Cognitive Neurology, Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Christopher Favilla
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly Sloane
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jens Witsch
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arjun V Masurkar
- Center for Cognitive Neurology, Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Neuroscience Institute, NYU Grossman School of Medicine, New York, New York, USA
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Trofimova O, Latypova A, DiDomenicantonio G, Lutti A, de Lange AMG, Kliegel M, Stringhini S, Marques-Vidal P, Vaucher J, Vollenweider P, Strippoli MPF, Preisig M, Kherif F, Draganski B. Topography of associations between cardiovascular risk factors and myelin loss in the ageing human brain. Commun Biol 2023; 6:392. [PMID: 37037939 PMCID: PMC10086032 DOI: 10.1038/s42003-023-04741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023] Open
Abstract
Our knowledge of the mechanisms underlying the vulnerability of the brain's white matter microstructure to cardiovascular risk factors (CVRFs) is still limited. We used a quantitative magnetic resonance imaging (MRI) protocol in a single centre setting to investigate the cross-sectional association between CVRFs and brain tissue properties of white matter tracts in a large community-dwelling cohort (n = 1104, age range 46-87 years). Arterial hypertension was associated with lower myelin and axonal density MRI indices, paralleled by higher extracellular water content. Obesity showed similar associations, though with myelin difference only in male participants. Associations between CVRFs and white matter microstructure were observed predominantly in limbic and prefrontal tracts. Additional genetic, lifestyle and psychiatric factors did not modulate these results, but moderate-to-vigorous physical activity was linked to higher myelin content independently of CVRFs. Our findings complement previously described CVRF-related changes in brain water diffusion properties pointing towards myelin loss and neuroinflammation rather than neurodegeneration.
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Affiliation(s)
- Olga Trofimova
- Laboratory for Research in Neuroimaging LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Adeliya Latypova
- Laboratory for Research in Neuroimaging LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giulia DiDomenicantonio
- Laboratory for Research in Neuroimaging LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antoine Lutti
- Laboratory for Research in Neuroimaging LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ann-Marie G de Lange
- Laboratory for Research in Neuroimaging LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Matthias Kliegel
- Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Silvia Stringhini
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Vaucher
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Pierre F Strippoli
- Center for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Center for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ferath Kherif
- Laboratory for Research in Neuroimaging LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- Neurology Department, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
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6
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Cheon SY, Song J. Novel insights into non-alcoholic fatty liver disease and dementia: insulin resistance, hyperammonemia, gut dysbiosis, vascular impairment, and inflammation. Cell Biosci 2022; 12:99. [PMID: 35765060 PMCID: PMC9237975 DOI: 10.1186/s13578-022-00836-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/20/2022] [Indexed: 02/08/2023] Open
Abstract
AbstractNon-alcoholic fatty liver disease (NAFLD) is a metabolic disease characterized by multiple pathologies. The progression of dementia with NAFLD may be affected by various risk factors, including brain insulin resistance, cerebrovascular dysfunction, gut dysbiosis, and neuroinflammation. Many recent studies have focused on the increasing prevalence of dementia in patients with NAFLD. Dementia is characterized by cognitive and memory deficits and has diverse subtypes, including vascular dementia, Alzheimer’s dementia, and diabetes mellitus-induced dementia. Considering the common pathological features of NAFLD and dementia, further studies on the association between them are needed to find appropriate therapeutic solutions for diseases. This review summarizes the common pathological characteristics and mechanisms of NAFLD and dementia. Additionally, it describes recent evidence on association between NAFLD and dementia progression and provides novel perspectives with regard to the treatment of patients with dementia secondary to NAFLD.
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He M, Li Y, Zhou L, Li Y, Lei T, Yan W, Song J, Chen L. Relationships Between Memory Impairments and Hippocampal Structure in Patients With Subcortical Ischemic Vascular Disease. Front Aging Neurosci 2022; 14:823535. [PMID: 35517055 PMCID: PMC9062133 DOI: 10.3389/fnagi.2022.823535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposePatients with subcortical ischemic vascular disease (SIVD) suffer from memory disorders that are thought to be associated with the hippocampus. We aimed to explore changes in hippocampal subfields and the relationship between different hippocampal subfield volumes and different types of memory dysfunction in SIVD patients.MethodsA total of 77 SIVD patients with cognitive impairment (SIVD-CI, n = 39) or normal cognition (HC-SIVD, n = 38) and 41 matched healthy controls (HCs) were included in this study. Memory function was measured in all subjects, and structural magnetic resonance imaging (MRI) was performed. Then, the hippocampus was segmented and measured by FreeSurfer 6.0 software. One-way ANOVA was used to compare the volume of hippocampal subfields among the three groups while controlling for age, sex, education and intracranial volume (ICV). Then, post hoc tests were used to evaluate differences between each pair of groups. Finally, correlations between significantly different hippocampal subfield volumes and memory scores were tested in SIVD patients.ResultsAlmost all hippocampal subfields were significantly different among the three groups except for the bilateral hippocampal fissure (p = 0.366, p = 0.086, respectively.) and left parasubiculum (p = 0.166). Furthermore, the SIVD-CI patients showed smaller volumes in the right subiculum (p < 0.001), CA1 (p = 0.002), presubiculum (p = 0.002) and molecular layer of the hippocampus (p = 0.017) than the HC-SIVD patients. In addition, right subiculum volumes were positively related to Rey’s Auditory Verbal Learning Test (RAVLT) word recognition (r = 0.230, p = 0.050), reverse digit span test (R-DST) (r = 0.326, p = 0.005) and Rey–Osterrieth Complex Figure Test (ROCF) immediate recall (r = 0.247, p = 0.035) scores, right CA1 volumes were positively correlated with RAVLT word recognition (r = 0.261, p = 0.026), and right presubiculum volumes showed positive relationships with R-DST (r = 0.254, p = 0.030) and ROCF immediate recall (r = 0.242, p = 0.039) scores.ConclusionSIVD might lead to general reductions in volume in multiple hippocampal subfields. However, SIVD-CI patients showed atrophy in specific subfields, which might be associated with memory deficits.
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Affiliation(s)
- Miao He
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of Radiology, Gaoping District People’s Hospital, Nanchong, China
| | - Yang Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Lijing Zhou
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yajun Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ting Lei
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Wei Yan
- 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
| | - Li Chen
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- *Correspondence: Li Chen,
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8
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Egle M, Hilal S, Tuladhar AM, Pirpamer L, Hofer E, Duering M, Wason J, Morris RG, Dichgans M, Schmidt R, Tozer D, Chen C, de Leeuw FE, Markus HS. Prediction of dementia using diffusion tensor MRI measures: the OPTIMAL collaboration. J Neurol Neurosurg Psychiatry 2022; 93:14-23. [PMID: 34509999 DOI: 10.1136/jnnp-2021-326571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/21/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES It has been suggested that diffusion tensor imaging (DTI) measures sensitive to white matter (WM) damage may predict future dementia risk not only in cerebral small vessel disease (SVD), but also in mild cognitive impairment. To determine whether DTI measures were associated with cognition cross-sectionally and predicted future dementia risk across the full range of SVD severity, we established the International OPtimising mulTImodal MRI markers for use as surrogate markers in trials of Vascular Cognitive Impairment due to cerebrAl small vesseL disease collaboration which included six cohorts. METHODS Among the six cohorts, prospective data with dementia incidences were available for three cohorts. The associations between six different DTI measures and cognition or dementia conversion were tested. The additional contribution to prediction of other MRI markers of SVD was also determined. RESULTS The DTI measure mean diffusivity (MD) median correlated with cognition in all cohorts, demonstrating the contribution of WM damage to cognition. Adding MD median significantly improved the model fit compared to the clinical risk model alone and further increased in all single-centre SVD cohorts when adding conventional MRI measures. Baseline MD median predicted dementia conversion. In a study with severe SVD (SCANS) change in MD median also predicted dementia conversion. The area under the curve was best when employing a multimodal MRI model using both DTI measures and other MRI measures. CONCLUSIONS Our results support a central role for WM alterations in dementia pathogenesis in all cohorts. DTI measures such as MD median may be a useful clinical risk predictor. The contribution of other MRI markers varied according to disease severity.
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Affiliation(s)
- Marco Egle
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Saima Hilal
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lim School of Medicine, National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System of Singapore, Singapore
| | - A M Tuladhar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Lukas Pirpamer
- Department of Neurology, Medical University Graz, Graz, Austria
| | - Edith Hofer
- Department of Neurology, Medical University Graz, Graz, Austria.,Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - James Wason
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge Institute of Public Health, Cambridge, UK.,Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, UK
| | - Robin G Morris
- Department of Psychology (R.G.M), King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | | | - Daniel Tozer
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Christopher Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lim School of Medicine, National University of Singapore, Singapore
| | - Frank-Erik de Leeuw
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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9
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The Association between the Binding Processes of Working Memory and Vascular Risk Profile in Adults. Brain Sci 2021; 11:brainsci11091140. [PMID: 34573162 PMCID: PMC8467480 DOI: 10.3390/brainsci11091140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
Episodic buffer (EB), a key component of working memory, seems to have a rather complicated function as part of binding processes. Recent papers on the field claim that binding processes of working memory (WM) are assisted by attention and executive functions. On the same page, vascular pathology is gaining more ground as the main underlying cause for many brain pathologies. Hypercholesterolemia, hypertension, obesity, diabetes, lack of exercise and smoking are the most common risk factors that people of all ages suffer from and constitute the main vascular risk factors responsible for a possible decline in executive functions and attention. Thus, this research is an attempt to examine the relation between the binding functions of WM and the existence of vascular risk factors via a computerized test focusing on feature binding. The study comprised adults (n = 229) with and without vascular risk factors. The main tools used were a biomarker questionnaire and a feature binding test (FBT). The results showed that participants who report suffering from one or more vascular risk factors had significantly lower performance on specific subtasks of the FBT in comparison to the participants who were healthy. This allows us to assume that there might be a positive association between feature binding and a vascular risk profile in adults, and such a test could be a useful diagnostic tool for early cognitive impairment due to incipient vascular pathology.
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10
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Watermeyer T, Goerdten J, Johansson B, Muniz-Terrera G. Cognitive dispersion and ApoEe4 genotype predict dementia diagnosis in 8-year follow-up of the oldest-old. Age Ageing 2021; 50:868-874. [PMID: 33196771 DOI: 10.1093/ageing/afaa232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cognitive dispersion, or inconsistencies in performance across cognitive domains, has been posited as a cost-effective tool to predict conversion to dementia in older adults. However, there is a dearth of studies exploring cognitive dispersion in the oldest-old (>80 years) and its relationship to dementia incidence. OBJECTIVE The main aim of this study was to examine whether higher cognitive dispersion at baseline was associated with dementia incidence within an 8-year follow-up of very old adults, while controlling for established risk factors and suggested protective factors for dementia. METHODS Participants (n = 468) were from the Origins of Variance in the Old-Old: Octogenarian Twins study, based on the Swedish Twin Registry. Cox regression analyses were performed to assess the association between baseline cognitive dispersion scores and dementia incidence, while controlling for sociodemographic variables, ApoEe4 carrier status, co-morbidities, zygosity and lifestyle engagement scores. An additional model included a composite of average cognitive performance. RESULTS Cognitive dispersion and ApoEe4 were significantly associated with dementia diagnosis. These variables remained statistically significant when global cognitive performance was entered into the model. Likelihood ratio tests revealed that cognitive dispersion and cognitive composite scores entered together in the same model was superior to either predictor alone in the full model. CONCLUSIONS The study underscores the usefulness of cognitive dispersion metrics for dementia prediction in the oldest-old and highlights the influence of ApoEe4 on cognition in very late age. Our findings concur with others suggesting that health and lifestyle factors pose little impact upon cognition in very advanced age.
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Affiliation(s)
- Tam Watermeyer
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Faculty of Health and Life Sciences, Department of Psychology, Northumbria University, Newcastle, UK
| | - Jantje Goerdten
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
| | - Boo Johansson
- Department of Psychology, Centre for Ageing and Health (AgeCap), University of Gothenburg, Gothenburg, Sweden
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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11
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Egle M, Loubiere L, Maceski A, Kuhle J, Peters N, Markus HS. Neurofilament light chain predicts future dementia risk in cerebral small vessel disease. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325681. [PMID: 33558370 PMCID: PMC8142459 DOI: 10.1136/jnnp-2020-325681] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Serum neurofilament light chain (NfL) has been proposed as prognostic markers in neurogenerative disease. A cross-sectional study in cerebral small vessel disease (SVD) reported an association with cognition and disability. If NfL is to be used to predict outcome, studies are required to demonstrate baseline NfL predicts future dementia risk. Furthermore, if it is to be used as a surrogate marker in clinical trials, change in NfL over time periods typical of a clinical trial must be linked to clinical progression. In a longitudinal study of patients with lacunar stroke and confluent white matter hyperintensities, we determined whether both baseline, and change, in NfL levels were linked to changes in MRI markers, cognitive decline and dementia risk. METHODS Patients underwent MRI, cognitive testing and blood taking at baseline and annually for 3 years. Clinical and cognitive follow-up continued for 5 years. RESULTS NfL data were available for 113 subjects for baseline analysis, and 90 patients for the longitudinal analysis. Baseline NfL predicted cognitive decline (global cognition β=-0.335, SE=0.094, p=0.001) and risk of converting to dementia (HR=1.676 (95% CI 1.183 to 2.373), p=0.004). In contrast to imaging, there was no change in NfL values over the follow-up period. CONCLUSIONS Baseline NfL predicts changes in MRI markers, cognitive decline and dementia rate over a 5 years follow-up period in SVD, suggesting NfL may be a useful prognostic marker. However, change in NfL values was not detected, and therefore NfL may not be a useful surrogate marker in clinical trials in SVD.
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Affiliation(s)
- Marco Egle
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Laurence Loubiere
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Aleksandra Maceski
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Nils Peters
- Stroke Center, Klinik Hirslanden, Zürich, Switzerland
- Stroke Center and Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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12
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Schaeffer MJ, Chan L, Barber PA. The neuroimaging of neurodegenerative and vascular disease in the secondary prevention of cognitive decline. Neural Regen Res 2021; 16:1490-1499. [PMID: 33433462 PMCID: PMC8323688 DOI: 10.4103/1673-5374.303011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Structural brain changes indicative of dementia occur up to 20 years before the onset of clinical symptoms. Efforts to modify the disease process after the onset of cognitive symptoms have been unsuccessful in recent years. Thus, future trials must begin during the preclinical phases of the disease before symptom onset. Age related cognitive decline is often the result of two coexisting brain pathologies: Alzheimer’s disease (amyloid, tau, and neurodegeneration) and vascular disease. This review article highlights some of the common neuroimaging techniques used to visualize the accumulation of neurodegenerative and vascular pathologies during the preclinical stages of dementia such as structural magnetic resonance imaging, positron emission tomography, and white matter hyperintensities. We also describe some emerging neuroimaging techniques such as arterial spin labeling, diffusion tensor imaging, and quantitative susceptibility mapping. Recent literature suggests that structural imaging may be the most sensitive and cost-effective marker to detect cognitive decline, while molecular positron emission tomography is primarily useful for detecting disease specific pathology later in the disease process. Currently, the presence of vascular disease on magnetic resonance imaging provides a potential target for optimizing vascular risk reduction strategies, and the presence of vascular disease may be useful when combined with molecular and metabolic markers of neurodegeneration for identifying the risk of cognitive impairment.
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Affiliation(s)
- Morgan J Schaeffer
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Leona Chan
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Philip A Barber
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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13
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Tay J, Morris RG, Tuladhar AM, Husain M, de Leeuw FE, Markus HS. Apathy, but not depression, predicts all-cause dementia in cerebral small vessel disease. J Neurol Neurosurg Psychiatry 2020; 91:953-959. [PMID: 32651249 PMCID: PMC7476304 DOI: 10.1136/jnnp-2020-323092] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether apathy or depression predicts all-cause dementia in small vessel disease (SVD) patients. METHODS Analyses used two prospective cohort studies of SVD: St. George's Cognition and Neuroimaging in Stroke (SCANS; n=121) and Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC; n=352). Multivariate Cox regressions were used to predict dementia using baseline apathy and depression scores in both datasets. Change in apathy and depression was used to predict dementia in a subset of 104 participants with longitudinal data from SCANS. All models were controlled for age, education and cognitive function. RESULTS Baseline apathy scores predicted dementia in SCANS (HR 1.49, 95% CI 1.05 to 2.11, p=0.024) and RUN DMC (HR 1.05, 95% CI 1.01 to 1.09, p=0.007). Increasing apathy was associated with dementia in SCANS (HR 1.53, 95% CI 1.08 to 2.17, p=0.017). In contrast, baseline depression and change in depression did not predict dementia in either dataset. Including apathy in predictive models of dementia improved model fit. CONCLUSIONS Apathy, but not depression, may be a prodromal symptom of dementia in SVD, and may be useful in identifying at-risk individuals.
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Affiliation(s)
- Jonathan Tay
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Robin G Morris
- Department of Psychology, Kings College London, London, UK
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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14
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Hunt JFV, Buckingham W, Kim AJ, Oh J, Vogt NM, Jonaitis EM, Hunt TK, Zuelsdorff M, Powell R, Norton D, Rissman RA, Asthana S, Okonkwo OC, Johnson SC, Kind AJH, Bendlin BB. Association of Neighborhood-Level Disadvantage With Cerebral and Hippocampal Volume. JAMA Neurol 2020; 77:451-460. [PMID: 31904767 DOI: 10.1001/jamaneurol.2019.4501] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Identifying risk factors for brain atrophy during the aging process can help direct new preventive approaches for dementia and cognitive decline. The association of neighborhood socioeconomic disadvantage with brain volume in this context is not well known. Objective To test whether neighborhood-level socioeconomic disadvantage is associated with decreased brain volume in a cognitively unimpaired population enriched for Alzheimer disease risk. Design, Setting, and Participants This study, conducted from January 6, 2010, to January 17, 2019, at an academic research neuroimaging center, used cross-sectional data on 951 participants from 2 large, ongoing cohort studies of Alzheimer disease (Wisconsin Registry for Alzheimer's Prevention and Wisconsin Alzheimer's Disease Research Center clinical cohort). Participants were cognitively unimpaired based on National Institute on Aging-Alzheimer's Association workgroup diagnostic criteria for mild cognitive impairment and Alzheimer disease, confirmed through a consensus diagnosis panel. The cohort was enriched for Alzheimer disease risk based on family history of dementia. Statistical analysis was performed from April 3 to September 27, 2019. Main Outcomes and Measures The Area Deprivation Index, a geospatially determined index of neighborhood-level disadvantage, and cardiovascular disease risk indices were calculated for each participant. Linear regression models were fitted to test associations between relative neighborhood-level disadvantage (highest 20% based on state of residence) and hippocampal and total brain tissue volume, as assessed by magnetic resonance imaging. Results In the primary analysis of 951 participants (637 women [67.0%]; mean [SD] age, 63.9 [8.1] years), living in the 20% most disadvantaged neighborhoods was associated with 4.1% lower hippocampal volume (β = -317.44; 95% CI, -543.32 to -91.56; P = .006) and 2.0% lower total brain tissue volume (β = -20 959.67; 95% CI, -37 611.92 to -4307.43; P = .01), after controlling for intracranial volume, individual-level educational attainment, age, and sex. Robust propensity score-matched analyses determined that this association was not due to racial/ethnic or demographic characteristics. Cardiovascular risk score, examined in a subsample of 893 participants, mediated this association for total brain tissue but not for hippocampal volume. Conclusions and Relevance For cognitively unimpaired individuals, living in the most disadvantaged neighborhoods was associated with significantly lower cerebral volumes, after controlling for maximal premorbid (total intracranial) volume. This finding suggests an association of community socioeconomic context, distinct from individual-level socioeconomic status, with brain volume during aging. Cardiovascular risk mediated this association for total brain tissue volume but not for hippocampal volume, suggesting that neighborhood-level disadvantage may be associated with these 2 outcomes via distinct biological pathways.
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Affiliation(s)
- Jack F V Hunt
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - William Buckingham
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - Alice J Kim
- Department of Psychology, University of Southern California, Los Angeles
| | - Jennifer Oh
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Nicholas M Vogt
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Erin M Jonaitis
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison
| | - Tenah K Hunt
- Wisconsin Center for Education Research, University of Wisconsin-Madison
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ryan Powell
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - Derek Norton
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison.,Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Robert A Rissman
- Department of Neurosciences, University of California, San Diego
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatric Research Education and Clinical Center, William S. Middleton Hospital Department of Veterans Affairs, Madison, Wisconsin
| | - Ozioma C Okonkwo
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatric Research Education and Clinical Center, William S. Middleton Hospital Department of Veterans Affairs, Madison, Wisconsin
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatric Research Education and Clinical Center, William S. Middleton Hospital Department of Veterans Affairs, Madison, Wisconsin
| | - Amy J H Kind
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison.,Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatric Research Education and Clinical Center, William S. Middleton Hospital Department of Veterans Affairs, Madison, Wisconsin
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison.,Geriatric Research Education and Clinical Center, William S. Middleton Hospital Department of Veterans Affairs, Madison, Wisconsin
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15
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Kandasamy M, Anusuyadevi M, Aigner KM, Unger MS, Kniewallner KM, de Sousa DMB, Altendorfer B, Mrowetz H, Bogdahn U, Aigner L. TGF-β Signaling: A Therapeutic Target to Reinstate Regenerative Plasticity in Vascular Dementia? Aging Dis 2020; 11:828-850. [PMID: 32765949 PMCID: PMC7390515 DOI: 10.14336/ad.2020.0222] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/22/2020] [Indexed: 12/11/2022] Open
Abstract
Vascular dementia (VaD) is the second leading form of memory loss after Alzheimer's disease (AD). Currently, there is no cure available. The etiology, pathophysiology and clinical manifestations of VaD are extremely heterogeneous, but the impaired cerebral blood flow (CBF) represents a common denominator of VaD. The latter might be the result of atherosclerosis, amyloid angiopathy, microbleeding and micro-strokes, together causing blood-brain barrier (BBB) dysfunction and vessel leakage, collectively originating from the consequence of hypertension, one of the main risk factors for VaD. At the histopathological level, VaD displays abnormal vascular remodeling, endothelial cell death, string vessel formation, pericyte responses, fibrosis, astrogliosis, sclerosis, microglia activation, neuroinflammation, demyelination, white matter lesions, deprivation of synapses and neuronal loss. The transforming growth factor (TGF) β has been identified as one of the key molecular factors involved in the aforementioned various pathological aspects. Thus, targeting TGF-β signaling in the brain might be a promising therapeutic strategy to mitigate vascular pathology and improve cognitive functions in patients with VaD. This review revisits the recent understanding of the role of TGF-β in VaD and associated pathological hallmarks. It further explores the potential to modulate certain aspects of VaD pathology by targeting TGF-β signaling.
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Affiliation(s)
- Mahesh Kandasamy
- Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India.
- Faculty Recharge Programme, University Grants Commission (UGC-FRP), New Delhi, India.
| | - Muthuswamy Anusuyadevi
- Molecular Gerontology Group, Department of Biochemistry, School of Life Sciences, Bharathidhasan University, Tiruchirappalli, Tamil Nadu, India.
| | - Kiera M Aigner
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Michael S Unger
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Kathrin M Kniewallner
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Diana M Bessa de Sousa
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Heike Mrowetz
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Ulrich Bogdahn
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
- Velvio GmbH, Regensburg, Germany.
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
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16
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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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17
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Williams OA, Zeestraten EA, Benjamin P, Lambert C, Lawrence AJ, Mackinnon AD, Morris RG, Markus HS, Barrick TR, Charlton RA. Predicting Dementia in Cerebral Small Vessel Disease Using an Automatic Diffusion Tensor Image Segmentation Technique. Stroke 2019; 50:2775-2782. [PMID: 31510902 PMCID: PMC6756294 DOI: 10.1161/strokeaha.119.025843] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Supplemental Digital Content is available in the text. Cerebral small vessel disease (SVD) is the most common cause of vascular cognitive impairment, with a significant proportion of cases going on to develop dementia. We explore the extent to which diffusion tensor image segmentation technique (DSEG; which characterizes microstructural damage across the cerebrum) predicts both degree of cognitive decline and conversion to dementia, and hence may provide a useful prognostic procedure.
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Affiliation(s)
- Owen A Williams
- From the Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (O.A.W., E.A.Z., C.L., T.R.B.)
| | - Eva A Zeestraten
- From the Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (O.A.W., E.A.Z., C.L., T.R.B.)
| | - Philip Benjamin
- Department of Radiology, Charing Cross Hospital campus, Imperial College NHS Trust, United Kingdom (P.B.)
| | - Christian Lambert
- From the Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (O.A.W., E.A.Z., C.L., T.R.B.).,Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom (C.L.)
| | - Andrew J Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (A.J.L., H.S.M.)
| | - Andrew D Mackinnon
- Atkinson Morley Regional Neuroscience Centre, St George's NHS Healthcare Trust, London, United Kingdom (A.G.M.)
| | - Robin G Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom (R.G.M.)
| | - Hugh S Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (A.J.L., H.S.M.)
| | - Thomas R Barrick
- From the Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (O.A.W., E.A.Z., C.L., T.R.B.)
| | - Rebecca A Charlton
- Department of Psychology, Goldsmiths University of London, United Kingdom (R.A.C.)
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18
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Naomaitai Ameliorated Brain Damage in Rats with Vascular Dementia by PI3K/PDK1/AKT Signaling Pathway. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2702068. [PMID: 30867669 PMCID: PMC6379870 DOI: 10.1155/2019/2702068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/21/2018] [Accepted: 12/13/2018] [Indexed: 12/30/2022]
Abstract
Background/Aims Naomaitai can improve blood perfusion and ameliorate the damage in the paraventricular white matter. This study was focused on observing the neuroprotective effect of Naomaitai on the vascular dementia of rat and exploring the action mechanism of PI3K/PDK1/AKT signaling pathway. Methods A vascular dementia model of rats was established by permanent, bilateral common carotid artery occlusion. Rats' behavior was tested by Neurological deficit score and the Morris water maze. The pathology and apoptosis were detected through HE staining and TUNEL assay. Myelin sheath loss and nerve fiber damage were detected by LFB staining. Inflammatory factors, oxidative stress, and brain damage markers were detected through ELISA. The expression of apoptosis-related proteins and PI3K/PDK1/AKT signaling pathway related proteins were measured by western blot. The expressions of PI3K, PDK1, AKT, and MBP in paraventricular white matter cells were detected by immunofluorescence. Results Naomaitai treatment decreased neurological function score in rats with vascular dementia, ameliorated paraventricular white matter damage caused by long-term hypoxia, and hypoperfusion reduced the brain injury markers S-100β and NSE contents, suppressed inflammatory reaction and oxidative stress, reduced IL-1β, IL-6, TNF-α, and MDA contents, and remarkably increased IL-10 and SOD contents. TUNEL and western blot assay showed that Naomaitai treatment decreased neuronal cell apoptosis, increased Bcl-2 expression, and reduced caspase-3 and Bax expression. Furthermore, we found Naomaitai inhibited PI3K and PDK1 expression and activated phosphorylated AKT protein in rats with vascular dementia. However, the protective effect of Naomatai in rats with vascular dementia was inhibited, and expression of PI3K signaling pathway-related proteins was blocked after administration of PI3K inhibitor. Conclusion Naomaitai can ameliorate brain damage in rats with vascular dementia, inhibit neuronal apoptosis, and have anti-inflammatory and antioxidative stress effects, which may be regulated by the PI3K/PDK1/AKT signaling pathway.
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