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Di Natale D, Rossi S, Dalla Zanna G, Funcis A, Nicoletti TF, Sicignano LL, Verrecchia E, Romano A, Vita MG, Caraglia N, Graziani F, Re F, Guerrera G, Battistini L, Silvestri G. Prevalence and Clinical Correlates of Cerebrovascular Alterations in Fabry Disease: A Cross-Sectional Study. Brain Sci 2025; 15:166. [PMID: 40002499 PMCID: PMC11852458 DOI: 10.3390/brainsci15020166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 02/02/2025] [Accepted: 02/05/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Fabry disease (FD) is an inborn error of the glycosphingolipid metabolism with variable kidney, heart, and central nervous system (CNS) involvement. CNS-related FD manifestations include early ischemic stroke and white matter lesions (WMLs) related to cerebral small-vessel disease (CSVD), possibly resulting in cognitive impairment. We studied 40 adult FD patients (17 male) to assess: (i) prevalence of cerebrovascular and cognitive manifestations in FD and their correlation with heart and renal involvement; and (ii) the potential value of serum neurofilament light chain (NfL) levels as an indicator of WMLs in FD. Methods: Patients underwent detailed diagnostic assessment related to FD, also including Mainz Severity Score Index (MSSI), neuropsychological tests, brain MRI to assess WMLs by the modified Fazekas score (mFS), and NfL determination by single-molecule array (SiMoA) (n = 22 FD patients vs. 15 healthy controls). Results: Overall, 4 FD patients had a history of ischemic stroke and 13/32 patients (40.6%) had an mFS ≥ 1. Almost two-thirds of FD patients (27/39, 69.2%) showed impairment on at least one cognitive test. On univariate analysis, only a reduction in estimated glomerular filtration rate was associated with an increased likelihood of having WMLs on brain MRI. Serum NfL levels were higher in FD patients vs. controls, with a trend toward significance (p = 0.08). Conclusions: Mild-to-moderate CSVD is a characteristic brain "signature" in FD patients. Both cardiac and renal involvement correlate with WML load, but only renal involvement appears to be predictive of CNS damage. Brain microvascular damage is associated with mild cognitive impairment in FD, and serum NfL might represent a potential biomarker of CSVD in FD.
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Affiliation(s)
- Daniele Di Natale
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.D.N.); (S.R.); (G.D.Z.); (A.F.); (T.F.N.)
| | - Salvatore Rossi
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.D.N.); (S.R.); (G.D.Z.); (A.F.); (T.F.N.)
| | - Gianmarco Dalla Zanna
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.D.N.); (S.R.); (G.D.Z.); (A.F.); (T.F.N.)
| | - Antonio Funcis
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.D.N.); (S.R.); (G.D.Z.); (A.F.); (T.F.N.)
| | - Tommaso Filippo Nicoletti
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.D.N.); (S.R.); (G.D.Z.); (A.F.); (T.F.N.)
| | - Ludovico Luca Sicignano
- Department of Aging, Orthopaedic and Rheumatological Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.L.S.); (E.V.)
| | - Elena Verrecchia
- Department of Aging, Orthopaedic and Rheumatological Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.L.S.); (E.V.)
| | - Angela Romano
- UOC Neurologia Dipartimento Neuroscienze, Organi Di Senso E Torace, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (M.G.V.); (N.C.)
| | - Maria Gabriella Vita
- UOC Neurologia Dipartimento Neuroscienze, Organi Di Senso E Torace, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (M.G.V.); (N.C.)
| | - Naike Caraglia
- UOC Neurologia Dipartimento Neuroscienze, Organi Di Senso E Torace, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (M.G.V.); (N.C.)
| | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Federica Re
- Cardiomyopathies Unit, Cardiology Division, St. Camillo Hospital, 00152 Rome, Italy;
| | - Gisella Guerrera
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, 00179 Rome, Italy; (G.G.); (L.B.)
| | - Luca Battistini
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, 00179 Rome, Italy; (G.G.); (L.B.)
| | - Gabriella Silvestri
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.D.N.); (S.R.); (G.D.Z.); (A.F.); (T.F.N.)
- UOC Neurologia Dipartimento Neuroscienze, Organi Di Senso E Torace, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (M.G.V.); (N.C.)
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2
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Huang WQ, Lin Q, Tzeng CM. Leukoaraiosis: Epidemiology, Imaging, Risk Factors, and Management of Age-Related Cerebral White Matter Hyperintensities. J Stroke 2024; 26:131-163. [PMID: 38836265 PMCID: PMC11164597 DOI: 10.5853/jos.2023.02719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
Leukoaraiosis (LA) manifests as cerebral white matter hyperintensities on T2-weighted magnetic resonance imaging scans and corresponds to white matter lesions or abnormalities in brain tissue. Clinically, it is generally detected in the early 40s and is highly prevalent globally in individuals aged >60 years. From the imaging perspective, LA can present as several heterogeneous forms, including punctate and patchy lesions in deep or subcortical white matter; lesions with periventricular caps, a pencil-thin lining, and smooth halo; as well as irregular lesions, which are not always benign. Given its potential of having deleterious effects on normal brain function and the resulting increase in public health burden, considerable effort has been focused on investigating the associations between various risk factors and LA risk, and developing its associated clinical interventions. However, study results have been inconsistent, most likely due to potential differences in study designs, neuroimaging methods, and sample sizes as well as the inherent neuroimaging heterogeneity and multi-factorial nature of LA. In this article, we provided an overview of LA and summarized the current knowledge regarding its epidemiology, neuroimaging classification, pathological characteristics, risk factors, and potential intervention strategies.
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Affiliation(s)
- Wen-Qing Huang
- Department of Central Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Lin
- Department of Neurology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Clinical Research Center for Brain Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- The Third Clinical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Chi-Meng Tzeng
- Translational Medicine Research Center, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian, China
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3
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Mena Romo L, Gómez-Choco M. Neuroimaging in small vessel disease. HIPERTENSION Y RIESGO VASCULAR 2023; 40:25-33. [PMID: 35676196 DOI: 10.1016/j.hipert.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
The objective of this article is to review the literature on neuroimaging in small vessel disease. A review was carried out through the Pubmed search engine, without a filter of years, using terms such as: cerebral small vessel disease; white matter hyperintensity; brain microbleed; WBC. Small vessel disease is the most common vascular pathology. Its basis is in the affectation of the small cerebral vessels that eventually causes an alteration in the blood-brain barrier. Its clinical implication is highly relevant. Using magnetic resonance imaging, different expressions of the disease have been observed, such as white matter hyperintensities, microbleeds or lacunar infarcts. Other more recent techniques, such as brain blood flow measurements, are helping to increase understanding of the pathophysiology of this disease.
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Affiliation(s)
- L Mena Romo
- Complex Hospitalari Despí Moisès Broggi, Servicio de Neurología, Spain.
| | - M Gómez-Choco
- Complex Hospitalari Despí Moisès Broggi, Servicio de Neurología, Spain
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4
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Al-Hashel JY, Alroughani R, Gad K, Al-Sarraf L, Ahmed SF. Risk factors of white matter hyperintensities in migraine patients. BMC Neurol 2022; 22:159. [PMID: 35488255 PMCID: PMC9052543 DOI: 10.1186/s12883-022-02680-8] [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: 01/28/2022] [Accepted: 04/18/2022] [Indexed: 10/13/2023] Open
Abstract
Background Migraine frequently is associated with White Matter Hyperintensities (WMHs). We aimed to assess the frequency of WMHs in migraine and to assess their risk factors. Methods This is cross-sectional study included 60 migraine patients of both genders, aged between 18 and 55 years. Patients with vascular risk factors were excluded. We also included a matched healthy control group with no migraine. Demographic, clinical data, and serum level of homocysteine were recorded. All subjects underwent brain MRI (3 Tesla). Results The mean age was 38.65 years and most of our cohort were female (83.3). A total of 24 migraine patients (40%) had WMHs versus (10%) in the control group, (P < 0.013). Patients with WMHs were significantly older (43.50 + 8.71 versus. 35.92+ 8.55 years, P < 0.001), have a longer disease duration (14.54+ 7.76versus 8.58+ 6.89 years, P < 0.002), higher monthly migraine attacks (9.27+ 4. 31 versus 7.78 + 2.41 P < 0.020) and high serum homocysteine level (11.05+ 5.63 versus 6.36 + 6.27, P < 0.006) compared to those without WMHs. WMHs were more frequent in chronic migraine compared to episodic migraine (75% versus 34.6%; P < 0.030) and migraine with aura compared to those without aura (38.3% versus 29,2; P < 0.001). WMHs were mostly situated in the frontal lobes (83.4%), both hemispheres (70.8%), and mainly subcortically (83.3%). Conclusion Older age, longer disease duration, frequent attacks, and high serum homocysteine level are main the risk factors for WMHs in this cohort. The severity or duration of migraine attacks did not increase the frequency of WMHs. The number of WMHs was significantly higher in chronic compared to episodic migraineurs.
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Affiliation(s)
- Jasem Yousef Al-Hashel
- Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, Safat, 13115, Kuwait City, Kuwait. .,Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait City, Kuwait.
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Khaled Gad
- Medical imaging Department, Ibn Sina Hospital, P.O. Box 25427, 13115, Safat, Kuwait.,Radiology Department, Suez Canal University, Ismailia, Egypt
| | - Lamiaa Al-Sarraf
- Medical imaging Department, Ibn Sina Hospital, P.O. Box 25427, 13115, Safat, Kuwait
| | - Samar Farouk Ahmed
- Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, Safat, 13115, Kuwait City, Kuwait.,Neuropsychiatry Department, Faculty of Medicine, Al-Minia University, P.O. Box 61519, Minia City, Minia, 61111, Egypt
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5
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Ferreira Tátá C, Massas M, Pinto F, Caçador N, Silva AL. Fabry Disease: A Atypical Presentation. Cureus 2021; 13:e18708. [PMID: 34790463 PMCID: PMC8582620 DOI: 10.7759/cureus.18708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/20/2022] Open
Abstract
Fabry Disease (FD) is a rare X-linked recessive disease caused by mutations in the GLA gene that lead to a decrease or lack of activity of the enzyme alpha galactosyl A. This lysosomal storage disorder results in progressive damage and dysfunction of several organs and, depending on the type of mutation and gender of the patient, and it may have different manifestations. As FD is a multisystem disease with a progressive character and varying severity, the diagnosis can be challenging, especially when it comes to non-classical forms. As this is a hereditary disease, its diagnosis impacts not only the patient but also his family, making an accurate and timely diagnosis even more important. We present the case of a 59-years-old man diagnosed with non-classical FD, with previous neurological and psychiatric complaints, who was admitted to the Emergency Department (ED) with a generalized tonic-clonic seizure that required orotracheal intubation for airway protection and transferred to an Intensive Care Unit (ICU).
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Affiliation(s)
| | - Margarida Massas
- Internal Medicine, Hospital do Espírito Santo de Évora, Évora, PRT
| | - Filipa Pinto
- Internal Medicine, Hospital do Espirito Santo de Évora, Évora, PRT
| | - Nuno Caçador
- Radiology • Neuroradiology, Hospital do Espirito Santo de Évora, Évora, PRT
| | - Ana Luisa Silva
- Internal Medicine, Hospital do Espirito Santo de Évora, Évora, PRT
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6
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Endres D, Matysik M, Feige B, Venhoff N, Schweizer T, Michel M, Meixensberger S, Runge K, Maier SJ, Nickel K, Bechter K, Urbach H, Domschke K, Tebartz van Elst L. Diagnosing Organic Causes of Schizophrenia Spectrum Disorders: Findings from a One-Year Cohort of the Freiburg Diagnostic Protocol in Psychosis (FDPP). Diagnostics (Basel) 2020; 10:diagnostics10090691. [PMID: 32937787 PMCID: PMC7555162 DOI: 10.3390/diagnostics10090691] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction: Secondary schizophrenia spectrum disorders (SSDs) have clearly identifiable causes. The Department for Psychiatry and Psychotherapy at the University Hospital Freiburg has continued to expand its screening practices to clarify the organic causes of SSDs. This retrospective analysis was carried out to analyze whether a comprehensive organic diagnostic procedure could be informative in patients with SSDs. Methods and Participants: The “Freiburg Diagnostic Protocol in Psychosis” (FDPP) included basic laboratory analyses (e.g., thyroid hormones), metabolic markers, pathogens, vitamin status, different serological autoantibodies, rheumatic/immunological markers (e.g., complement factors), cerebrospinal fluid (CSF) basic and antineuronal antibody analyses, as well as cranial magnetic resonance imaging (cMRI) and electroencephalography (EEG). The findings of 76 consecutive patients with SSDs (55 with paranoid–hallucinatory; 14 with schizoaffective; 4 with hebephrenic; and 1 each with catatonic, acute polymorphic psychotic, and substance-induced psychotic syndromes) were analyzed. Results: Overall, vitamin and trace element deficiency was identified in 92%. Complement factor analyses detected reduced C3 levels in 11%. Immunological laboratory alterations were detected in 76%. CSF analysis revealed general alterations in 54% of the patients, mostly with signs of blood–brain barrier dysfunction. cMRI analyses showed chronic inflammatory lesions in 4%. Combination of EEG, cMRI, and CSF revealed alterations in 76% of the patients. In three patients, autoimmune psychosis was suspected (4%). Discussion: On the basis of these findings, we conclude that a comprehensive diagnostic procedure according to the FDPP in patients with SSD is worthwhile, considering the detection of secondary, organic forms of SSDs, as well as alterations in “modulating factors” of the disease course, such as vitamin deficiency. Larger studies using comprehensive diagnostic protocols are warranted to further validate this approach.
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Affiliation(s)
- Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (D.E.); (M.M.); (B.F.); (T.S.); (S.M.); (K.R.); (S.J.M.); (K.N.)
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
| | - Miriam Matysik
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (D.E.); (M.M.); (B.F.); (T.S.); (S.M.); (K.R.); (S.J.M.); (K.N.)
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
| | - Bernd Feige
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (D.E.); (M.M.); (B.F.); (T.S.); (S.M.); (K.R.); (S.J.M.); (K.N.)
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Tina Schweizer
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (D.E.); (M.M.); (B.F.); (T.S.); (S.M.); (K.R.); (S.J.M.); (K.N.)
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
| | - Maike Michel
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
| | - Sophie Meixensberger
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (D.E.); (M.M.); (B.F.); (T.S.); (S.M.); (K.R.); (S.J.M.); (K.N.)
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
| | - Kimon Runge
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (D.E.); (M.M.); (B.F.); (T.S.); (S.M.); (K.R.); (S.J.M.); (K.N.)
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
| | - Simon J. Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (D.E.); (M.M.); (B.F.); (T.S.); (S.M.); (K.R.); (S.J.M.); (K.N.)
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
| | - Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (D.E.); (M.M.); (B.F.); (T.S.); (S.M.); (K.R.); (S.J.M.); (K.N.)
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
| | - Karl Bechter
- Department for Psychiatry and Psychotherapy II, Ulm University, Bezirkskrankenhaus Günzburg, 89312 Günzburg, Germany;
| | - Horst Urbach
- Department of Neuroradiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
- Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (D.E.); (M.M.); (B.F.); (T.S.); (S.M.); (K.R.); (S.J.M.); (K.N.)
- Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (M.M.); (K.D.)
- Correspondence:
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Ramirez J, Holmes MF, Scott CJM, Ozzoude M, Adamo S, Szilagyi GM, Goubran M, Gao F, Arnott SR, Lawrence-Dewar JM, Beaton D, Strother SC, Munoz DP, Masellis M, Swartz RH, Bartha R, Symons S, Black SE. Ontario Neurodegenerative Disease Research Initiative (ONDRI): Structural MRI Methods and Outcome Measures. Front Neurol 2020; 11:847. [PMID: 32849254 PMCID: PMC7431907 DOI: 10.3389/fneur.2020.00847] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/07/2020] [Indexed: 01/18/2023] Open
Abstract
The Ontario Neurodegenerative Research Initiative (ONDRI) is a 3 years multi-site prospective cohort study that has acquired comprehensive multiple assessment platform data, including 3T structural MRI, from neurodegenerative patients with Alzheimer's disease, mild cognitive impairment, Parkinson's disease, amyotrophic lateral sclerosis, frontotemporal dementia, and cerebrovascular disease. This heterogeneous cross-section of patients with complex neurodegenerative and neurovascular pathologies pose significant challenges for standard neuroimaging tools. To effectively quantify regional measures of normal and pathological brain tissue volumes, the ONDRI neuroimaging platform implemented a semi-automated MRI processing pipeline that was able to address many of the challenges resulting from this heterogeneity. The purpose of this paper is to serve as a reference and conceptual overview of the comprehensive neuroimaging pipeline used to generate regional brain tissue volumes and neurovascular marker data that will be made publicly available online.
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Affiliation(s)
- Joel Ramirez
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Melissa F Holmes
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Christopher J M Scott
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Miracle Ozzoude
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Sabrina Adamo
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Gregory M Szilagyi
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Maged Goubran
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Derek Beaton
- Rotman Research Institute, Baycrest, Toronto, ON, Canada
| | - Stephen C Strother
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Rotman Research Institute, Baycrest, Toronto, ON, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Centre for Functional and Metabolic Mapping, Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Sean Symons
- Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
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8
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Armstrong NJ, Mather KA, Sargurupremraj M, Knol MJ, Malik R, Satizabal CL, Yanek LR, Wen W, Gudnason VG, Dueker ND, Elliott LT, Hofer E, Bis J, Jahanshad N, Li S, Logue MA, Luciano M, Scholz M, Smith AV, Trompet S, Vojinovic D, Xia R, Alfaro-Almagro F, Ames D, Amin N, Amouyel P, Beiser AS, Brodaty H, Deary IJ, Fennema-Notestine C, Gampawar PG, Gottesman R, Griffanti L, Jack CR, Jenkinson M, Jiang J, Kral BG, Kwok JB, Lampe L, C M Liewald D, Maillard P, Marchini J, Bastin ME, Mazoyer B, Pirpamer L, Rafael Romero J, Roshchupkin GV, Schofield PR, Schroeter ML, Stott DJ, Thalamuthu A, Trollor J, Tzourio C, van der Grond J, Vernooij MW, Witte VA, Wright MJ, Yang Q, Morris Z, Siggurdsson S, Psaty B, Villringer A, Schmidt H, Haberg AK, van Duijn CM, Jukema JW, Dichgans M, Sacco RL, Wright CB, Kremen WS, Becker LC, Thompson PM, Mosley TH, Wardlaw JM, Ikram MA, Adams HHH, Seshadri S, Sachdev PS, Smith SM, Launer L, Longstreth W, DeCarli C, Schmidt R, Fornage M, Debette S, Nyquist PA. Common Genetic Variation Indicates Separate Causes for Periventricular and Deep White Matter Hyperintensities. Stroke 2020; 51:2111-2121. [PMID: 32517579 DOI: 10.1161/strokeaha.119.027544] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Periventricular white matter hyperintensities (WMH; PVWMH) and deep WMH (DWMH) are regional classifications of WMH and reflect proposed differences in cause. In the first study, to date, we undertook genome-wide association analyses of DWMH and PVWMH to show that these phenotypes have different genetic underpinnings. METHODS Participants were aged 45 years and older, free of stroke and dementia. We conducted genome-wide association analyses of PVWMH and DWMH in 26,654 participants from CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology), ENIGMA (Enhancing Neuro-Imaging Genetics Through Meta-Analysis), and the UKB (UK Biobank). Regional correlations were investigated using the genome-wide association analyses -pairwise method. Cross-trait genetic correlations between PVWMH, DWMH, stroke, and dementia were estimated using LDSC. RESULTS In the discovery and replication analysis, for PVWMH only, we found associations on chromosomes 2 (NBEAL), 10q23.1 (TSPAN14/FAM231A), and 10q24.33 (SH3PXD2A). In the much larger combined meta-analysis of all cohorts, we identified ten significant regions for PVWMH: chromosomes 2 (3 regions), 6, 7, 10 (2 regions), 13, 16, and 17q23.1. New loci of interest include 7q36.1 (NOS3) and 16q24.2. In both the discovery/replication and combined analysis, we found genome-wide significant associations for the 17q25.1 locus for both DWMH and PVWMH. Using gene-based association analysis, 19 genes across all regions were identified for PVWMH only, including the new genes: CALCRL (2q32.1), KLHL24 (3q27.1), VCAN (5q27.1), and POLR2F (22q13.1). Thirteen genes in the 17q25.1 locus were significant for both phenotypes. More extensive genetic correlations were observed for PVWMH with small vessel ischemic stroke. There were no associations with dementia for either phenotype. CONCLUSIONS Our study confirms these phenotypes have distinct and also shared genetic architectures. Genetic analyses indicated PVWMH was more associated with ischemic stroke whilst DWMH loci were implicated in vascular, astrocyte, and neuronal function. Our study confirms these phenotypes are distinct neuroimaging classifications and identifies new candidate genes associated with PVWMH only.
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Affiliation(s)
- Nicola J Armstrong
- Mathematics and Statistics, Murdoch University, Perth, Australia (N.J.A.)
| | - Karen A Mather
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia (K.A.M., P.R.S., A.T.)
| | | | - Maria J Knol
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.)
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU Munich, Germany (R.M., M.D.)
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX (C.L.S., S.S.).,The Framingham Heart Study, MA (C.L.S., A.S.B., J.R.R., S.S.).,Department of Neurology (C.L.S., A.S.B., J.R.R., S.S.), Boston University School of Medicine, MA
| | - Lisa R Yanek
- GeneSTAR Research Program (L.R.Y., B.G.K., L.C.B., P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia
| | - Vilmundur G Gudnason
- Icelandic Heart Association, Kopavogur (V.G.G., S.S.).,University of Iceland, Reykjavik, Iceland (V.G.G., A.V.S.)
| | - Nicole D Dueker
- Dr. John T. Macdonald Foundation Department of Human Genetics (R.L.S.), University of Miami, FL
| | - Lloyd T Elliott
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada (L.T.E.).,Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - Edith Hofer
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria (E.H., R.S.).,Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria (E.H.)
| | - Joshua Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (J.B., B.P., W.L.)
| | - Neda Jahanshad
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Marina del Rey (N.J., P.M.T.)
| | - Shuo Li
- Department of Biostatistics, Boston University School of Public Health, Boston, MA (S.L., M.A.L., A.S.B., Q.Y.)
| | - Mark A Logue
- Department of Psychiatry and Biomedical Genetics Section (M.A.L.), Boston University School of Medicine, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA (S.L., M.A.L., A.S.B., Q.Y.).,National Center for PTSD: Behavioral Science Division, VA Boston Healthcare System, Boston, MA (M.A.L.)
| | - Michelle Luciano
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.)
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology (M.S.)
| | - Albert V Smith
- University of Iceland, Reykjavik, Iceland (V.G.G., A.V.S.)
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics (S.T.), Leiden University Medical Center, the Netherlands.,Department of Cardiology (S.T.), Leiden University Medical Center, the Netherlands
| | - Dina Vojinovic
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.)
| | - Rui Xia
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, TX (R.X., M.F.)
| | - Fidel Alfaro-Almagro
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - David Ames
- National Ageing Research Institute, Parkville, Victoria, Australia (D.A.).,Academic Unit for Psychiatry of Old Age, University of Melbourne, St George's Hospital, Kew, Australia (D.A.)
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.)
| | - Philippe Amouyel
- Lille University, Inserm, Institut Pasteur de Lille, RID-AGE - Risk Factors and Molecular Determinants of Aging-Related Diseases and Labex Distalz, France (P.A.).,Lille University, Inserm, CHU Lille, Institut Pasteur de Lille, RID-AGE (P.A.)
| | - Alexa S Beiser
- The Framingham Heart Study, MA (C.L.S., A.S.B., J.R.R., S.S.).,Department of Neurology (C.L.S., A.S.B., J.R.R., S.S.), Boston University School of Medicine, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA (S.L., M.A.L., A.S.B., Q.Y.)
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration (H.B.), University of New South Wales, Sydney, Australia
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.)
| | - Christine Fennema-Notestine
- Department of Psychiatry (C.F.-N.), University of California, San Diego, La Jolla, CA.,Center for Behavior Genetics of Aging (C.F.-N.), University of California, San Diego, La Jolla, CA
| | - Piyush G Gampawar
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging), Medical University of Graz, Austria (P.G.G., H.S.)
| | - Rebecca Gottesman
- Department of Neurology, Cerebrovascular and stroke Division (R.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ludovica Griffanti
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN (C.R.J.J.)
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia
| | - Brian G Kral
- GeneSTAR Research Program (L.R.Y., B.G.K., L.C.B., P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - John B Kwok
- School of Medical Sciences (J.B.K., P.R.S.), University of New South Wales, Sydney, Australia.,Brain and Mind Centre - The University of Sydney, Camperdown, NSW, Australia (J.B.K.)
| | - Leonie Lampe
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (L.L., V.A.W.)
| | - David C M Liewald
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.)
| | - Pauline Maillard
- Imaging of Dementia and Aging (IDeA) Laboratory, Department of Neurology, University of California-Davis, Davis, CA (P.M.)
| | - Jonathan Marchini
- Statistical Genetics and Methods at Regeneron Pharmaceuticals, Inc, New York, NY (J.M.)
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.).,Centre for Clinical Brain Sciences, Edinburgh Imaging, Centre for Cognitive Ageing, University of Edinburgh, United Kingdom (M.E.B., J.M.W.)
| | - Bernard Mazoyer
- Institut des Maladies Neurodégénératives, University of Bordeaux, France (B.M.)
| | - Lukas Pirpamer
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria (L.P.)
| | - José Rafael Romero
- The Framingham Heart Study, MA (C.L.S., A.S.B., J.R.R., S.S.).,Department of Neurology (C.L.S., A.S.B., J.R.R., S.S.), Boston University School of Medicine, MA
| | - Gennady V Roshchupkin
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.).,Department of Radiology and Nuclear Medicine (G.V.R., M.W.V., H.H.H.A.)
| | - Peter R Schofield
- School of Medical Sciences (J.B.K., P.R.S.), University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia (K.A.M., P.R.S., A.T.)
| | - Matthias L Schroeter
- LIFE Research Center for Civilization Disease, Leipzig, Germany (M.S.).,Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (M.L.S., A.V.).,Day Clinic for Cognitive Neurology, University Hospital Leipzig, Germany (M.L.S., A.V.)
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (D.J.S.)
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia (K.A.M., P.R.S., A.T.)
| | - Julian Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), University of New South Wales, Sydney, Australia
| | - Christophe Tzourio
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, France (M.S., C.T., S.D.).,CHU de Bordeaux, Public Health Department, Medical information Department, Bordeaux, France (C.T.)
| | - Jeroen van der Grond
- Department of Radiology (J.v.d.G.), Leiden University Medical Center, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.).,Department of Radiology and Nuclear Medicine (G.V.R., M.W.V., H.H.H.A.)
| | - Veronica A Witte
- Collaborative Research Center 1052 Obesity Mechanisms, Faculty of Medicine, University of Leipzig, Germany (V.A.W).,Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (L.L., V.A.W.)
| | - Margaret J Wright
- Queensland Brain Institute (M.J.W.), The University of Queensland, St Lucia, QLD, Australia.,Centre for Advanced Imaging (M.J.W.), The University of Queensland, St Lucia, QLD, Australia
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA (S.L., M.A.L., A.S.B., Q.Y.)
| | - Zoe Morris
- Neuroradiology Department, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (Z.M.)
| | - Siggi Siggurdsson
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX (C.L.S., S.S.).,The Framingham Heart Study, MA (C.L.S., A.S.B., J.R.R., S.S.).,Department of Neurology (C.L.S., A.S.B., J.R.R., S.S.), Boston University School of Medicine, MA
| | - Bruce Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (J.B., B.P., W.L.)
| | - Arno Villringer
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (M.L.S., A.V.).,Day Clinic for Cognitive Neurology, University Hospital Leipzig, Germany (M.L.S., A.V.)
| | - Helena Schmidt
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging), Medical University of Graz, Austria (P.G.G., H.S.)
| | - Asta K Haberg
- Department of Neuromedicine and Movement Science (A.K.H.), Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine (A.K.H.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.).,Nuffield Department of Population Health (C.M.v.D.), University of Oxford, United Kingdom
| | - J Wouter Jukema
- Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden, the Netherlands (J.W.J.)
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU Munich, Germany (R.M., M.D.).,German Center for Neurodegenerative Diseases, Munich, Germany (M.D.).,Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.)
| | - Ralph L Sacco
- Department of Public Health Sciences, Miller School of Medicine (R.L.S.), University of Miami, FL.,Department of Neurology, Miller School of Medicine (R.L.S.), University of Miami, FL.,Evelyn F. McKnight Brain Institute, Department of Neurology (R.L.S.), University of Miami, FL
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke (C.B.W.), National Institutes of Health, Bethesda, MD
| | - William S Kremen
- Center for Behavior Genetics of Aging (W.S.K.), University of California, San Diego, La Jolla, CA.,Department of Psychiatry (W.S.K.), University of California, San Diego, La Jolla, CA
| | - Lewis C Becker
- GeneSTAR Research Program (L.R.Y., B.G.K., L.C.B., P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul M Thompson
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Marina del Rey (N.J., P.M.T.)
| | - Thomas H Mosley
- Department of Geriatric Medicine, Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson (T.H.M.)
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.).,Centre for Clinical Brain Sciences, Edinburgh Imaging, Centre for Cognitive Ageing, University of Edinburgh, United Kingdom (M.E.B., J.M.W.)
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.)
| | - Hieab H H Adams
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.).,Department of Radiology and Nuclear Medicine (G.V.R., M.W.V., H.H.H.A.).,Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands (H.H.H.A.)
| | | | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (P.S.S.)
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - Lenore Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program (L.L.), National Institutes of Health, Bethesda, MD
| | - William Longstreth
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (J.B., B.P., W.L.)
| | - Charles DeCarli
- Alzheimer's Disease Center and Imaging of Dementia and Aging (IDeA) Laboratory, Department of Neurology and Center for Neuroscience University of California at Davis (C.D.)
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria (E.H., R.S.)
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, TX (R.X., M.F.).,Human Genetics Center, School of Public Health UT, Houston, TX (M.F.)
| | - Stephanie Debette
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, France (M.S., C.T., S.D.).,Department of Neurology, CHU de Bordeaux (University Hospital), Bordeaux, France (S.D.)
| | - Paul A Nyquist
- GeneSTAR Research Program (L.R.Y., B.G.K., L.C.B., P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD.,Departments of Neurology, Critical Care Medicine, Neurosurgery (P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD.,Critical Care Medicine Department (P.A.N.), National Institutes of Health, Bethesda, MD
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Prevalence of White Matter Hyperintensity in Young Clinical Patients. AJR Am J Roentgenol 2019; 213:667-671. [PMID: 31063420 DOI: 10.2214/ajr.18.20888] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Shaaban CE, Jorgensen DR, Gianaros PJ, Mettenburg J, Rosano C. Cerebrovascular disease: Neuroimaging of cerebral small vessel disease. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:225-255. [DOI: 10.1016/bs.pmbts.2019.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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11
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Bendorius M, Po C, Muller S, Jeltsch-David H. From Systemic Inflammation to Neuroinflammation: The Case of Neurolupus. Int J Mol Sci 2018; 19:E3588. [PMID: 30428632 PMCID: PMC6274746 DOI: 10.3390/ijms19113588] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 12/17/2022] Open
Abstract
It took decades to arrive at the general consensus dismissing the notion that the immune system is independent of the central nervous system. In the case of uncontrolled systemic inflammation, the relationship between the two systems is thrown off balance and results in cognitive and emotional impairment. It is specifically true for autoimmune pathologies where the central nervous system is affected as a result of systemic inflammation. Along with boosting circulating cytokine levels, systemic inflammation can lead to aberrant brain-resident immune cell activation, leakage of the blood⁻brain barrier, and the production of circulating antibodies that cross-react with brain antigens. One of the most disabling autoimmune pathologies known to have an effect on the central nervous system secondary to the systemic disease is systemic lupus erythematosus. Its neuropsychiatric expression has been extensively studied in lupus-like disease murine models that develop an autoimmunity-associated behavioral syndrome. These models are very useful for studying how the peripheral immune system and systemic inflammation can influence brain functions. In this review, we summarize the experimental data reported on murine models developing autoimmune diseases and systemic inflammation, and we explore the underlying mechanisms explaining how systemic inflammation can result in behavioral deficits, with a special focus on in vivo neuroimaging techniques.
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Affiliation(s)
- Mykolas Bendorius
- UMR 7242 Biotechnologie et Signalisation Cellulaire, École Supérieure de Biotechnologie de Strasbourg (ESBS), Laboratoire d'Excellence Médalis, Université de Strasbourg/CNRS, 67412 Illkirch, France.
| | - Chrystelle Po
- ICube UMR 7357, Université de Strasbourg/CNRS, Fédération de Médecine Translationnelle de Strasbourg, 67000 Strasbourg, France.
| | - Sylviane Muller
- UMR 7242 Biotechnologie et Signalisation Cellulaire, École Supérieure de Biotechnologie de Strasbourg (ESBS), Laboratoire d'Excellence Médalis, Université de Strasbourg/CNRS, 67412 Illkirch, France.
- University of Strasbourg Institute for Advanced Study (USIAS), 67000 Strasbourg, France.
| | - Hélène Jeltsch-David
- UMR 7242 Biotechnologie et Signalisation Cellulaire, École Supérieure de Biotechnologie de Strasbourg (ESBS), Laboratoire d'Excellence Médalis, Université de Strasbourg/CNRS, 67412 Illkirch, France.
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12
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Körver S, Vergouwe M, Hollak CEM, van Schaik IN, Langeveld M. Development and clinical consequences of white matter lesions in Fabry disease: a systematic review. Mol Genet Metab 2018; 125:205-216. [PMID: 30213639 DOI: 10.1016/j.ymgme.2018.08.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Fabry disease (FD) is a rare lysosomal storage disorder that might result in, amongst other complications, early stroke and white matter lesions (WMLs). More insight in WMLs in FD could clarify the role of WMLs in the disease presentation and prognosis in FD. In this systematic review we assessed the prevalence, severity, location and course of WMLs in FD. We also systematically reviewed the evidence on the relation between WMLs, disease characteristics and clinical parameters. METHODS We searched Pubmed, EMBASE and CINAHL (inception to Feb 2018) and identified articles reporting on FD and WMLs assessed with MRI. Prevalence and severity were assessed for all patients combined and divided by sex. RESULTS Out of 904 studies a total of 46 studies were included in the analyses. WMLs were present in 46% of patients with FD (581 out of 1276 patients, corrected mean age: 38.8 years, range 11.8-79.3) and increased with age. A total of 16.4% of patients (31 out of 189 patients, corrected mean age: 41.1 years, range 35.8-43.3 years) showed substantial confluent WMLs. Men and women showed comparable prevalence and severity of WMLs. However, men were significantly younger at time of WML assessment. Patients with classical FD had a higher chance on WMLs compared to non-classical patients. Progression of WMLs was seen in 24.6% of patients (49 out of 199 patients) during 38.1 months follow-up. Progression was seen in both men and women, with and without enzyme replacement therapy, but at an earlier age in men. Stroke seemed to be related to WMLs, but cerebrovascular risk factors, cardiac and renal (dys)function did not. Pathology in the brain in FD seemed to extend beyond the WMLs into the normal appearing white matter. CONCLUSIONS A significant group of FD patients has substantial WMLs and male patients develop WMLs earlier compared to female patients. WMLs could be used in clinical trials to evaluate possible treatment effects on the brain. Future studies should focus on longitudinal follow-up using modern imaging techniques, focusing on the clinical consequences of WMLs. In addition, ischemic and non-ischemic pathways resulting in WML development should be studied.
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Affiliation(s)
- Simon Körver
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Magda Vergouwe
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - Carla E M Hollak
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Ivo N van Schaik
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Mirjam Langeveld
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, Amsterdam, the Netherlands.
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Huang CC, Yang AC, Chou KH, Liu ME, Fang SC, Chen CC, Tsai SJ, Lin CP. Nonlinear pattern of the emergence of white matter hyperintensity in healthy Han Chinese: an adult lifespan study. Neurobiol Aging 2018; 67:99-107. [DOI: 10.1016/j.neurobiolaging.2018.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/25/2018] [Accepted: 03/10/2018] [Indexed: 12/24/2022]
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Brugulat-Serrat A, Rojas S, Bargalló N, Conesa G, Minguillón C, Fauria K, Gramunt N, Molinuevo JL, Gispert JD. Incidental findings on brain MRI of cognitively normal first-degree descendants of patients with Alzheimer's disease: a cross-sectional analysis from the ALFA (Alzheimer and Families) project. BMJ Open 2017; 7:e013215. [PMID: 28341686 PMCID: PMC5372150 DOI: 10.1136/bmjopen-2016-013215] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To describe the prevalence of brain MRI incidental findings (IF) in a cohort of cognitively normal first-degree descendants of patients with Alzheimer's disease (AD). DESIGN Cross-sectional observational study. SETTING All scans were obtained with a 3.0 T scanner. Scans were evaluated by a single neuroradiologist and IF recorded and categorised. The presence of white matter hyperintensities (WMH) was determined with the Fazekas scale and reported as relevant if ≥2. PARTICIPANTS 575 participants (45-75 years) underwent high-resolution structural brain MRI. Participants were cognitively normal and scored over the respective cut-off values in all the following neuropsychological tests: Mini-Mental State Examination (≥26), Memory Impairment Screen (≥6), Time Orientation Subtest of the Barcelona Test II (≥68), verbal semantic fluency (naming animals ≥12). Clinical Dementia Rating (CDR) had to be 0. RESULTS 155 participants (27.0%) presented with at least one IF. Relevant WMH were present in 7.8% of the participants, and vascular abnormalities, cyst and brain volume loss in 10.7%, 3.1% and 6.9% of the study volunteers, respectively. Neoplastic brain findings were found in 2.4% of participants and within these, meningiomas were the most common (1.7%) and more frequently found in women. A positive correlation between increasing age and the presence of IF was found. Additionally, brain atrophy greater than that expected by age was significantly more prevalent in participants without a parental history of AD. CONCLUSIONS Brain MRIs of healthy middle-aged participants show a relatively high prevalence of IF even when study participants have been screened for subtle cognitive alterations. Most of our participants are first-degree descendants of patients with AD, and therefore these results are of special relevance for novel imaging studies in the context of AD prevention in cognitively healthy middle-aged participants. TRIAL REGISTRATION NUMBER NCT02198586.
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Affiliation(s)
- Anna Brugulat-Serrat
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Santiago Rojas
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
- Unit of Human Anatomy and Embryology, Faculty of Medicine, Department of Morphological Sciences, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Nuria Bargalló
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre Mèdic Diagnòstic Alomar, Barcelona, Spain
| | - Gerardo Conesa
- Servicio de Neurocirugía, Hospital del Mar, Barcelona, Spain
| | - Carolina Minguillón
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Karine Fauria
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Nina Gramunt
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
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Sachdev PS, Thalamuthu A, Mather KA, Ames D, Wright MJ, Wen W. White Matter Hyperintensities Are Under Strong Genetic Influence. Stroke 2016; 47:1422-8. [PMID: 27165950 DOI: 10.1161/strokeaha.116.012532] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE The genetic basis of white matter hyperintensities (WMH) is still unknown. This study examines the heritability of WMH in both sexes and in different brain regions, and the influence of age. METHODS Participants from the Older Australian Twins Study were recruited (n=320; 92 monozygotic and 68 dizygotic pairs) who volunteered for magnetic resonance imaging scans and medical assessments. Heritability, that is, the ratio of the additive genetic variance to the total phenotypic variance, was estimated using the twin design. RESULTS Heritability was high for total WMH volume (0.76), and for periventricular WMH (0.64) and deep WMH (0.77), and varied from 0.18 for the cerebellum to 0.76 for the occipital lobe. The genetic correlation between deep and periventricular WMH regions was 0.85, with one additive genetics factor accounting for most of the shared variance. Heritability was consistently higher in women in the cerebral regions. Heritability in deep but not periventricular WMH declined with age, in particular after the age of 75. CONCLUSIONS WMH have a strong genetic influence but this is not uniform through the brain, being higher for deep than periventricular WMH and in the cerebral regions. The genetic influence is higher in women, and there is an age-related decline, most markedly for deep WMH. The data suggest some heterogeneity in the pathogenesis of WMH for different brain regions and for men and women.
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Affiliation(s)
- Perminder S Sachdev
- From the Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia (P.S.S., A.T., K.A.M., W.W.); Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia (P.S.S., W.W.); National Ageing Research Institute, University of Melbourne, Parkville, Victoria, Australia (D.A.); NeuroImaging Genetics Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia (M.J.W.); and Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia (M.J.W.).New South WalesNew South WalesNew South WalesNew South WalesNew South WalesNew South WalesQueenslandQueenslandVictoria
| | - Anbupalam Thalamuthu
- From the Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia (P.S.S., A.T., K.A.M., W.W.); Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia (P.S.S., W.W.); National Ageing Research Institute, University of Melbourne, Parkville, Victoria, Australia (D.A.); NeuroImaging Genetics Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia (M.J.W.); and Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia (M.J.W.).New South WalesNew South WalesNew South WalesNew South WalesNew South WalesNew South WalesQueenslandQueenslandVictoria
| | - Karen A Mather
- From the Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia (P.S.S., A.T., K.A.M., W.W.); Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia (P.S.S., W.W.); National Ageing Research Institute, University of Melbourne, Parkville, Victoria, Australia (D.A.); NeuroImaging Genetics Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia (M.J.W.); and Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia (M.J.W.).New South WalesNew South WalesNew South WalesNew South WalesNew South WalesNew South WalesQueenslandQueenslandVictoria
| | - David Ames
- From the Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia (P.S.S., A.T., K.A.M., W.W.); Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia (P.S.S., W.W.); National Ageing Research Institute, University of Melbourne, Parkville, Victoria, Australia (D.A.); NeuroImaging Genetics Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia (M.J.W.); and Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia (M.J.W.).New South WalesNew South WalesNew South WalesNew South WalesNew South WalesNew South WalesQueenslandQueenslandVictoria
| | - Margaret J Wright
- From the Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia (P.S.S., A.T., K.A.M., W.W.); Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia (P.S.S., W.W.); National Ageing Research Institute, University of Melbourne, Parkville, Victoria, Australia (D.A.); NeuroImaging Genetics Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia (M.J.W.); and Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia (M.J.W.).New South WalesNew South WalesNew South WalesNew South WalesNew South WalesNew South WalesQueenslandQueenslandVictoria
| | - Wei Wen
- From the Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia (P.S.S., A.T., K.A.M., W.W.); Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia (P.S.S., W.W.); National Ageing Research Institute, University of Melbourne, Parkville, Victoria, Australia (D.A.); NeuroImaging Genetics Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia (M.J.W.); and Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia (M.J.W.).New South WalesNew South WalesNew South WalesNew South WalesNew South WalesNew South WalesQueenslandQueenslandVictoria
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Pamfil C, Fanouriakis A, Damian L, Rinzis M, Sidiropoulos P, Tsivgoulis G, Rednic S, Bertsias G, Boumpas DT. EULAR recommendations for neuropsychiatric systemic lupus erythematosusvsusual care: results from two European centres. Rheumatology (Oxford) 2015; 54:1270-8. [DOI: 10.1093/rheumatology/keu482] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Indexed: 12/22/2022] Open
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Age differences in periventricular and deep white matter lesions. Neurobiol Aging 2015; 36:1653-1658. [PMID: 25659858 DOI: 10.1016/j.neurobiolaging.2015.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 12/04/2014] [Accepted: 01/03/2015] [Indexed: 11/23/2022]
Abstract
Deep white matter hyperintensity (DWMH) and periventricular (PV) white matter lesion volumes are associated with age and subsequent stroke. We studied age differences in these volumes accounting for collinearity and risk factors. Subjects were 563 healthy family members of early-onset coronary artery disease patients. Using 3T magnetic resonance imaging, lesions were classified as DWMH or PV. Age association with lesion classification was analyzed using random effects Tobit regression, adjusting for intracranial volume (ICV) and risk factors. Subjects were 60% women, 36% African-American, mean age 51 ± 11 years. In multivariable analysis adjusted for PV and ICV, DWMH was associated with age (p < 0.001) and female sex (p = 0.003). PV, adjusted for DWMH and ICV, was age associated (p < 0.001). For each age decade, DWMH showed 0.07 log units/decade greater volume (95% CI = 0.04-0.11); PV was 0.18 log units/decade greater (95% CI = 0.14-0.23); slope differences (p < 0.001). In people with a family history of coronary artery disease, PV and DWMH are independently and differentially associated with age controlling for traditional risk factors.
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Glodzik L, Rusinek H, Li J, Zhou C, Tsui W, Mosconi L, Li Y, Osorio R, Williams S, Randall C, Spector N, McHugh P, Murray J, Pirraglia E, Vallabhajolusa S, de Leon M. Reduced retention of Pittsburgh compound B in white matter lesions. Eur J Nucl Med Mol Imaging 2014; 42:97-102. [PMID: 25331458 DOI: 10.1007/s00259-014-2897-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/13/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE One of the interesting features of the amyloid tracer Pittsburgh compound B (PiB) is that it generates a signal in the white matter (WM) in both healthy subjects and cognitively impaired individuals. This characteristic gave rise to the possibility that PiB could be used to trace WM pathology. In a group of cognitively healthy elderly we examined PiB retention in normal-appearing WM (NAWM) and WM lesions (WML), one of the most common brain pathologies in aging. METHODS We segmented WML and NAWM on fluid attenuation inversion recovery (FLAIR) images of 73 subjects (age 61.9 ± 10.0, 71 % women). PiB PET images were corrected for partial volume effects and coregistered to FLAIR images and WM masks. WML and NAWM PiB signals were then extracted. RESULTS PiB retention in WML was lower than in NAWM (p < 0.001, 14.6 % reduction). This was true both for periventricular WML (p < 0.001, 17.8 % reduction) and deep WML (p = 0.001, 7.5 % reduction). CONCLUSION PiB binding in WM is influenced by the presence of WML, which lower the signal. Our findings add to the growing evidence that PiB can depict WM pathology and should prompt further investigations into PiB binding targets in WM.
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Affiliation(s)
- Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, 145 East 32nd Street, New York, NY, 10016, USA,
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Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus: pathogenesis and biomarkers. Nat Rev Neurol 2014; 10:579-96. [DOI: 10.1038/nrneurol.2014.148] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus and cognitive dysfunction: the MRL-lpr mouse strain as a model. Autoimmun Rev 2014; 13:963-73. [PMID: 25183233 DOI: 10.1016/j.autrev.2014.08.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/10/2014] [Indexed: 12/19/2022]
Abstract
Mouse models of autoimmunity, such as (NZB×NZW)F1, MRL/MpJ-Fas(lpr) (MRL-lpr) and BXSB mice, spontaneously develop systemic lupus erythematosus (SLE)-like syndromes with heterogeneity and complexity that characterize human SLE. Despite their inherent limitations, such models have highly contributed to our current understanding of the pathogenesis of SLE as they provide powerful tools to approach the human disease at the genetic, cellular, molecular and environmental levels. They also allow novel treatment strategies to be evaluated in a complex integrated system, a favorable context knowing that very few murine models that adequately mimic human autoimmune diseases exist. As we move forward with more efficient medications to treat lupus patients, certain forms of the disease that requires to be better understood at the mechanistic level emerge. This is the case of neuropsychiatric (NP) events that affect 50-60% at SLE onset or within the first year after SLE diagnosis. Intense research performed at deciphering NP features in lupus mouse models has been undertaken. It is central to develop the first lead molecules aimed at specifically treating NPSLE. Here we discuss how mouse models, and most particularly MRL-lpr female mice, can be used for studying the pathogenesis of NPSLE in an animal setting, what are the NP symptoms that develop, and how they compare with human SLE, and, with a critical view, what are the neurobehavioral tests that are pertinent for evaluating the degree of altered functions and the progresses resulting from potentially active therapeutics.
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Affiliation(s)
- Hélène Jeltsch-David
- CNRS, Immunopathologie et chimie thérapeutique/Laboratory of excellence Medalis, Institut de Biologie Moléculaire et Cellulaire, 67000 Strasbourg, France.
| | - Sylviane Muller
- CNRS, Immunopathologie et chimie thérapeutique/Laboratory of excellence Medalis, Institut de Biologie Moléculaire et Cellulaire, 67000 Strasbourg, France.
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Ramirez J, McNeely AA, Scott CJ, Stuss DT, Black SE. Subcortical hyperintensity volumetrics in Alzheimer's disease and normal elderly in the Sunnybrook Dementia Study: correlations with atrophy, executive function, mental processing speed, and verbal memory. ALZHEIMERS RESEARCH & THERAPY 2014; 6:49. [PMID: 25478020 PMCID: PMC4255416 DOI: 10.1186/alzrt279] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 07/15/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Subcortical hyperintensities (SHs) are radiological entities commonly observed on magnetic resonance imaging (MRI) of patients with Alzheimer's disease (AD) and normal elderly controls. Although the presence of SH is believed to indicate some form of subcortical vasculopathy, pathological heterogeneity, methodological differences, and the contribution of brain atrophy associated with AD pathology have yielded inconsistent results in the literature. METHODS Using the Lesion Explorer (LE) MRI processing pipeline for SH quantification and brain atrophy, this study examined SH volumes of interest and cognitive function in a sample of patients with AD (n = 265) and normal elderly controls (n = 100) from the Sunnybrook Dementia Study. RESULTS Compared with healthy controls, patients with AD were found to have less gray matter, less white matter, and more sulcal and ventricular cerebrospinal fluid (all significant, P <0.0001). Additionally, patients with AD had greater volumes of whole-brain SH (P <0.01), periventricular SH (pvSH) (P <0.01), deep white SH (dwSH) (P <0.05), and lacunar lesions (P <0.0001). In patients with AD, regression analyses revealed a significant association between global atrophy and pvSH (P = 0.02) and ventricular atrophy with whole-brain SH (P <0.0001). Regional volumes of interest revealed significant correlations with medial middle frontal SH volume and executive function (P <0.001) in normal controls but not in patients with AD, global pvSH volume and mental processing speed (P <0.01) in patients with AD, and left temporal SH volume and memory (P <0.01) in patients with AD. CONCLUSIONS These brain-behavior relationships and correlations with brain atrophy suggest that subtle, yet measurable, signs of small vessel disease may have potential clinical relevance as targets for treatment in Alzheimer's dementia.
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Affiliation(s)
- Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada ; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada ; Sunnybrook Health Sciences Centre, Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alicia A McNeely
- LC Campbell Cognitive Neurology Research Unit, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada ; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada ; Sunnybrook Health Sciences Centre, Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Christopher Jm Scott
- LC Campbell Cognitive Neurology Research Unit, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada ; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada ; Sunnybrook Health Sciences Centre, Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Donald T Stuss
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada ; Rotman Research Institute, Baycrest, Toronto, ON, Canada ; Ontario Brain Institute, Toronto, ON, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology Research Unit, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada ; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada ; Sunnybrook Health Sciences Centre, Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada ; Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada ; Rotman Research Institute, Baycrest, Toronto, ON, Canada
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Zardi EM, Taccone A, Marigliano B, Margiotta DP, Afeltra A. Neuropsychiatric systemic lupus erythematosus: Tools for the diagnosis. Autoimmun Rev 2014; 13:831-9. [DOI: 10.1016/j.autrev.2014.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/30/2014] [Indexed: 01/18/2023]
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Hankee LD, Preis SR, Beiser AS, Devine SA, Liu Y, Seshadri S, Wolf PA, Au R. Qualitative neuropsychological measures: normative data on executive functioning tests from the Framingham offspring study. Exp Aging Res 2014; 39:515-35. [PMID: 24151914 DOI: 10.1080/0361073x.2013.839029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED BACKGROUND/STUDY CONTEXT: Studies have found that executive functioning is affected early in the pathophysiological processes associated with Alzheimer's disease and vascular dementia. There also exists a range of functioning on executive tasks during normal aging. Although qualitative data are commonly utilized in clinical practice for evaluating subtle changes in cognitive functioning and diagnostic discernment, it is not clear whether error responses used in clinical practice are also evident as normative behavior. METHODS As part of an extensive battery of neuropsychological tests, executive functioning measures (i.e., Trail Making Test Part B, Similarities and Verbal Fluency tests) were administered via standardized administration prescript. Regression analyses were used to determine associations between vascular aging indices and qualitative performance measures. Descriptive statistics are included for 1907 cognitively normal individuals. RESULTS Results suggest that although qualitative errors do occur, they are relatively infrequent within a presumably cognitively normal sample. Error commission rates on executive functioning tests are significantly associated with both age and education. CONCLUSION Provided is a baseline profile of errors committed on tests of executive function across a range of age and educational levels. The normative data sets are included, stratified by age and educational achievement, for which to compare qualitative test performance of clinical and research populations.
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Affiliation(s)
- Lisa D Hankee
- a Boston University School of Medicine , Boston , Massachusetts , USA
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Abstract
PURPOSE OF REVIEW Neuropsychiatric manifestations pose diagnostic and therapeutic challenges in systemic lupus erythematosus (SLE). We review recently published studies on the epidemiology, pathogenesis, neuroimaging, and treatment of NPSLE. RECENT FINDINGS Generalized SLE activity or damage and antiphospholipid antibodies are identified as major risk factors for neuropsychiatric involvement. NPSLE patients have increased genetic burden and novel genomic approaches are expected to elucidate its pathogenesis. Animal data suggest that, in cases of disturbed blood-brain barrier, autoantibodies against the NR2 subunits of the N-methyl-D-aspartate receptor and 16/6 idiotype antibodies may cause diffuse neuropsychiatric manifestations through neuronal apoptosis or brain inflammation; data in humans are still circumstantial. In NPSLE, advanced neuroimaging uncovers structural and metabolic abnormalities in brain regions with normal appearance on conventional MRI. Treatment includes corticosteroids/immunosuppressants for inflammatory manifestations or generalized SLE activity, and antiplatelets/anticoagulation for manifestations related to antiphospholipid antibodies. In refractory cases, uncontrolled studies suggest a beneficial role of rituximab. SUMMARY We have begun to better understand how brain-reactive autoantibodies, present in a proportion of SLE patients, can cause brain injury and diffuse NPSLE. Further testing will be required to determine the clinical utility of advanced neuroimaging. Controlled trials are needed to guide therapeutic decisions.
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Salminen LE, Paul RH. Oxidative stress and genetic markers of suboptimal antioxidant defense in the aging brain: a theoretical review. Rev Neurosci 2014; 25:805-19. [PMID: 25153586 PMCID: PMC6378111 DOI: 10.1515/revneuro-2014-0046] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/17/2014] [Indexed: 12/17/2022]
Abstract
Normal aging involves a gradual breakdown of physiological processes that leads to a decline in cognitive functions and brain integrity, yet the onset and progression of decline are variable among older individuals. While many biological changes may contribute to this degree of variability, oxidative stress is a key mechanism of the aging process that can cause direct damage to cellular architecture within the brain. Oligodendrocytes are at a high risk for oxidative damage due to their role in myelin maintenance and production and limited repair mechanisms, suggesting that white matter may be particularly vulnerable to oxidative activity. Antioxidant defense enzymes within the brain, such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione-S-transferase (GST), are crucial for breaking down the harmful end products of oxidative phosphorylation. Previous studies have revealed that allele variations of polymorphisms that encode these antioxidants are associated with abnormalities in SOD, CAT, GPx, and GST activity in the central nervous system. This review will focus on the role of oxidative stress in the aging brain and the impact of decreased antioxidant defense on brain integrity and cognitive function. Directions for future research investigations of antioxidant defense genes will also be discussed.
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Affiliation(s)
- Lauren E Salminen
- Department of Psychology, University of Missouri-Saint Louis, 1 University Boulevard, Stadler Hall 442 A, St. Louis, MO 63121, USA
| | - Robert H Paul
- Department of Psychology, University of Missouri-Saint Louis, 1 University Boulevard, Stadler Hall 442 A, St. Louis, MO 63121, USA
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Huang CC, Liu ME, Chou KH, Yang AC, Hung CC, Hong CJ, Tsai SJ, Lin CP. Effect of BDNF Val66Met polymorphism on regional white matter hyperintensities and cognitive function in elderly males without dementia. Psychoneuroendocrinology 2014; 39:94-103. [PMID: 24275008 DOI: 10.1016/j.psyneuen.2013.09.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 12/26/2022]
Abstract
White matter lesions, also termed White Matter Hyperintensities (WMH), on T2-weighted MR images, are common in the elderly population. Of note, their presence is often accompanied with cognitive decline and the risk of dementia. Even though previous brain ischemia and WM lesion studies have been conducted and indicated that brain-derived neurotrophic factor (BDNF) might protect against neuronal cell death, the interaction between regional WMH volume and the BDNF Val66Met polymorphism on the cognitive performance of healthy elderly population remains unclear. To investigate the genetic effect of BDNF on cognitive function and regional WMH in the healthy elderly population, 90 elderly men, without dementia, with a mean age of 80.6 ± 5.6 y/o were recruited to undergo cognitive tests, structural magnetic resonance imaging (MRI) scans, and genotyping of BDNF alleles. Compared with Met homozygotes, Val homozygotes showed significantly inferior short-term memory (STM) performance (P = .001). A tendency toward dose-dependent effects of the Val allele on WMH volume was found, and Val homozygotes showed larger WMH volume in the temporal (P = .035), the occipital (P = .006), and the global WMH volume (P = .025) than others. Significant interaction effects of BDNF genotypes with temporal WMH volume on STM performance was observed (F1,89 = 4.306, P = .041). Val homozygotes presented steeper negative correlation compared to Met carriers. Mediation analysis also demonstrated that WMH in temporal, limbic, and subcortical regions might mediate the relationship between BDNF's genetic effect and STM performance. Our findings supported the hypothesis that the BDNF Val66Met polymorphism may affect susceptibility to regional WMH volume and such genotype-by-WMH interaction effect is correlated with cognitive decline in non-demented elderly males, in which the Met allele plays a protective role.
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Affiliation(s)
- Chu-Chung Huang
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Mu-En Liu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kun-Hsien Chou
- Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taiwan
| | - Albert C Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Chia-Chun Hung
- Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Jee Hong
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ching-Po Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taiwan.
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Kieseppä T, Mäntylä R, Tuulio-Henriksson A, Luoma K, Mantere O, Ketokivi M, Holma M, Jylhä P, Melartin T, Suominen K, Vuorilehto M, Isometsä E. White matter hyperintensities and cognitive performance in adult patients with bipolar I, bipolar II, and major depressive disorders. Eur Psychiatry 2013; 29:226-32. [PMID: 24176647 DOI: 10.1016/j.eurpsy.2013.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE We evaluate for the first time the associations of brain white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) with neuropsychological variables among middle-aged bipolar I (BPI), II (BPII) and major depressive disorder (MDD) patients and controls using a path model. METHODS Thirteen BPI, 15 BPII, 16 MDD patients, and 21 controls underwent brain MRI and a neuropsychological examination. Two experienced neuroradiologists evaluated WMHs on the MRI scans. We constructed structural equation models to test the strength of the associations between deep WMH (DWMH) grade, neuropsychological performance and diagnostic group. RESULTS Belonging in the BPI group as opposed to the control group predicted higher DWMH grade (coefficient estimate 1.13, P=0.012). The DWMH grade independently predicted worse performance on the Visual Span Forward test (coefficient estimate -0.48, P=0.002). Group effects of BPI and MDD were significant in predicting poorer performance on the Digit Symbol test (coefficient estimate -5.57, P=0.016 and coefficient estimate -5.66, P=0.034, respectively). LIMITATIONS Because of the small number of study subjects in groups, the negative results must be considered with caution. CONCLUSIONS Only BPI patients had an increased risk for DWMHs. DWMHs were independently associated with deficits in visual attention.
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Affiliation(s)
- T Kieseppä
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, 00300 Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
| | - R Mäntylä
- HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland; Hyvinkää Hospital, Hyvinkää, Finland
| | - A Tuulio-Henriksson
- Social Insurance Institution, Research Department, Helsinki, Finland; Department of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - K Luoma
- HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - O Mantere
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, 00300 Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - M Ketokivi
- Operations and Technology Department, IE Business School, Madrid, Spain
| | - M Holma
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, 00300 Helsinki, Finland; Department of Psychiatry, City of Helsinki, Helsinki, Finland
| | - P Jylhä
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, 00300 Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - T Melartin
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, 00300 Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - K Suominen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, 00300 Helsinki, Finland; Department of Psychiatry, City of Helsinki, Helsinki, Finland
| | - M Vuorilehto
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, 00300 Helsinki, Finland
| | - E Isometsä
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, 00300 Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
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The brain study: Cognition, quality of life and social functioning following preeclampsia; An observational study. Pregnancy Hypertens 2013; 3:227-34. [DOI: 10.1016/j.preghy.2013.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/09/2013] [Indexed: 11/22/2022]
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Valdés Hernández MC, Piper RJ, Bastin ME, Royle NA, Maniega SM, Aribisala BS, Murray C, Deary IJ, Wardlaw JM. Morphologic, distributional, volumetric, and intensity characterization of periventricular hyperintensities. AJNR Am J Neuroradiol 2013; 35:55-62. [PMID: 23811980 DOI: 10.3174/ajnr.a3612] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities are characteristic of old age and identifiable on FLAIR and T2-weighted MR imaging. They are typically separated into periventricular or deep categories. It is unclear whether the innermost segment of periventricular white matter hyperintensities is truly abnormal or is imaging artifacts. MATERIALS AND METHODS We used FLAIR MR imaging from 665 community-dwelling subjects 72-73 years of age without dementia. Periventricular white matter hyperintensities were visually allocated into 4 categories: 1) thin white line; 2) thick rim; 3) penetrating toward or confluent with deep white matter hyperintensities; and 4) diffuse ill-defined, labeled as "subtle extended periventricular white matter hyperintensities." We measured the maximum intensity and width of the periventricular white matter hyperintensities, mapped all white matter hyperintensities in 3D, and investigated associations between each category and hypertension, stroke, diabetes, hypercholesterolemia, cardiovascular disease, and total white matter hyperintensity volume. RESULTS The intensity patterns and morphologic features were different for each periventricular white matter hyperintensity category. Both the widths (r = 0.61, P < .001) and intensities (r = 0.51, P < .001) correlated with total white matter hyperintensity volume and with each other (r = 0.55, P < .001) for all categories with the exception of subtle extended periventricular white matter hyperintensities, largely characterized by evidence of erratic, ill-defined, and fragmented pale white matter hyperintensities (width: r = 0.02, P = .11; intensity: r = 0.02, P = .84). The prevalence of hypertension, hypercholesterolemia, and neuroradiologic evidence of stroke increased from periventricular white matter hyperintensity categories 1 to 3. The mean periventricular white matter hyperintensity width was significantly larger in subjects with hypertension (mean difference = 0.5 mm, P = .029) or evidence of stroke (mean difference = 1 mm, P < .001). 3D mapping revealed that periventricular white matter hyperintensities were discontinuous with deep white matter hyperintensities in all categories, except only in particular regions in brains with category 3. CONCLUSIONS Periventricular white matter hyperintensity intensity levels, distribution, and association with risk factors and disease suggest that in old age, these are true tissue abnormalities and therefore should not be dismissed as artifacts. Dichotomizing periventricular and deep white matter hyperintensities by continuity from the ventricle edge toward the deep white matter is possible.
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Zueva IB, Moroshkina NV, Barantsevich ER, Trufanov GE. MAGNETIC RESONANCE SPECTROSCOPY IN EVALUATION OF COGNITIVE FUNCTIONS IN PATIENTS WITH METABOLIC SYNDROME. ACTA ACUST UNITED AC 2013. [DOI: 10.18705/1607-419x-2013-19-1-51-58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective. To evaluate the role of magnetic resonance spectroscopy (MR-spectroscopy) in the study of cognitive functions in patients with metabolic syndrome (MS).Design and methods. The study included patients with MS (10 patients without cognitive impairment and 11 subjects with cognitive dysfunction). All patients underwent neuropsychological testing, and cognitive evoked potential for the assessment of cognitive functions. Brain metabolism was studied by proton MR-spectroscopy.Results. In patients with MS and cognitive impairment, and without cognitive dysfunction no morphological changes in the brain according to the magnetic resonance imaging (MRI) were found. According to MR-spectroscopy of the brain in patients with MS and cognitive dysfunction the metabolism impairment is primarily associated with the increase in lactate and inositol.Conclusion. Indicators of neuropsychological testing, the cognitive evoked potential are associated with the violation of brain metabolism in patients with MS and cognitive impairment.
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Affiliation(s)
- I. B. Zueva
- Almazov Federal Heart, Blood, and Endocrinology Centre, St Petersburg
| | - N. V. Moroshkina
- Almazov Federal Heart, Blood, and Endocrinology Centre, St Petersburg
| | - E. R. Barantsevich
- Almazov Federal Heart, Blood, and Endocrinology Centre, St Petersburg; Pavlov St Petersburg State Medical University, St Petersburg
| | - G. E. Trufanov
- Military Medical Academy named after S.M. Kirov, St Petersburg
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Lenders M, Duning T, Schelleckes M, Schmitz B, Stander S, Rolfs A, Brand SM, Brand E. Multifocal white matter lesions associated with the D313Y mutation of the α-galactosidase A gene. PLoS One 2013; 8:e55565. [PMID: 23393592 PMCID: PMC3564750 DOI: 10.1371/journal.pone.0055565] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/27/2012] [Indexed: 11/29/2022] Open
Abstract
White matter lesions (WML) are clinically relevant since they are associated with strokes, cognitive decline, depression, or epilepsy, but the underlying etiology in young adults without classical risk factors still remains elusive. Our aim was to elucidate the possible clinical diagnosis and mechanisms leading to WML in patients carrying the D313Y mutation in the α-galactosidase A (GLA) gene, a mutation that was formerly described as nonpathogenic. Pathogenic GLA mutations cause Fabry disease, a vascular endothelial glycosphingolipid storage disease typically presenting with a symptom complex of renal, cardiac, and cerebrovascular manifestations. We performed in-depths clinical, biochemical and genetic examinations as well as advanced magnetic resonance imaging analyses in a pedigree with the genetically determined GLA mutation D313Y. We detected exclusive neurologic manifestations of the central nervous system of the “pseudo”-deficient D313Y mutation leading to manifest WML in 7 affected adult family members. Furthermore, two family members that do not carry the mutation showed no WML. The D313Y mutation resulted in a normal GLA enzyme activity in leukocytes and severely decreased activities in plasma. In conclusion, our results provide evidence that GLA D313Y is potentially involved in neural damage with significant WML, demonstrating the necessity of evaluating patients carrying D313Y more thoroughly. D313Y might broaden the spectrum of hereditary small artery diseases of the brain, which preferably occur in young adults without classical risk factors. In view of the existing causal therapy regime, D313Y should be more specifically taken into account in these patients.
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Affiliation(s)
- Malte Lenders
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Thomas Duning
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Michael Schelleckes
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Boris Schmitz
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Muenster, Germany
- Institute for Sports Medicine, Molecular Genetics and Cardiovascular Disease, University Hospital Muenster, Muenster, Germany
| | - Sonja Stander
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Arndt Rolfs
- Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany
| | - Stefan-Martin Brand
- Institute for Sports Medicine, Molecular Genetics and Cardiovascular Disease, University Hospital Muenster, Muenster, Germany
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Muenster, Germany
- * E-mail:
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d’Esterre CD, Fainardi E, Aviv RI, Lee TY. Improving Acute Stroke Management with Computed Tomography Perfusion: A Review of Imaging Basics and Applications. Transl Stroke Res 2012; 3:205-20. [DOI: 10.1007/s12975-012-0178-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022]
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Abstract
Cardiovascular risk factors including hypertension (HTN) have been shown to increase the risk of Alzheimer disease. The current study investigated whether individuals with HTN are more susceptible to increased cognitive decline and whether the influence of HTN on cognitive decline varied as a function of dementia severity. A total of 224 nursing home and assisted living residents, with a mean age of 84.9 (±7.6) years, were assessed longitudinally with Mini Mental State Exams (MMSEs) and Clinical Dementia Ratings (CDR). Baseline dementia status was defined by the CDR score. As described in , MMSE scores in persons with HTN and questionable dementia (CDR = 0.5) declined significantly faster than nonhypertensive questionably demented persons. Hypertensive participants did not decline significantly faster than nonhypertensive participants in persons with intact cognition (CDR = 0) or frank dementia (CDR ≥ 1). These results suggest an increased risk of subsequent cognitive decline in hypertensive individuals who are especially vulnerable to developing dementia and raises the possibility that avoiding or controlling HTN might reduce the rate of cognitive decline in cognitively vulnerable individuals, potentially delaying their conversion to full-fledged dementia.
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Seldenrijk A, van Hout HPJ, van Marwijk HWJ, de Groot E, Gort J, Rustemeijer C, Diamant M, Penninx BWJH. Carotid atherosclerosis in depression and anxiety: associations for age of depression onset. World J Biol Psychiatry 2011; 12:549-58. [PMID: 21745125 DOI: 10.3109/15622975.2011.583942] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Mental health and cardiovascular disease have been associated, whereas the temporal course and underlying mechanisms are still incompletely understood. Our aims were to examine the presence of subclinical atherosclerosis in subjects with depressive or anxiety disorder, also taking into account disorder characteristics (subtype, severity, duration, age of onset, medication). METHODS The sample included 470 depression or anxiety cases and 179 controls, aged 20-66 years, participating in the Netherlands Study of Depression and Anxiety (NESDA). Diagnoses were assigned using the DSM-IV based Composite International Diagnostic Interview. Carotid intima-media thickness (CIMT) and plaque information were obtained using B-mode ultrasound imaging. RESULTS Overall, depressive and anxiety disorders were not associated with carotid atherosclerosis. However, age of depression onset was associated with CIMT (total: 0.01 mm per 10 years, P = 0.01; bifurcation: 0.02 mm per 10 years, P = 0.003) and plaque presence (OR = 1.35 per 10 years, 95%CI = 1.02-1.80, P = 0.04). When compared with controls, late-onset (≥ 40 years) depressed had an increased CIMT in the atherosclerosis progression-prone bifurcation segment (0.75 vs. 0.81 mm, P = 0.004). CONCLUSIONS These findings suggest a distinct pathophysiology of late-onset as compared with early-onset depression, including a vascular component.
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Affiliation(s)
- Adrie Seldenrijk
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
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35
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Functional magnetic resonance imaging of working memory reveals frontal hypoactivation in middle-aged adults with cognitive complaints. J Int Neuropsychol Soc 2011; 17:915-24. [PMID: 21880172 DOI: 10.1017/s1355617711000956] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Older adults with cardiovascular disease (CVD) often complain about cognitive difficulties including reduced processing speed and attention. On cross-sectional examination, such reports relate more closely to mood than to cognitive performance; yet, in longitudinal studies, these complaints have foreshadowed cognitive decline over time. To test the hypothesis that self-reported cognitive difficulties reflect early changes in brain function, we examined cognitive complaints and depression in relation to blood oxygen level dependent (BOLD) response to a cognitive task in middle-aged adults at risk for CVD. Forty-nine adults (ages 40 to 60 years) completed a measure of perceived cognitive dysfunction (Cognitive Difficulties Scale), medical history questionnaire, neuropsychological assessment and functional magnetic resonance imaging (fMRI) during a working memory task. Increased report of cognitive difficulties was significantly associated with weaker task-related activation in the right superior frontal/ middle frontal gyrus (F(4,44) = 3.26; p = .020, CDS ß = -0.39; p = .009) and the right inferior frontal gyrus (F(4,44) = 3.14; p = .024, CDS ß = -0.45; p = .003), independent of age, education, and self-reported depressive symptoms. Lower activation intensity in the right superior frontal gyrus was related to trends toward poorer task performance. Thus, self-reported cognitive difficulties among cognitively normal middle-aged adults may provide important clinical information about early brain vulnerability that should be carefully monitored.
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Hoth KF, Gonzales MM, Tarumi T, Miles SC, Tanaka H, Haley AP. Functional MR imaging evidence of altered functional activation in metabolic syndrome. AJNR Am J Neuroradiol 2011; 32:541-7. [PMID: 21183618 PMCID: PMC8013105 DOI: 10.3174/ajnr.a2315] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/11/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE MetS is a cluster of risk factors associated with significant cardiovascular morbidity and mortality and diminished cognitive function. Given that little is known about the early signs of brain vulnerability related to persistent metabolic dysfunction, we set out to determine whether cognitively healthy middle-aged individuals with MetS exhibit an altered cerebrovascular response to a cognitive challenge relative to those without MetS. MATERIALS AND METHODS Forty neurologically healthy adults aged 40-60 years (19 with MetS and 21 healthy controls) performed a 2-back verbal working memory task during fMRI. We compared BOLD responses between the 2 groups in 8 a priori regions of interest previously shown to be associated with the 2-back in patients with cardiovascular disease. RESULTS Age, education level, sex distribution, cognitive and emotional functioning, and task performance (accuracy and reaction time) were not different between the groups. Compared with healthy controls, individuals with MetS demonstrated a lower 2-back-related BOLD response in the right superior frontal gyrus, right superior parietal lobule, and left inferior parietal lobule. CONCLUSIONS This study provides preliminary evidence that cognitively intact middle-aged individuals with MetS exhibit significant alterations in cerebrovascular response to a cognitive challenge. Our results also demonstrate that fMRI may identify early brain changes associated with MetS.
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Affiliation(s)
- K F Hoth
- Department of Medicine, Division of Psychosocial Medicine, National Jewish Health, Denver, Colorado, USA
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Luyendijk J, Steens SCA, Ouwendijk WJN, Steup-Beekman GM, Bollen ELEM, van der Grond J, Huizinga TWJ, Emmer BJ, van Buchem MA. Neuropsychiatric systemic lupus erythematosus: Lessons learned from magnetic resonance imaging. ACTA ACUST UNITED AC 2011; 63:722-32. [DOI: 10.1002/art.30157] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Zheng JJ, Delbaere K, Close JCT, Sachdev PS, Wen W, Lord SR. White matter hyperintensities and impaired choice stepping reaction time in older people. Neurobiol Aging 2011; 33:1177-85. [PMID: 21257231 DOI: 10.1016/j.neurobiolaging.2010.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 12/07/2010] [Accepted: 12/12/2010] [Indexed: 10/18/2022]
Abstract
White matter hyperintensities (WMHs) are associated with impaired mobility in older people, but no studies have identified neuropsychological and sensorimotor mediating factors for this association. Our objective was to determine whether neuropsychological and sensorimotor functions mediate the association of WMHs and choice stepping reaction time (CSRT) under standard and dual-task conditions using structural equation modeling. Two hundred fifty-four older community dwellers (77.8 ± 4.5 years) underwent structural magnetic resonance imaging, CSRT tests, neuropsychological and sensorimotor assessments. WMH volumes were quantified using an automated method. WMH volumes were significantly associated with neuropsychological tests and dual task CSRT performance. All neuropsychological and sensorimotor variables were also significantly associated with standard and dual task CSRT. The structural equation modeling revealed that impaired sensorimotor function was the only factor influencing impaired stepping performances in the standard condition. In the dual task condition, the association between WMHs and CSRT was mediated through slowed cognitive processing and not through reduced sensorimotor functioning. The conclusion was that WMHs are associated with slowed performance on a dual task CSRT task and this relationship is explained primarily by underlying neuropsychological impairments.
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Affiliation(s)
- Jacqueline J Zheng
- Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
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Ramirez J, Gibson E, Quddus A, Lobaugh NJ, Feinstein A, Levine B, Scott CJM, Levy-Cooperman N, Gao FQ, Black SE. Lesion Explorer: a comprehensive segmentation and parcellation package to obtain regional volumetrics for subcortical hyperintensities and intracranial tissue. Neuroimage 2010; 54:963-73. [PMID: 20849961 DOI: 10.1016/j.neuroimage.2010.09.013] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 09/01/2010] [Accepted: 09/03/2010] [Indexed: 12/16/2022] Open
Abstract
Subcortical hyperintensities (SH) are a commonly observed phenomenon on MRI of the aging brain (Kertesz et al., 1988). Conflicting behavioral, cognitive and pathological associations reported in the literature underline the need to develop an intracranial volumetric analysis technique to elucidate pathophysiological origins of SH in Alzheimer's disease (AD), vascular cognitive impairment (VCI) and normal aging (De Leeuw et al., 2001; Mayer and Kier, 1991; Pantoni and Garcia, 1997; Sachdev et al., 2008). The challenge is to develop processing tools that effectively and reliably quantify subcortical small vessel disease in the context of brain tissue compartments. Segmentation and brain region parcellation should account for SH subtypes which are often classified as: periventricular (pvSH) and deep white (dwSH), incidental white matter disease or lacunar infarcts and Virchow-Robin spaces. Lesion Explorer (LE) was developed as the final component of a comprehensive volumetric segmentation and parcellation image processing stream built upon previously published methods (Dade et al., 2004; Kovacevic et al., 2002). Inter-rater and inter-method reliability was accomplished both globally and regionally. Volumetric analysis showed high inter-rater reliability both globally (ICC=.99) and regionally (ICC=.98). Pixel-wise spatial congruence was also high (SI=.97). Whole brain pvSH volumes yielded high inter-rater reliability (ICC=.99). Volumetric analysis against an alternative kNN segmentation revealed high inter-method reliability (ICC=.97). Comparison with visual rating scales showed high significant correlations (ARWMC: r=.86; CHIPS: r=.87). The pipeline yields a comprehensive and reliable individualized volumetric profile for subcortical vasculopathy that includes regionalized (26 brain regions) measures for: GM, WM, sCSF, vCSF, lacunar and non-lacunar pvSH and dwSH.
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Affiliation(s)
- J Ramirez
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Dalby RB, Chakravarty MM, Ahdidan J, Sørensen L, Frandsen J, Jonsdottir KY, Tehrani E, Rosenberg R, Ostergaard L, Videbech P. Localization of white-matter lesions and effect of vascular risk factors in late-onset major depression. Psychol Med 2010; 40:1389-1399. [PMID: 19895719 DOI: 10.1017/s0033291709991656] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Several studies suggest that patients with late-onset major depression (MD) have an increased load of cerebral white-matter lesions (WMLs) compared with age-matched controls. Vascular risk factors such as hypertension and smoking may confound such findings. Our aim was to investigate the association between the localization and load of WMLs in late-onset MD with respect to vascular risk factors. METHOD We examined 22 consecutive patients with late-onset first-episode MD and 22 age- and gender-matched controls using whole-brain magnetic resonance imaging (MRI). The localization, number and volume of WMLs were compared between patients and controls, while testing the effect of vascular risk factors. RESULTS Among subjects with one or more WMLs, patients displayed a significantly higher WML density in two white-matter tracts: the left superior longitudinal fasciculus and the right frontal projections of the corpus callosum. These tracts are part of circuitries essential for cognitive and emotional functions. Analyses revealed no significant difference in the total number and volume of WMLs between groups. Patients and controls showed no difference in vascular risk factors, except for smoking. Lesion load was highly correlated with smoking. CONCLUSIONS Our results indicate that lesion localization rather than lesion load differs between patients with late-onset MD and controls. Increased lesion density in regions associated with cognitive and emotional functions may be crucial in late-onset MD, and vascular risk factors such as smoking may play an important role in the pathophysiology of late-onset MD, consistent with the vascular depression hypothesis.
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Affiliation(s)
- R B Dalby
- Center for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark.
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Haley AP, Tarumi T, Gonzales MM, Sugawara J, Tanaka H. Subclinical atherosclerosis is related to lower neuronal viability in middle-aged adults: a 1H MRS study. Brain Res 2010; 1344:54-61. [PMID: 20460114 PMCID: PMC2900442 DOI: 10.1016/j.brainres.2010.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 04/25/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Increased carotid artery intima-media thickness (IMT) is a noninvasive marker of systemic arterial disease, associated with atherosclerosis, abnormal arterial mechanics, myocardial infarction, and stroke. In the elderly, clinically elevated IMT is related to diminished attention-executive function. In this context, previous work involving paper-and-pencil measures of cognition has demonstrated that a threshold of pathology (i.e., IMT>or=0.9 mm) is needed before IMT consistently relates to poor neuropsychological test performance. Given the critical role of arterial health in the development of cognitive dysfunction, the goal of this study was to investigate early markers of brain vulnerability by examining subclinical levels of IMT in relation to a sensitive marker of neuronal integrity, cerebral N-acetyl-aspartate/creatine (NAA/Cr) ratio, in midlife. METHODS A total of 40 participants aged 50+/-6 years, underwent neuropsychological assessment, proton magnetic resonance spectroscopy ((1)H MRS) examination of occipitoparietal grey matter and B-mode ultrasound of the common carotid artery. IMT was defined as the distance between the luminal-endothelial interface and the junction between the media and the adventitia. The relation between IMT and cerebral metabolite ratios was modeled using a single multivariate multiple regression analysis adjusted for age and current systolic blood pressure. RESULTS Increased IMT was associated with significantly lower NAA/Cr ratios (IMT beta=-0.62, p=0.001), independent of age and systolic blood pressure (F(3,36)=4.928, p=0.006). CONCLUSIONS Our study extends previous findings by demonstrating a significant relationship between IMT and NAA concentration, suggesting compromised neuronal viability even at IMT levels below thresholds for clinical end-organ damage.
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Affiliation(s)
- Andreana P Haley
- Department of Psychology, The University of Texas at Austin, TX 78712, USA.
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Diniz BS, Teixeira AL, Talib LL, Mendonça VA, Gattaz WF, Forlenza OV. Serum brain-derived neurotrophic factor level is reduced in antidepressant-free patients with late-life depression. World J Biol Psychiatry 2010; 11:550-5. [PMID: 20109109 DOI: 10.3109/15622970903544620] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of the present study is to investigate serum BDNF levels in older depressed patients as compared to healthy elderly controls. METHODS Twenty-nine elderly subjects with major depression and 42 healthy older adults were enrolled to this study. All depressed patients were antidepressant-free for at least 1 month prior clinical and laboratorial assessments. Serum BDNF levels were determined by sandwich ELISA. RESULTS BDNF levels were lower in elderly depressed patients as compared to controls (P=0.034). Patients with late-onset depression had the lowest BDNF level (median 478.5, interquartile range 373.5-740.9 pg/l) when compared to early-onset depression (median 620.7, interquartile range 366.1-971.9 pg/l) and healthy controls (median 711.3, interquartile range 534.7-1181.0 pg/l) (P<0.03). CONCLUSIONS Reduced serum BDNF level may be a state marker of late-life depression in non-medicated elderly patients. Our findings provide further evidences that reduced neurotrophic support may have an important role in the physiopathology of late-life depression.
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Affiliation(s)
- Breno Satler Diniz
- Laboratory of Neuroscience-LIM 27, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Rua Dr. Ovidio Pires de Campos 785, São Paulo, Brazil.
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Maclullich AMJ, Ferguson KJ, Reid LM, Deary IJ, Starr JM, Seckl JR, Bastin ME, Wardlaw JM. Higher systolic blood pressure is associated with increased water diffusivity in normal-appearing white matter. Stroke 2009; 40:3869-71. [PMID: 19850898 DOI: 10.1161/strokeaha.109.547877] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hypertension is associated with the development of white matter lesions in older people. Diffusion tensor MRI can detect subtle, previsible white matter damage, but relationships between diffusion tensor MRI parameters and blood pressure (BP) remain unclear. We examined correlations among mean diffusivity (MD), fractional anisotropy and BP in 45 men aged 71 to 76 years. METHODS MD and fractional anisotropy were measured in 6 regions of interest in normal-appearing white matter. Visible white matter lesions were quantified using the Fazekas scale. Both were correlated with systolic and diastolic BP. RESULTS Systolic BP was positively and significantly correlated with MD in all 6 regions (r=0.31 to 0.45; P=0.037 to 0.002). MD was also correlated with diastolic BP in the genu of the corpus callosum (r=0.34, P=0.018). A summary factor derived from principal component analysis of the MD measurements accounted for 53.8% of the variance and correlated at r=0.51 (P<0.001) with systolic BP and r=0.33 (P=0.028) with diastolic BP. Fractional anisotropy did not correlate significantly with BP. Deep white matter Fazekas scores correlated with diastolic BP (rho=0.35, P=0.019). CONCLUSIONS The increase in MD without change in fractional anisotropy indicates that, in normal-appearing white matter, higher BP may be associated with increased extracellular fluid before any cytoarchitectural damage occurs.
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