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Sullivan EV, Zahr NM, Zhao Q, Pohl KM, Sassoon SA, Pfefferbaum A. Contributions of cerebral white matter hyperintensities, age, and pedal perception to postural sway in people with HIV. AIDS 2024; 38:1153-1162. [PMID: 38537080 DOI: 10.1097/qad.0000000000003894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE With aging, people with HIV (PWH) have diminishing postural stability that increases liability for falls. Factors and neuromechanisms contributing to instability are incompletely known. Brain white matter abnormalities seen as hyperintense (WMH) signals have been considered to underlie instability in normal aging and PWH. We questioned whether sway-WMH relations endured after accounting for potentially relevant demographic, physiological, and HIV-related variables. DESIGN Mixed cross-sectional/longitudinal data were acquired over 15 years in 141 PWH and 102 age-range matched controls, 25-80 years old. METHODS Multimodal structural MRI data were quantified for seven total and regional WMH volumes. Static posturography acquired with a force platform measured sway path length separately with eyes closed and eyes open. Statistical analyses used multiple regression with mixed modeling to test contributions from non-MRI and nonpath data on sway path-WMH relations. RESULTS In simple correlations, longer sway paths were associated with larger WMH volumes in PWH and controls. When demographic, physiological, and HIV-related variables were entered into multiple regressions, the sway-WMH relations under both vision conditions in the controls were attenuated when accounting for age and two-point pedal discrimination. Although the sway-WMH relations in PWH were influenced by age, 2-point pedal discrimination, and years with HIV infection, the sway-WMH relations endured for five of the seven regions in the eyes-open condition. CONCLUSION The constellation of age-related increasing instability while standing, degradation of brain white matter integrity, and peripheral pedal neuropathy is indicative of advancing fraility and liability for falls as people age with HIV infection.
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Natalie M Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
| | - Qingyu Zhao
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Kilian M Pohl
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Stephanie A Sassoon
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
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2
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Sullivan EV, Zahr NM, Zhao Q, Pohl KM, Sassoon SA, Pfefferbaum A. Contributions of Cerebral White Matter Hyperintensities to Postural Instability in Aging with and without Alcohol Use Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00083-1. [PMID: 38569932 DOI: 10.1016/j.bpsc.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/29/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Postural instability and brain white matter hyperintensities (WMH) are both noted markers of normal aging and alcohol use disorder (AUD). Here, we questioned what variables contribute to sway path/WMH relations in individuals with AUD and healthy control participants. METHOD The data comprised 404 balance platform sessions, yielding sway path length and MRI acquired cross-sectionally or longitudinally, in 102 control and 158 AUD participants, ages 25-80 years. Balance sessions were typically conducted on the same day as MRI FLAIR acquisitions, permitting WMH volume quantification. Factors considered in multiple regression analyses as potential contributors to relations between WMH volumes and postural instability were age, sex, socioeconomic status, education, pedal 2-point discrimination, systolic and diastolic blood pressure, body mass index, depressive symptoms, total alcohol consumed in the past year, and race. RESULTS Initial analysis identified diagnosis, age, sex, and race as significant contributors to observed sway path/WMH relations. Inclusion of these factors as predictors in multiple regression analysis substantially attenuated the sway/WMH relations in both AUD and healthy control groups. Women, irrespective of diagnosis or race, had shorter sway paths than men. Black participants, irrespective of diagnosis or sex, had shorter sway paths than non-Black participants despite having modestly larger WMH volumes than non-Black participants, possibly a reflection of the younger age of the Black sample. DISCUSSION Longer sway paths were related to larger WMH volumes in healthy men and women, with and without AUD. Critically, however, age nearly fully accounted for these relations.
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
| | - Natalie M Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA; Center for Health Sciences, SRI International, Menlo Park, CA
| | - Qingyu Zhao
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Kilian M Pohl
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Stephanie A Sassoon
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA; Center for Health Sciences, SRI International, Menlo Park, CA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA; Center for Health Sciences, SRI International, Menlo Park, CA
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3
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Blumberg MJ, Petersson AM, Jones PW, Jones AA, Panenka WJ, Leonova O, Vila-Rodriguez F, Lang DJ, Barr AM, MacEwan GW, Buchanan T, Honer WG, Gicas KM. Differential sensitivity of intraindividual variability dispersion and global cognition in the prediction of functional outcomes and mortality in precariously housed and homeless adults. Clin Neuropsychol 2024:1-24. [PMID: 38444068 DOI: 10.1080/13854046.2024.2325167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To examine cognitive intraindividual variability (IIV) dispersion as a predictor of everyday functioning and mortality in persons who are homeless or precariously housed. METHOD Participants were 407 community-dwelling adults, followed for up to 13 years. Neurocognition was assessed at baseline and IIV dispersion was derived using a battery of standardized tests. Functional outcomes (social, physical) were obtained at baseline and last follow-up. Mortality was confirmed with Coroner's reports and hospital records (N = 103 deaths). Linear regressions were used to predict current social and physical functioning from IIV dispersion. Repeated measures Analysis of Covariance were used to predict long-term change in functioning. Cox regression models examined the relation between IIV dispersion and mortality. Covariates included global cognition (i.e. mean-level performance), age, education, and physical comorbidities. RESULTS Higher IIV dispersion predicted poorer current physical functioning (B = -0.46 p = .010), while higher global cognition predicted better current (B = 0.21, p = .015) and change in social functioning over a period of up to 13 years (F = 4.23, p = .040). Global cognition, but not IIV dispersion, predicted mortality in individuals under 55 years old (HR = 0.50, p = .013). CONCLUSIONS Our findings suggest that indices of neurocognitive functioning (i.e. IIV dispersion and global cognition) may be differentially related to discrete dimensions of functional outcomes in an at-risk population. IIV dispersion may be a complimentary marker of emergent physical health dysfunction in precariously housed adults and may be best used in conjunction with traditional neuropsychological indices.
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Affiliation(s)
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Canada
- Department of Psychology, University of the Fraser Valley, Abbotsford, Canada
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4
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Bronstein AM, Kattah J. Vascular neuro-otology: vestibular transient ischemic attacks and chronic dizziness in the elderly. Curr Opin Neurol 2024; 37:59-65. [PMID: 38032270 PMCID: PMC10779463 DOI: 10.1097/wco.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE OF REVIEW To explore the differential diagnosis of posterior fossa transient ischemic attacks (TIA) associated with vertigo and/or imbalance.To review the contribution of cerebral small vessel (SVD) disease to balance dysfunction and dizziness in the elderly. MAIN FINDINGS TIAs involving vestibular structures that mediate the vestibulo-ocular and vestibulospinal reflexes remain a diagnostic challenge because they overlap with causes of benign episodic vertigo. Here, we summarize the results of multidisciplinary specialty efforts to improve timely recognition and intervention of peripheral and central vestibular ischemia. More papers confirm that SVD is a major cause of gait disability, falls and cognitive disorder in the elderly. Recent work shows that early stages of SVD may also be responsible for dizziness in the elderly. The predominant location of the white matter changes, in the frontal deep white matter and genu of the corpus callosum, explains the association between cognitive and balance dysfunction in SVD related symptoms. SUMMARY The evaluation of patients with intermittent vascular vertigo represent a major diagnostic challenge, recent reviews explore the ideal design approach for a multidisciplinary study to increase early recognition and intervention. Hemispheric white matter microvascular ischemia has been the subject of research progress - advanced stages are known to cause gait disorder and dementia but early stages are associated with "idiopathic" dizziness in the elderly.
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Affiliation(s)
- Adolfo M. Bronstein
- Centre for Vestibular Neuroscience, Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Jorge Kattah
- University of Illinois at Chicago | UIC Department of Neurology (Peoria), Chicago, Illinois, USA
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5
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Shao H, Li S. A new perspective on HIV: effects of HIV on brain-heart axis. Front Cardiovasc Med 2023; 10:1226782. [PMID: 37600062 PMCID: PMC10436320 DOI: 10.3389/fcvm.2023.1226782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
The human immunodeficiency virus (HIV) infection can cause damage to multiple systems within the body, and the interaction among these various organ systems means that pathological changes in one system can have repercussions on the functions of other systems. However, the current focus of treatment and research on HIV predominantly centers around individual systems without considering the comprehensive relationship among them. The central nervous system (CNS) and cardiovascular system play crucial roles in supporting human life, and their functions are closely intertwined. In this review, we examine the effects of HIV on the CNS, the resulting impact on the cardiovascular system, and the direct damage caused by HIV to the cardiovascular system to provide new perspectives on HIV treatment.
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Affiliation(s)
| | - Sijun Li
- Department of Internal Medicine, The Fourth People's Hospital of Nanning, Nanning, China
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6
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Tap L, Vernooij MW, Wolters F, van den Berg E, Mattace-Raso FUS. New horizons in cognitive and functional impairment as a consequence of cerebral small vessel disease. Age Ageing 2023; 52:afad148. [PMID: 37585592 PMCID: PMC10431695 DOI: 10.1093/ageing/afad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/06/2023] [Indexed: 08/18/2023] Open
Abstract
Cerebral small vessel disease (cSVD) is a frequent finding in imaging of the brain in older adults, especially in the concomitance of cardiovascular disease risk factors. Despite the well-established link between cSVD and (vascular) cognitive impairment (VCI), it remains uncertain how and when these vascular alterations lead to cognitive decline. The extent of acknowledged markers of cSVD is at best modestly associated with the severity of clinical symptoms, but technological advances increasingly allow to identify and quantify the extent and perhaps also the functional impact of cSVD more accurately. This will facilitate a more accurate diagnosis of VCI, against the backdrop of concomitant other neurodegenerative pathology, and help to identify persons with the greatest risk of cognitive and functional deterioration. In this study, we discuss how better assessment of cSVD using refined neuropsychological and comprehensive geriatric assessment as well as modern image analysis techniques may improve diagnosis and possibly the prognosis of VCI. Finally, we discuss new avenues in the treatment of cSVD and outline how these contemporary insights into cSVD can contribute to optimise screening and treatment strategies in older adults with cognitive impairment and multimorbidity.
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Affiliation(s)
- Lisanne Tap
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank Wolters
- Department of Epidemiology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Francesco U S Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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7
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Manto M, Serrao M, Filippo Castiglia S, Timmann D, Tzvi-Minker E, Pan MK, Kuo SH, Ugawa Y. Neurophysiology of cerebellar ataxias and gait disorders. Clin Neurophysiol Pract 2023; 8:143-160. [PMID: 37593693 PMCID: PMC10429746 DOI: 10.1016/j.cnp.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
There are numerous forms of cerebellar disorders from sporadic to genetic diseases. The aim of this chapter is to provide an overview of the advances and emerging techniques during these last 2 decades in the neurophysiological tests useful in cerebellar patients for clinical and research purposes. Clinically, patients exhibit various combinations of a vestibulocerebellar syndrome, a cerebellar cognitive affective syndrome and a cerebellar motor syndrome which will be discussed throughout this chapter. Cerebellar patients show abnormal Bereitschaftpotentials (BPs) and mismatch negativity. Cerebellar EEG is now being applied in cerebellar disorders to unravel impaired electrophysiological patterns associated within disorders of the cerebellar cortex. Eyeblink conditioning is significantly impaired in cerebellar disorders: the ability to acquire conditioned eyeblink responses is reduced in hereditary ataxias, in cerebellar stroke and after tumor surgery of the cerebellum. Furthermore, impaired eyeblink conditioning is an early marker of cerebellar degenerative disease. General rules of motor control suggest that optimal strategies are needed to execute voluntary movements in the complex environment of daily life. A high degree of adaptability is required for learning procedures underlying motor control as sensorimotor adaptation is essential to perform accurate goal-directed movements. Cerebellar patients show impairments during online visuomotor adaptation tasks. Cerebellum-motor cortex inhibition (CBI) is a neurophysiological biomarker showing an inverse association between cerebellothalamocortical tract integrity and ataxia severity. Ataxic gait is characterized by increased step width, reduced ankle joint range of motion, increased gait variability, lack of intra-limb inter-joint and inter-segmental coordination, impaired foot ground placement and loss of trunk control. Taken together, these techniques provide a neurophysiological framework for a better appraisal of cerebellar disorders.
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Affiliation(s)
- Mario Manto
- Service des Neurosciences, Université de Mons, Mons, Belgium
- Service de Neurologie, CHU-Charleroi, Charleroi, Belgium
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Polo Pontino, Corso della Repubblica 79 04100, Latina, Italy
- Gait Analysis LAB Policlinico Italia, Via Del Campidano 6 00162, Rome, Italy
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Polo Pontino, Corso della Repubblica 79 04100, Latina, Italy
- Gait Analysis LAB Policlinico Italia, Via Del Campidano 6 00162, Rome, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi, 21, 27100 Pavia, Italy
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Elinor Tzvi-Minker
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
- Syte Institute, Hamburg, Germany
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 10002, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei City 11529, Taiwan
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Sheng-Han Kuo
- Institute of Biomedical Sciences, Academia Sinica, Taipei City 11529, Taiwan
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
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Gagliardo A, Grippo A, Di Stefano V, Carrai R, Scarpino M, Martini M, Falsini C, Rimmaudo G, Brighina F. Spatial and Temporal Gait Characteristics in Patients Admitted to a Neuro-Rehabilitation Department with Age-Related White Matter Changes: A Gait Analysis and Clinical Study. Neurol Int 2023; 15:708-724. [PMID: 37368328 DOI: 10.3390/neurolint15020044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Patients with age-related white matter changes (ARWMC) frequently present a gait disorder, depression and cognitive impairment. Our aims are to define which alterations in the gait parameters are associated with motor or neuro-psychological impairment and to assess the role of motor, mood or cognitive dysfunction in explaining the variance of the gait parameters. METHODS Patients with gait disorders admitted to a Neuro-rehabilitation Department, affected by vascular leukoencephalopathy who had ARWMC confirmed by a brain MRI, were consecutively enrolled, classified by a neuroradiological scale (Fazekas 1987) and compared to healthy controls. We excluded subjects unable to walk independently, subjects with hydrocephalus or severe aphasia, with orthopaedic and other neurological pathologies conditioning the walking pattern. Patients and controls were assessed by clinical and functional scales (Mini Mental State Examination, Geriatric Depression Scale, Nevitt Motor Performance Scale, Berg Balance Scale, Functional Independence Measure), and computerised gait analysis was performed to assess the spatial and temporal gait parameters in a cross-sectional study. RESULTS We recruited 76 patients (48 males, aged 78.3 ± 6.2 years) and 14 controls (6 males, aged 75.8 ± 5 years). In the multiple regression analysis, the gait parameter with overall best model summary values, associated with the ARWMC severity, was the stride length even after correction for age, sex, weight and height (R2 = 0.327). The motor performances justified at least in part of the gait disorder (R2 change = 0.220), but the mood state accounted independently for gait alterations (R2 change = 0.039). The increase in ARWMC severity, the reduction of motor performance and a depressed mood state were associated with a reduction of stride length (R = 0.766, R2 = 0.587), reduction of gait speed (R2 = 0.573) and an increase in double support time (R2 = 0.421). CONCLUSION The gait disorders in patients with ARWMC are related to motor impairment, but the presence of depression is an independent factor for determining gait alterations and functional status. These data pave the way for longitudinal studies, including gait parameters, to quantitatively assess gait changes after treatment or to monitor the natural progression of the gait disorders.
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Affiliation(s)
- Andrea Gagliardo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Riccardo Carrai
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Monica Martini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
| | | | - Giulia Rimmaudo
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
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Marshall S, Gabiazon R, Persaud P, Nagamatsu LS. What do functional neuroimaging studies tell us about the association between falls and cognition in older adults? A systematic review. Ageing Res Rev 2023; 85:101859. [PMID: 36669688 DOI: 10.1016/j.arr.2023.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
Impaired cognition is a known risk factor for falls in older adults. To enhance prevention strategies and treatment of falls among an aging global population, an understanding of the neural processes and networks involved is required. We present a systematic review investigating how functional neuroimaging techniques have been used to examine the association between falls and cognition in seniors. Peer-reviewed articles were identified through searching five electronic databases: 1) Medline, 2) PsycINFO, 3) CINAHL, 4) EMBASE, and 5) Pubmed. Key author, key paper, and reference searching was also conducted. Nine studies were included in this review. A questionnaire composed of seven questions was used to assess the quality of each study. EEG, fMRI, and PET were utilized across studies to examine brain function in older adults. Consistent evidence demonstrates that cognition is associated with measures of falls/falls risk, specifically visual attention and executive function. Our results show that falls/falls risk may be implicated with specific brain regions and networks. Future studies should be prospective and long-term in nature, with standardized outcome measures. Mobile neuroimaging techniques may also provide insight into brain activity as it pertains to cognition and falls in older adults in real-world settings.
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Affiliation(s)
- Samantha Marshall
- Faculty of Health Sciences, School of Kinesiology, Western University, Ontario, Canada
| | - Raphael Gabiazon
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Priyanka Persaud
- Faculty of Health Sciences, School of Kinesiology, Western University, Ontario, Canada
| | - Lindsay S Nagamatsu
- Faculty of Health Sciences, School of Kinesiology, Western University, Ontario, Canada.
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10
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Zedde M, Linn J, Katsanos AH, Pascarella R. Editorial: Small vessel disease: From diagnosis to organized management pathways. Front Neurol 2023; 13:1120426. [PMID: 36703631 PMCID: PMC9872149 DOI: 10.3389/fneur.2022.1120426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy,*Correspondence: Marialuisa Zedde ✉
| | - Jennifer Linn
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Aristeidis H. Katsanos
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Montero-Odasso M. Are falls a manifestation of brain failure? Revisited 40 years later. Age Ageing 2023; 52:afac321. [PMID: 36626324 PMCID: PMC9831260 DOI: 10.1093/ageing/afac321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Manuel Montero-Odasso
- Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
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Zou X, Dong Z, Chen X, Yu Q, Yin H, Yi L, Zuo H, Xu J, Du X, Han Y, Zou D, Peng J, Cheng O. White matter hyperintensities burden in the frontal regions is positively correlated to the freezing of gait in Parkinson's disease. Front Aging Neurosci 2023; 15:1156648. [PMID: 37181626 PMCID: PMC10172504 DOI: 10.3389/fnagi.2023.1156648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Objective Previous studies have reported that white matter hyperintensities (WMHs) are associated with freezing of gait (FOG), but it is not clear whether their distribution areas have correlations with FOG in Parkinson's disease (PD) and the potential influencing factors about WMHs. Methods Two hundred and forty-six patients with PD who underwent brain MRI were included. Participants were divided into PD with FOG (n = 111) and PD without FOG (n = 135) groups. Scheltens score was used to assess the WMHs burden in the areas of deep white matter hyperintensities (DWMHs), periventricular hyperintensities (PVHs), basal ganglia hyperintensities (BGHs), and infratentorial foci of hyperintensities (ITF). Whole brain WMHs volume was evaluated by automatic segmentation. Binary logistic regression was used to evaluate relationships between WMHs and FOG. The common cerebrovascular risk factors that may affect WMHs were evaluated by mediation analysis. Results There were no statistical differences between PD with and without FOG groups in whole brain WMHs volume, total Scheltens score, BGHs, and ITF. Binary logistic regression showed that the total scores of DWMHs (OR = 1.094; 95% CI, 1.001, 1.195; p = 0.047), sum scores of PVHs and DWMHs (OR = 1.080; 95% CI, 1.003, 1.164; p = 0.042), especially the DWMHs in frontal (OR = 1.263; 95% CI, 1.060, 1.505 p = 0.009), and PVHs in frontal caps (OR = 2.699; 95% CI, 1.337, 5.450; p = 0.006) were associated with FOG. Age, hypertension, and serum alkaline phosphatase (ALP) are positively correlated with scores of DWMHs in frontal and PVHs in frontal caps. Conclusion These results indicate that WMHs distribution areas especially in the frontal of DWMHs and PVHs play a role in PD patients with FOG.
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Affiliation(s)
- Xiaoya Zou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhaoying Dong
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinwei Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Yu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huimei Yin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Yi
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongzhou Zuo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaman Xu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyi Du
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Han
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dezhi Zou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Peng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Juan Peng,
| | - Oumei Cheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Oumei Cheng,
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Sheets KM, Buzkova P, Chen Z, Carbone LD, Cauley JA, Barzilay JI, Starks JL, Miller LM, Fink HA. Association of covert brain infarcts and white matter hyperintensities with risk of hip fracture in older adults: the Cardiovascular Health Study. Osteoporos Int 2023; 34:91-99. [PMID: 36355067 PMCID: PMC9812913 DOI: 10.1007/s00198-022-06565-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
Covert brain infarcts and white matter hyperintensities (WMHs), incidental markers of brain microvascular disease commonly seen on brain MRIs in older adults, have been associated with falls and lower bone mineral density. We found covert infarcts and WMHs may also be associated with an increased risk of future hip fracture. INTRODUCTION To determine whether covert infarcts and white matter hyperintensities (WMHs) are associated with increased risk of incident hip fracture. METHODS A prospective cohort of 3373 community-dwelling adults aged ≥ 65 years enrolled in the Cardiovascular Health Study with a brain MRI (1992-1993) was analyzed. Covert infarcts were categorized by number of infarcts and largest infarct size. WMH burden was assessed by radiologists and graded qualitatively from 0 (no WMHs) to 9 (extensive). RESULTS Participants had 465 incident hip fractures during a mean follow-up of 12.8 years. The demographic-adjusted hazard of incident hip fracture was 32% higher among participants with ≥ 1 covert infarct compared to those without infarcts (hazard ratio (HR) 1.32; 95% CI, 1.08-1.62). The hazard of incident hip fracture was similar after further adjustment for medications and medical history (HR = 1.34; 95% CI, 1.08-1.65), but attenuated following additional adjustment for functional status, frailty, and falls (HR = 1.25; 95% CI, 0.99-1.57). Fully adjusted hazard of incident hip fracture per increase in infarct number was 1.10 (95% CI, 0.98-1.23); risk in individuals whose largest infarct was ≥ 20 mm versus 3 to < 20 mm was similar. Compared with WMH grades 0-1, the demographic-adjusted hazard of hip fracture was 1.34 (95% CI, 1.09-1.66) and 1.83 (95% CI, 1.37-2.46), respectively, for WMH grades 2-3 and 4-9. The hazard was similar following adjustment for medications and medical history (grades 2-3: HR = 1.32; 95% CI, 1.05-1.64; grades 4-9: HR = 1.69; 95% CI, 1.23-2.30), but attenuated following additional adjustment for functional status, frailty, and falls (grades 2-3: HR = 1.24; 95% CI, 0.98-1.56; grades 4-9: HR = 1.34; 95% CI, 0.95-1.90). CONCLUSION Older, community-dwelling adults with covert infarcts or WMHs may be at increased risk of hip fracture.
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Affiliation(s)
- Kerry M Sheets
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare, 701 Park Ave, Minneapolis, MN, 55415, USA.
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Zhao Chen
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Center, Augusta, GA, USA
- Department of Medicine, J. Harold Harrison M.D. Distinguished Chair in Rheumatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburg, Pittsburg, PA, USA
| | - Joshua I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, Duluth, GA, USA
- Division of Endocrinology, Emory University School of Medicine, Druid Hills, USA
| | - Jamie L Starks
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
- Department of Neurology, VA Health Care System, Minneapolis, MN, USA
| | - Lindsay M Miller
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA, USA
| | - Howard A Fink
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN, USA
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Su C, Yang X, Wei S, Zhao R. Periventricular white matter hyperintensities are associated with gait and balance in patients with minor stroke. Front Neurol 2022; 13:941668. [PMID: 35937058 PMCID: PMC9355320 DOI: 10.3389/fneur.2022.941668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveCerebral small vessel disease (CSVD) is associated with gait and balance deficits in older adults. However, the effect of CSVD-related brain injury on post-stroke mobility is unknown. This study aimed to investigate the association of CSVD with gait and balance impairment after a minor stroke.MethodsA total of 273 patients with a minor stroke (NIHSS ≤ 5 points) who were hospitalized at the Affiliated Hospital of Qingdao University were enrolled. The manifestations of white matter hyperintensities (WMH), lacunes, enlarged perivascular spaces (EPVS), and cerebral microbleeds (CMB) were statistically analyzed according to magnetic resonance imaging results, and the total burden score of CSVD was calculated. Gait function was assessed by a 6-m walking speed test, and balance function was assessed by the timed-up-and-go (TUG) test. Linear regression analysis was applied to determine the association after adjusting for key variables.ResultsThe correlation results showed that in patients with minor stroke, age, sex, smoking history, and the infarct site were associated with gait speed, and age and the infarct site were associated with the TUG test. In the univariate linear regression model, periventricular white matter hyperintensities (PVWMH), deep white matter hyperintensities (DWMH), and the total burden of CSVD were correlated with gait speed, while only PVWMH correlated with the TUG test. After adjusting for confounders, only PVWMH were independent predictors of gait speed (β = −0.089, p < 0.05) and the TUG test (β = 0.517, p < 0.05).ConclusionsOur study confirmed that CSVD is associated with gait and balance disorders after a minor stroke. PVWMH are independent predictors of gait and balance disorders in patients with minor stroke. These findings should be confirmed in larger prospective studies.
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Su C, Yang X, Wei S, Zhao R. Association of Cerebral Small Vessel Disease With Gait and Balance Disorders. Front Aging Neurosci 2022; 14:834496. [PMID: 35875801 PMCID: PMC9305071 DOI: 10.3389/fnagi.2022.834496] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/14/2022] [Indexed: 12/27/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common cerebrovascular disease and an important cause of gait and balance disorders. Gait and balance disorders can further lead to an increased risk of falls and a decreased quality of life. CSVD can damage gait and balance function by affecting cognitive function or directly disrupting motor pathways, and different CSVD imaging features have different characteristics of gait and balance impairment. In this article, the correlation between different imaging features of sporadic CSVD and gait and balance disorders has been reviewed as follows, which can provide beneficial help for standardized management of CSVD.
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16
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Bastos P, Barbosa R. Motor reserve: How to build neuronal resilience against ageing and neurodegeneration? Rev Neurol (Paris) 2022; 178:845-854. [DOI: 10.1016/j.neurol.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/14/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
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Effect of Executive Dysfunction on Posture Control and Gait after Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3051750. [PMID: 34675982 PMCID: PMC8526208 DOI: 10.1155/2021/3051750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
Objective The purpose of the study was to observe the effects of executive dysfunction (ED) on gait and postural control during walking after stroke. Methods In this study, 34 subjects with stroke and ED (8 women and 26 men; age, 55.41 ± 7.89 years; time since stroke onset, 1.3 ± 0.12 months) were recruited. Stroop color-word test (SCWT), 10-meter walk test (10MWT), timed-up-and-go test (TUGT), and gait analysis were evaluated. The correlation among the correct number of Stroop tasks (SCWT-C), the number of time-consuming tasks (SCWT-T), the amount of interference (SIE-M and SIE-T) and posture control, and gait-related parameters was analyzed. Results The results indicated that SCWT-C was negatively correlated with 10MWT, TUGT, and bilateral symmetry (P < 0.05). However, there was no significant correlation between SCWT-C and stride (P > 0.05). A significant negative correlation was seen between SCWT-C and bilateral symmetry (P < 0.05). There was no significant correlation between SCWT-T and stride (P > 0.05). SCWT-T was positively correlated with TUGT, 10MWT, and bilateral symmetry (P < 0.05). SIE-T was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). SIE-M was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). Conclusions ED is closely related to the decline in postural control and the occurrence of falls. In the early phases of stroke rehabilitation, physiotherapists should focus on the patients' executive function to accelerate the recovery of postural control.
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18
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Mind the gaps: functional networks disrupted by white matter hyperintensities are associated with greater falls risk. Neurobiol Aging 2021; 109:166-175. [PMID: 34740078 DOI: 10.1016/j.neurobiolaging.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 12/12/2022]
Abstract
White matter hyperintensities (WMH) are associated with greater falls risk and slow gait speed. Whether these deficits are caused by the disruption of large-scale functional networks remains inconclusive. Further, physical activity moderates the association between WMHs and falls, but whether this extends to the disruption of functional networks remains unknown. One hundred and sixty-four adults (>55 years old) were included in this study. Using lesion network mapping, we identified significant correlations between the percentage of WMH-related disruption of the dorsal attention network and Physiological Profile Assessment (PPA) score (r = 0.24, p < 0.01); and between disruption of both the sensorimotor (r = 0.23, p < 0.01) and ventral attention networks (r = 0.21, p = 0.01) with foam sway. There were no significant associations with floor sway or gait speed. Physical activity moderated the association between the dorsal attention network and PPA score (p = 0.045). Thus, future research should investigate whether physical activity should be recommended in the clinical management of older adults with cerebral small vessel disease.
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19
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Jokinen H, Laakso HM, Ahlström M, Arola A, Lempiäinen J, Pitkänen J, Paajanen T, Sikkes SAM, Koikkalainen J, Lötjönen J, Korvenoja A, Erkinjuntti T, Melkas S. Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease. Eur J Neurol 2021; 29:158-167. [PMID: 34528346 DOI: 10.1111/ene.15108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive and motor impairments are the key clinical manifestations of cerebral small vessel disease (SVD), but their combined effects on functional outcome have not been elucidated. This study investigated the interactions and mediating effects of cognitive and motor functions on instrumental activities of daily living (IADL) and quality of life in older individuals with various degrees of white matter hyperintensities (WMH). METHODS Participants of the Helsinki Small Vessel Disease Study (n = 152) were assessed according to an extensive clinical, physical, neuropsychological and MRI protocol. Volumes of WMH and gray matter (GM) were obtained with automated segmentation. RESULTS Cognitive (global cognition, executive functions, processing speed, memory) and motor functions (gait speed, single-leg stance, timed up-and-go) had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and GM volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant-evaluated IADL, but not on self-evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of GM volume with IADL was mediated by global cognition and timed up-and-go performance. CONCLUSION The results highlight the complex interplay and synergism between motor and cognitive abilities on functional outcome in SVD. The combined effect of motor and cognitive disturbances on IADL is likely to be greater than their individual effects. Patients with both impairments are at disproportionate risk for poor outcome. WMH and brain atrophy contribute to disability through cognitive and motor impairment.
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Affiliation(s)
- Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna M Laakso
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Matti Ahlström
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anne Arola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Lempiäinen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Pitkänen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Teemu Paajanen
- Research and Service Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Sietske A M Sikkes
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands.,Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands
| | - Juha Koikkalainen
- Combinostics Ltd, Tampere, Finland.,Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jyrki Lötjönen
- Combinostics Ltd, Tampere, Finland.,Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland
| | - Antti Korvenoja
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timo Erkinjuntti
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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20
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Effect of Cognitive Function on Balance and Posture Control after Stroke. Neural Plast 2021; 2021:6636999. [PMID: 33574837 PMCID: PMC7861954 DOI: 10.1155/2021/6636999] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/01/2021] [Accepted: 01/13/2021] [Indexed: 11/17/2022] Open
Abstract
Hemiplegic gait is the most common sequela of stroke. Patients with hemiplegic gait are at a risk of falling because of poor balance. The theory of cognitive-motor networks paved the way for a new field of research. However, the mechanism of the relationship of cognition with gait or posture control networks is unclear because of the dynamic characteristics of walking and changing postures. To explore differences in the balance function and fall risk between patients with and without cognitive impairment after stroke, we utilized the Berg balance scale, Timed “Up and Go” test, and 10 m walking test. Patients were divided into two groups: the observation group (16 patients, female 6 and male 10), comprising patients with cognitive impairment after stroke, and the control group (16 patients, female 7 and male 9), comprising patients without cognitive impairment after stroke. We found that patients with cognitive impairment had worse balance function and a higher risk of falls. They needed a longer time to turn around or sit down. Our findings indicated that posture control in turning around and sitting down required more cognitive resources in daily life.
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21
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Galvin JE, Cohen I, Greenfield KK, Walker M. The Frontal Behavioral Battery: A Measure of Frontal Lobe Symptoms in Brain Aging and Neurodegenerative Disease. J Alzheimers Dis 2021; 83:721-739. [PMID: 34366351 PMCID: PMC10731583 DOI: 10.3233/jad-210446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Approximately 90%of persons living with dementia experience behavioral symptoms, including frontal lobe features involving motivation, planning, social behavior, language, personality, mood, swallowing, and gait. OBJECTIVE We conducted a two-stage study with a development sample (n = 586) and validation sample (n = 274) to evaluate a brief informant-rated measure of non-cognitive features of frontal lobe dysfunction: the Frontal Behavioral Battery (FBB). METHODS In the development sample, internal consistency, principal factor analysis, and correlations between the FBB and outcomes were evaluated. In the validation sample, we examined (a) FBB scores by diagnosis, (b) known-group validity by demographics, subjective complaints, and dementia staging, and (c) correlation between FBB and MRI volumes. Receiver operator characteristic curves assessed the ability of the FBB to discriminate individuals with frontal lobe features due to a neurodegenerative disease. RESULTS The FBB characterized 11 distinct frontal lobe features. Individuals with dementia with Lewy bodies and frontotemporal degeneration had the greatest number of frontal lobe features. Premorbid personality traits of extroversion, agreeableness, and openness were associated with fewer frontal lobe behavioral symptoms, while subjective cognitive complaints were associated with greater symptoms. The FBB provided very good discrimination between individuals with and without cognitive impairment (diagnostic odds ratio: 13.1) and between individuals with and without prominent frontal lobe symptoms (diagnostic odds ratio: 84.8). CONCLUSION The FBB may serve as an effective and efficient method to assess the presence of non-cognitive symptoms associated with frontal lobe dysfunction, but in a brief fashion that could facilitate its use in clinical care and research.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Iris Cohen
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keri K. Greenfield
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcia Walker
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Effects of Nintendo Wii fit game training on balance among Lebanese older adults. Aging Clin Exp Res 2020; 32:2271-2278. [PMID: 31802405 DOI: 10.1007/s40520-019-01425-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Falls are the second leading cause of accidental death, with persons older than 65 years being the most affected. Moreover, gait- and balance-related problems represent the most consistent predictors of future falls. AIMS The aim was to determine the effects of Wii fit game training on dynamic and static balance among Lebanese older adults. METHODS A randomized-controlled trial was conducted over a period of 8 weeks, where institutionalized older adults with no history of falls were randomized into two groups. The participants of each group were carefully followed up during the intervention and data collection periods. The intervention group was trained for standing balance during a 40-min session, starting with the "Soccer Heading" game during the first 4 weeks, followed by the "Table Tilt" game for the remaining 4 weeks. Timed up-and-go (TUG) test and the Nintendo Wii Balance Board were used to measure the dynamic and static balance, respectively, both at baseline and post-intervention. RESULTS Sixty-four participants recruited from both, the Tyre and Saida districts were enrolled in the study. Within-group comparison of TUG test values between baseline and post-intervention; both groups showed an extremely significant difference (P = 0.000). Similarly, the between-group comparison showed a significant difference (P = 0.013). Concerning the center of pressure measures, only the intervention group showed a very significant improvement between baseline and post-intervention measures (P = 0.002). CONCLUSION Wii fit balance training is a valid method for improving both dynamic and static balance among Lebanese older adults.
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Chung SJ, Lee JJ, Lee PH, Sohn YH. Emerging Concepts of Motor Reserve in Parkinson's Disease. J Mov Disord 2020; 13:171-184. [PMID: 32854486 PMCID: PMC7502292 DOI: 10.14802/jmd.20029] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/05/2020] [Indexed: 01/18/2023] Open
Abstract
The concept of cognitive reserve (CR) in Alzheimer's disease (AD) explains the differences between individuals in their susceptibility to AD-related pathologies. An enhanced CR may lead to less cognitive deficits despite severe pathological lesions. Parkinson's disease (PD) is also a common neurodegenerative disease and is mainly characterized by motor dysfunction related to striatal dopaminergic depletion. The degree of motor deficits in PD is closely correlated to the degree of dopamine depletion; however, significant individual variations still exist. Therefore, we hypothesized that the presence of motor reserve (MR) in PD explains the individual differences in motor deficits despite similar levels of striatal dopamine depletion. Since 2015, we have performed a series of studies investigating MR in de novo patients with PD using the data of initial clinical presentation and dopamine transporter PET scan. In this review, we summarized the results of these published studies. In particular, some premorbid experiences (i.e., physical activity and education) and modifiable factors (i.e., body mass index and white matter hyperintensity on brain image studies) could modulate an individual's capacity to tolerate PD pathology, which can be maintained throughout disease progression.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Jae Jung Lee
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Zakharov VV, Vakhnina NV, Gogoleva AG, Mezhmidinova SK. Diagnostics and treatment of chronic cerebral ischemia. ACTA ACUST UNITED AC 2020. [DOI: 10.21518/2079-701x-2020-8-36-45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
5560 patients with the diagnosis “Other cerebral vascular diseases” per 100 000 of elderly population were registered in RF in 2017. Usually this is a code for chronic brain ischemia (CBI) – the most popular diagnosis in Russian neurological practice. However, diagnostic criteria of CBI are not well defined and need to be ascertained. Recent studies show that the most reliable clinical feature of CBI could be cognitive impairment. It is developed before other clinical signs and correlate with severity of vascular brain lesions. Typically, cognitive impairment is subcortical with prominent bradyphrenia, attentional, dysexecutive and visuospatial deficit and relative sparing of memory. However clinical diagnosis of CBI could be only hypothetical. Diagnosis should be verified by MRI or other visualization technic. Diagnosis is verified if neuroimaging revealed silent strokes, microbleeds and vascular leukoencephalopathy. The most important objective of chronic brain ischemia management is the control of basic vascular disease. Besides this, pathogenetic therapy should be performed to improve cerebral microcirculation, neuronal metabolism and to provide neuroprotection. There is positive data on dipyridamole usage in chronic brain ischemia. It has desagregative, vasotropic, antioxidative and antiinflammation properties. Dypiridamole treatment in CBI patients lead to decrease of neuropsychiatric symptoms and improvement of well-being.
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Affiliation(s)
- V. V. Zakharov
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
| | - N. V. Vakhnina
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
| | - A. G. Gogoleva
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
| | - S. K. Mezhmidinova
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
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25
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Lee Y, Ko J, Choi YE, Oh JS, Kim JS, Sunwoo MK, Yoon JH, Kang SY, Hong JY. Areas of white matter hyperintensities and motor symptoms of Parkinson disease. Neurology 2020; 95:e291-e298. [PMID: 32576636 DOI: 10.1212/wnl.0000000000009890] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/10/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether deep white matter and periventricular hyperintensities affect the motor symptoms of Parkinson disease (PD) differently, we analyzed MRI and dopamine transporter imaging. METHODS We analyzed the medical records of patients with de novo PD who underwent dopamine transporter PET scanning and MRI at their first visit. Deep white matter and periventricular hyperintensities were scored with a visual rating scale, and motor symptoms were assessed by Unified Parkinson's Disease Rating Scale motor score and tremor, rigidity, bradykinesia, and axial symptom subscores. The influence of white matter hyperintensity on motor symptoms was explored using multivariable linear regression models. RESULTS A total of 93 patients (mean age, 67.2 ± 9.9 years; 44 male) were included and the mean motor score was 25.0 ± 10.8. Subscores for bradykinesia and axial symptoms were correlated with both deep white matter and periventricular hyperintensities scores. Multivariable linear regression models revealed that deep white matter hyperintensities score was significantly associated with subscore for bradykinesia and periventricular hyperintensities score was associated with subscores for bradykinesia and axial symptoms after adjusting for putaminal dopamine transporter availability and clinical factors. CONCLUSIONS These results demonstrate that deep white matter hyperintensities are associated with bradykinesia and periventricular hyperintensities are associated with bradykinesia and axial symptoms in patients with PD independently of the severity of dopaminergic depletion.
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Affiliation(s)
- Yoonju Lee
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jeongmin Ko
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Ye Eun Choi
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jungsu S Oh
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jae Seung Kim
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Mun Kyung Sunwoo
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jung Han Yoon
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Suk Yun Kang
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jin Yong Hong
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea.
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26
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Chabriat H, Jouvent E. Imaging of the aging brain and development of MRI signal abnormalities. Rev Neurol (Paris) 2020; 176:661-669. [PMID: 32229042 DOI: 10.1016/j.neurol.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 02/04/2023]
Abstract
Major changes occur at the cerebral level with aging. Cerebral atrophy develops progressively. Multiple lesions related to small-vessel diseases are detected in association with cerebral atrophy including white-matter hyperintensities, lacunes, microbleeds, dilated perivascular spaces and cerebral, including cortex, atrophy. The clinical impact and predictive value of these Imaging makers were examined.
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Affiliation(s)
- H Chabriat
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France.
| | - E Jouvent
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France
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27
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Wang B, Zhang J, Pan W, Cao S, Li B, Bai L, Hu P, Tian Y, Jiang D, Wang K. Differential Influence of Location-Specific White-Matter Hyperintensities on Attention Subdomains Measured Using the Attention Network Test. Med Sci Monit 2020; 26:e921874. [PMID: 31940305 PMCID: PMC6983326 DOI: 10.12659/msm.921874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Elderly people with white-matter hyperintensities (WMHs) typically show cognitive impairment. Attention, consisting of 3 independent component processes (alerting, orienting, and executive control), is crucial for cognitive functioning. Little is known about how WMHs interfere with these attention subdomains. In the present study, we sought to describe characteristics of attention deficits in patients with age-related WMHs and to assess whether the severity and location of lesions differentially affect specific attention subdomains using the attention network test (ANT), which is a computer-based paradigm tailored to accurately provide behavioral measures of the aforementioned subdomains. MATERIAL AND METHODS A total of 39 WMH patients and 39 age-, sex-, and education-matched controls underwent comprehensive neuropsychological and ANT evaluation. Brain magnetic resonance imaging (MRI) was performed to visualize severity of total and location-specific WMH lesions. Multiple linear regression analyses adjusted for possible confounders were performed. RESULTS Compared with controls, WMH patients showed pronounced deficits in orienting and executive control efficiencies (P<0.050), but not alerting efficiency (P=0.642). As total WMH severity increased, efficiencies in the impaired subdomains significantly declined (P<0.050). In terms of lesion location, fronto-parietal type of periventricular WMH (PWMH) and deep WMH (DWMH) in the parietal lobe affected orienting efficiency, while all PWMH types and DWMH in the frontal, parietal, and temporal lobes affected executive control efficiency (P<0.050). Additional adjustment for other MRI lesions significantly changed the impact on orienting, but not on executive control efficiency. CONCLUSIONS Our results reveal specific attention deficits in patients with age-related WMH and may help clarify how the location of lesions influences their effects on attention subdomains.
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Affiliation(s)
- Bing Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Department of Neurology, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland)
| | - Jun Zhang
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland).,Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Wen Pan
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
| | - Shanshan Cao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
| | - Bin Li
- Department of Neurology, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China (mainland)
| | - Lu Bai
- Department of Neurology, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China (mainland)
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
| | - Dan Jiang
- Department of Neurology, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China (mainland)
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China (mainland).,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China (mainland)
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28
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Brain White Matter: A Substrate for Resilience and a Substance for Subcortical Small Vessel Disease. Brain Sci 2019; 9:brainsci9080193. [PMID: 31398858 PMCID: PMC6721396 DOI: 10.3390/brainsci9080193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 01/01/2023] Open
Abstract
Age-related brain white matter disease is a form of small vessel disease (SVD) that may be associated with lacunar and other small subcortical infarcts, cerebral microbleeds, and perivascular spaces. This common form of cerebrovascular disease may manifest clinically as cognitive impairment of varying degrees and difficulty with mobility. Whereas some persons show cognitive decline and mobility failure when there are brain white matter hyperintensities (WMH) and acute stroke, others recover, and not everyone with brain white matter disease is disabled. Thus, repair or compensation of brain white matter may be possible, and furthermore, certain vascular risks, such as raised blood pressure, are targets for prevention of white matter disease or are administered to reduce the burden of such disease. Vascular risk modification may be useful, but alone may not be sufficient to prevent white matter disease progression. In this chapter, we specifically focus on WMH of vascular origin and explore white matter development, plasticity, and enduring processes of myelination across the health span in the context of experimental and human data, and compare and contrast resilient brain white matter propensity to a diseased white matter state. We conclude with thoughts on novel ways one might study white matter resilience, and predict future healthy cognitive and functional outcomes.
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29
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Age- and disease-related cerebral white matter changes in patients with Parkinson's disease. Neurobiol Aging 2019; 80:203-209. [DOI: 10.1016/j.neurobiolaging.2019.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 11/18/2022]
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30
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White matter hyperintensities as a predictor of freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2019; 66:105-109. [PMID: 31324555 DOI: 10.1016/j.parkreldis.2019.07.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/14/2019] [Accepted: 07/14/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION To investigate the effect of white matter hyperintensities (WMH) on long-term motor outcomes in Parkinson's disease (PD). METHODS We retrospectively reviewed medical records of 268 patients with de novo PD (follow-up > 3 years). According to the Clinical Research Center for Dementia of South Korea (CREDOS) WMH visual rating scale scores, the patients were divided into two groups: a PD group with minimal WMH (PD-WMH-; n = 198) and a PD group with moderate to severe WMH (PD-WMH+; n = 70). We compared longitudinal increases in doses of dopaminergic medications between the two groups using a mixed model. We also assessed the effects of WMH on the development of freezing of gait (FOG). RESULTS Patients in the PD-WMH + group were older than those in the PD-WMH- group, and had more severe motor deficits and more severely decreased striatal dopamine transporter availability. The PD-WMH + group required higher doses of dopaminergic medications for symptom control, compared to the PD-WMH- group, over the follow-up period. After adjusting for age, sex, striatal dopamine transporter availability, and levodopa-equivalent dose, the PD-WMH + group showed a higher risk of developing FOG (HR, 3.29; 95% CI, 1.79-6.05; p < 0.001) than the PD-WMH- group. CONCLUSION This study demonstrates that WMH burden negatively affects the longitudinal requirement of dopaminergic medication and the development of FOG. These findings suggest that baseline WMH severity or volume may be a useful prognostic marker of motor outcomes in PD.
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31
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Can the trail making test black and white predict white matter hyperintensity on MRI? J Clin Neurosci 2019; 64:155-159. [DOI: 10.1016/j.jocn.2019.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
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32
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Ko EJ, Choi KH, Kwon SU. The Relationship Between Leukoaraiosis Involving Contralateral Corticobulbar Tract and Dysphagia in Patients with Acute Unilateral Corona Radiata Infarction with Corticobulbar Tract Involvement. Dysphagia 2018; 34:654-664. [PMID: 30465078 DOI: 10.1007/s00455-018-9963-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/14/2018] [Indexed: 02/04/2023]
Abstract
This study investigated the impact of leukoaraiosis (LA) involving the contralateral corticobulbar tract (CBT) on dysphagia in patients with unilateral corona radiata (CR) infarction with CBT involvement. Patients admitted to the Department of Neurology (September 2011-August 2014) were evaluated; those with a first episode of acute unilateral CR infarction involving the CBT and with LA were included. The 'Case' group comprised patients with LA involving the contralateral CBT; the 'Control' group comprised patients with LA not involving the contralateral CBT. The primary outcome was the feeding method at discharge; secondary outcomes were the feeding method at admission and results of the bedside swallowing test, videofluoroscopic swallowing study (VFSS), videofluoroscopic dysphagia scale, penetration-aspiration scale, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA NOMS), oral transit time, and pharyngeal transit time. Infarct size was measured using brain magnetic resonance imaging; LA severity was rated using the Fazekas scale. Eighty-one patients were included (mean age 64.6 ± 11.5 years; 64% male; Case group: 20, 5 underwent VFSS; Control group: 67, 11 underwent VFSS). The Case group was older and had higher total Fazekas scale score than the Control group. The feeding method at discharge and ASHA NOMS score were significantly worse in the Case group than in the Control group. Multivariate analysis revealed that LA involving the contralateral CBT independently predicted the feeding method at discharge and ASHA NOMS score. In conclusion, LA involving the contralateral CBT is associated with dysphagia in patients with unilateral CR infarction involving the CBT.
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Affiliation(s)
- Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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33
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Moon HI, Kim GS, Lee E. Is the Location of White Matter Lesions Important in the Swallowing Function of Older Patients with Mild Stroke? Dysphagia 2018; 34:407-414. [PMID: 30382381 DOI: 10.1007/s00455-018-9955-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
Older patients with stroke have poor functional prognosis compared to younger patients. Patients with stroke who have severe white matter (WM) lesions have been reported to have swallowing problems. The aim of this study was to determine whether the location of WM lesions affects swallowing function in older patients with mild stroke. We conducted a retrospective analysis of 88 patients aged > 65 years who had a National Institutes of Health Stroke Scale score of ≤ 5 and who underwent videofluoroscopic swallowing examination after their first stroke. Participants were divided into three groups according to the involvement of corticobulbar tract (CBT) as follows: group I, no involvement of CBT; group II, involvement of CBT in one hemisphere; and group III, involvement of CBT in both hemispheres. Linear regression analysis showed that pharyngeal transit time tended to increase according to the involvement of CBT in WM lesion (p = 0.043). In addition, inadequate laryngeal elevation was related to the involvement of CBT (p = 0.016). Early spillage, inadequate laryngeal elevation, and penetration could also be predicted by Fazekas grade. Accordingly, the location of WM lesions can be regarded as a potential predictive factor for dysphagia. Moreover, in patients with WM lesions involving CBT, detailed evaluation of dysphagia is required.
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Affiliation(s)
- Hyun Im Moon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13590, Republic of Korea.
| | - Gyu Seong Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13590, Republic of Korea
| | - Eunchae Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13590, Republic of Korea
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34
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Henstra MJ, Houbolt CM, Seppala LJ, de Rooij SE, Rhebergen D, Stek ML, van der Velde N. Age modifies the association between apathy and recurrent falling in Dutch ambulant older persons with a high fall risk: Recurrent falling in Dutch outpatients, does apathy play a role? Exp Gerontol 2018; 112:54-62. [PMID: 30217662 DOI: 10.1016/j.exger.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
Abstract
Apathy, a common and disabling behavioural syndrome in older persons, has been associated with impaired physical performance and executive dysfunction. Both are fall risk factors and they share pathophysiological pathway. We cross-sectionally examined the association between apathy and recurrent falling (≥2 falls in the past 12 months) and number of falls in the past 12 months in 243 outpatients aged ≥65 years with ≥3 fall risk-factors visiting a fall-clinic after a fall. We calculated Odds Ratio's (ORs), Incidence Rate Ratio's (IRRs) and their 95% Confidential Intervals (CI95) using multivariable regression and negative binomial regression analyses. We adjusted for cognitive functioning, depression, the use of fall risk increasing drugs, visual impairment, urine incontinence, comorbidity, smoking, use of alcohol, body mass index (BMI), and the number of months between assessment of fall risk and of apathy. We assessed effect modification by age and gender. In our study, apathy was independently associated with recurrent falling in patients aged 65-75 years: OR 2.8 (CI95 1.0-7.7). Overall, patients with apathy experienced 1.46 times as many falls in the past 12 months compared to patients without apathy (IRR 1.46 (CI95 1.0-2.1). To conclude, in high fall-risk older outpatients, apathy was cross-sectionally associated with recurrent falling in patients aged 65-75 years and the number of falls. Apathy appeared to be especially relevant in relation to falling in this age group. Whether apathy predicts recurrent falling is yet to be determined.
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Affiliation(s)
- M J Henstra
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - C M Houbolt
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - L J Seppala
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - S E de Rooij
- UMCG Department of Internal Medicine, Geriatrics, University Medical Centre Groningen, Groningen, the Netherlands; AMC Department of Internal Medicine, Geriatrics, Academic Medical Center, University of Amsterdam, the Netherlands
| | - D Rhebergen
- Department of Psychiatry, GGZ inGeest, Amsterdam, the Netherlands; EMGO+ Institute for Health and Care Research VU Medical Center, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - M L Stek
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; GGZ inGeest/Department of Psychiatry, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, the Netherlands
| | - N van der Velde
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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35
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Ciliz M, Sartor J, Lindig T, Pilotto A, Schäffer E, Weiss M, Scheltens P, Becker S, Hobert MA, Berg D, Liepelt-Scarfone I, Maetzler W. Brain-Area Specific White Matter Hyperintensities: Associations to Falls in Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2018; 8:455-462. [DOI: 10.3233/jpd-181351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Meltem Ciliz
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jennifer Sartor
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University of Tuebingen, Tuebingen, Germany
| | - Andrea Pilotto
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Eva Schäffer
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Michael Weiss
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Sara Becker
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Markus A. Hobert
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
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Willey JZ, Moon YP, Dhamoon MS, Kulick ER, Bagci A, Alperin N, Cheung YK, Wright CB, Sacco RL, Elkind MSV. Regional Subclinical Cerebrovascular Disease Is Associated with Balance in an Elderly Multi-Ethnic Population. Neuroepidemiology 2018; 51:57-63. [PMID: 29953989 DOI: 10.1159/000490351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/22/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION White matter hyperintensity volume (WMHV) and subclinical brain infarcts (SBI) are associated with impaired mobility, but less is known about the association of WMHV in specific brain regions. We hypothesized that anterior WMHV would be associated with lower scores on the Short Physical Performance Battery (SPPB), a well-validated mobility scale. METHODS The SPPB was measured a median of 5 years after enrollment into the Northern Manhattan MRI sub study. Volumetric distributions for WMHV in 14 brain regions as a proportion of total cranial volume were determined. Multi-variable linear regression was performed to examine the association of SBI and regional log-WMHV with the SPPB score. RESULTS Among 668 participants with SPPB measurements (mean 74 ± 9 years, 37% male and 70% Hispanic), the mean SPPB score was 8.2 ± 2.9. Total (beta = -0.3 per SD, p = 0.001), anterior periventricular (beta = -0.4 per SD, p = 0.001), parietal (beta = -0.2 per SD, p = 0.02) and frontal (beta = -0.3 per SD, p = 0.002) WMHVs were associated with SPPB; other WMHV and SBI were not associated with the SPPB. CONCLUSIONS WMHV, especially in the anterior -cerebral regions, is associated with a lower SPPB. Prevention of subclinical cerebrovascular disease is a potential target to prevent physical decline in the elderly.
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Affiliation(s)
- Joshua Z Willey
- Department of Neurology, Columbia University, New York, New York, USA
| | - Yeseon P Moon
- Department of Neurology, Columbia University, New York, New York, USA
| | - Mandip S Dhamoon
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, USA
| | - Erin R Kulick
- Department of Epidemiology, Columbia University, New York, New York, USA
| | - Ahmet Bagci
- Evelyn McKnight Brain Institute, University of Miami, Miami, Florida, USA
| | - Noam Alperin
- Evelyn McKnight Brain Institute, University of Miami, Miami, Florida, USA
| | - Ying Kuen Cheung
- Department of Biostatistics, Columbia University, New York, New York, USA
| | | | - Ralph L Sacco
- Evelyn McKnight Brain Institute, University of Miami, Miami, Florida, USA.,Department of Neurology, University of Miami, Miami, Florida, USA
| | - Mitchell S V Elkind
- Department of Neurology, Columbia University, New York, New York, USA.,Department of Epidemiology, Columbia University, New York, New York, USA
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Fujino Y, Amimoto K, Sugimoto S, Fukata K, Inoue M, Uchino A, Takahashi H, Makita S. Relationship of white matter lesions and severity of pushing behavior after stroke. J Phys Ther Sci 2018; 29:2116-2120. [PMID: 29643587 PMCID: PMC5890213 DOI: 10.1589/jpts.29.2116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 09/06/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The relationship between white matter lesions (WMLs) and pushing behavior (PB)
is still poorly understood. The purpose of this study was to investigate whether damage
from WMLs affects the functional outcome of PB after acute stroke. [Subjects and Methods]
In total, 37 patients were included. PB was assessed using the standardized Scale for
Contraversive Pushing (SCP). Stroke types were classified as total anterior circulation
infarct (TACI), partial anterior circulation infarct (PACI), or lacunar syndrome using the
Bamford classification. WML severity was categorized into four groups using the Fazekas
visual scale. Thereafter, patients were divided into 4 groups according to the stroke type
and/or presence of WMLs. The SCP, Trunk Control Test (TCT), Stroke Impairment Assessment
Set (SIAS), and Barthel Index were the outcome measures. [Results] The SCP and TCT in
patients with PACI without WMLs were better than those in patients with TACI with or
without WMLs. Regarding SCP, TCT, and SIAS, patients with TACI had poorer values compared
with PACI, regardless of WML severity. Barthel Index efficiency was not significantly
different between the groups. [Conclusion] Our results suggest that moderate to severe
WMLs and PACI had a relationship with PB severity and truncal balance.
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Affiliation(s)
- Yuji Fujino
- Department of Rehabilitation, Saitama Medical University International Medical Center: 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Japan
| | - Satoshi Sugimoto
- Department of Physical Therapy, University of Tokyo Health Sciences, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center: 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center: 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Akira Uchino
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center: 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center: 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
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Dhamoon MS, Cheung YK, Bagci A, Alperin N, Sacco RL, Elkind MSV, Wright CB. Periventricular White Matter Hyperintensities and Functional Decline. J Am Geriatr Soc 2018; 66:113-119. [PMID: 29155435 PMCID: PMC5777880 DOI: 10.1111/jgs.15149] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES We previously showed that global brain white matter hyperintensity volume (WMHV) was associated with accelerated long-term functional decline. The objective of the current study was to determine whether WMHV in particular brain regions is more predictive of functional decline. DESIGN Prospective population-based study. SETTING Northern Manhattan magnetic resonance imaging (MRI) study. PARTICIPANTS Individuals free of stroke at baseline (N = 1,195; mean age 71 ± 9; n = 460 (39%) male). MEASUREMENTS Participants had brain MRI with axial T1, T2, and fluid attenuated inversion recovery sequences. Volumetric WMHV distribution across 14 brain regions (brainstem; cerebellum; bilateral frontal, occipital, temporal, and parietal lobes; and bilateral anterior and posterior periventricular white matter (PVWM)) was determined using a combination of bimodal image intensity distribution and atlas-based methods. Participants had annual functional assessments using the Barthel Index (BI) (range 0-100) over a mean of 7.3 years and were followed for stroke, myocardial infarction (MI), and mortality. Because there were multiple collinear variables, least absolute shrinkage and selection operator (LASSO) regression-selected regional WMHV variables most associated with outcomes and adjusted generalized estimating equations models were used to estimate associations with baseline BI and change over time. RESULTS Using LASSO regularization, only right anterior PVWM was found to meet criteria for selection, and each standard deviation greater WMHV was associated with accelerated functional decline of 0.95 additional BI points per year (95% confidence interval (CI) = -1.20 to -0.70) in an unadjusted model, -0.92 points per year (95% CI = -1.18 to -0.67) with baseline covariate adjustment, and -0.87 points per year (95% CI = -1.12 to -0.62) after adjusting for incident stroke and MI. CONCLUSION In this large population-based study with long-term repeated measures of function, periventricular WMHV was particularly associated with accelerated functional decline.
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Affiliation(s)
- Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ying-Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Ahmet Bagci
- Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Noam Alperin
- Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ralph L Sacco
- Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, Florida
- Departments of Public Health Sciences and Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mitchell S V Elkind
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
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Domínguez RO, Marschoff ER, Oudkerk LM, Neira LJ, Serra JA. Daily Living Activities and Cognition in Aged Patients: Effect of Acute Systemic Diseases and Stroke on Leukoaraiosis. Curr Aging Sci 2018; 11:133-139. [PMID: 30338749 PMCID: PMC6388423 DOI: 10.2174/1874609811666181019103642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/19/2018] [Accepted: 10/01/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute Systemic Diseases (ASD) impact on extended leukoaraiosis (ExLA) have been seldom described. We study the deterioration in daily life activities (DLA) and cognition associated with ASD events compared with the well-described impacts of stroke in patients with leukoaraiosis (L-A). METHODS Cross-sectional surveys of aged adults from the emergency room after an acute event of ASD or stroke, hospitalized or receiving home care, were followed for one year. From 268 initial patients 206 were included in the study, all with moderate to severe L-A (Fazekas 2 and 3). The Clinical Deterioration Rating (CDR) and the modified Rankin scale with structured interview were obtained one week previous to admission and after 3 and 12 months of evolution. Comparisons were conducted within and between groups with nonparametric techniques. RESULTS We formed three groups of similar age, A: Inpatients with one Stroke, B: Inpatients with one ASD, and C: Outpatients with one ASD. A sudden deterioration in Rankin was evident in Group A, while in B and C impairment was progressive. Impairment in CDR was smooth in all groups while in Rankin it was always greater than in cognition (CDR). No differences were found in the associations between groups and risk factors, hypertension being the most frequent one. CONCLUSION ASD in ExL-A causes a worsening of DLA and cognition similar to that observed in ExL-A with concomitant stroke indicating the need, in ageing patients, of differential diagnosis in order to achieve the best possible treatment.
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Affiliation(s)
| | | | | | | | - Jorge A. Serra
- Address correspondence to this author at the National Council of Scientific and Technical Investigations (CONICET), School of Biochemistry and Pharmacy, Oxidative Stress Lab., Institute of Biochemistry and Molecular Medicine (IBIMOL), Junín 954, C1113AAD, CABA, Argentina;
Tel: 5411 5287-4260. E-mail:
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O’Callaghan G, O’Dowd A, Stapleton J, Merriman NA, Roudaia E, Newell FN. Changes in Regional Brain Grey-Matter Volume Following Successful Completion of a Sensori-Motor Intervention Targeted at Healthy and Fall-Prone Older Adults. Multisens Res 2018; 31:317-344. [DOI: 10.1163/22134808-00002604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/08/2017] [Indexed: 02/03/2023]
Abstract
Previous studies have suggested that discrete cross-sensory events could be incorrectly combined in the brain of older adults with a history of falls, possibly undermining motor and balance control. Based on previous findings that multisensory integration is modifiable with practice, even in an ageing population, we designed a serious game, named CityQuest, to train typical, everyday multisensory processes including sensori-motor control, spatial navigation, obstacle avoidance and balance control. Played over several sessions, this game was shown to improve these functions in older adults with and without a history of falls, depending on the specific condition of the game on which they were trained. Here, using voxel-based morphometry analysis of anatomical magnetic resonance imaging (MRI) data, we investigated structural changes in the brain of a smaller group of older adults from those who successfully completed this five-week intervention. A grey-matter (GM) volume increase in the precentral gyrus, and GM volume reduction in the inferior temporal and orbitofrontal gyri, was found for all participants. Changes in GM volume within regions of the cerebellum were differentially associated with fall-prone and healthy older adults. Furthermore, a greater GM volume increase in the precentral gyrus was observed in participants who performed the full CityQuest intervention relative to those required to avoid obstacles only. Our results support previous evidence that multisensory training can affect structural changes in the older brain and have implications for programmes designed for the successful rehabilitation of perceptual and cognitive functions.
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Affiliation(s)
- Georgia O’Callaghan
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Alan O’Dowd
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - John Stapleton
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Niamh A. Merriman
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Eugenie Roudaia
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Fiona N. Newell
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
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The Evolving Interconnectedness of 3 Fields of Study. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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You H, Zhang H, Liu J, Han T, Zhang M, Zhao W, Jiang S. Effect of balance training with Pro-kin System on balance in patients with white matter lesions. Medicine (Baltimore) 2017; 96:e9057. [PMID: 29390433 PMCID: PMC5758135 DOI: 10.1097/md.0000000000009057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/27/2017] [Accepted: 11/12/2017] [Indexed: 11/26/2022] Open
Abstract
Patients with white matter lesions (WMLs) often present with problems of balance. The aim of this study was to verify the effects of combined Pro-kin system and conventional balance training to improve balance ability in WMLs patients.This is a randomized controlled study, and 40 participants were divided into 2 groups: the intervention group (n=18) received Pro-kin system with additional conventional balance training for 20 minutes per session, 5 times a week, for 2 weeks. The control group (n = 19) received only conventional balance training. Outcome measures were examined before and after the 2 weeks intervention using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Pro-kin system.After completion of the 2 weeks intervention, BBS, TUG, and Pro-kin system results significantly improved in the intervention group (P < .05). In the control group, BBS and Pro-kin system results significantly improved (P < .05). Changes in all outcomes but the ellipse area with eye closed (P < .05) were significantly higher in the intervention group than in the control group.The combination of Pro-kin system and conventional balance training is a potentially valuable treatment for patients with WMLs.
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Su N, Zhai FF, Zhou LX, Ni J, Yao M, Li ML, Jin ZY, Gong GL, Zhang SY, Cui LY, Tian F, Zhu YC. Cerebral Small Vessel Disease Burden Is Associated with Motor Performance of Lower and Upper Extremities in Community-Dwelling Populations. Front Aging Neurosci 2017; 9:313. [PMID: 29021757 PMCID: PMC5623680 DOI: 10.3389/fnagi.2017.00313] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/13/2017] [Indexed: 11/23/2022] Open
Abstract
Objective: To investigate the correlation between cerebral small vessel disease (CSVD) burden and motor performance of lower and upper extremities in community-dwelling populations. Methods: We performed a cross-sectional analysis on 770 participants enrolled in the Shunyi study, which is a population-based cohort study. CSVD burden, including white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMBs), perivascular spaces (PVS), and brain atrophy were measured using 3T magnetic resonance imaging. All participants underwent quantitative motor assessment of lower and upper extremities, which included 3-m walking speed, 5-repeat chair-stand time, 10-repeat pronation–supination time, and 10-repeat finger-tapping time. Data on demographic characteristics, vascular risk factors, and cognitive functions were collected. General linear model analysis was performed to identify potential correlations between motor performance measures and imaging markers of CSVD after controlling for confounding factors. Results: For motor performance of the lower extremities, WMH was negatively associated with gait speed (standardized β = -0.092, p = 0.022) and positively associated with chair-stand time (standardized β = 0.153, p < 0.0001, surviving FDR correction). For motor performance of the upper extremities, pronation–supination time was positively associated with WMH (standardized β = 0.155, p < 0.0001, surviving FDR correction) and negatively with brain parenchymal fraction (BPF; standardized β = -0.125, p = 0.011, surviving FDR correction). Only BPF was found to be negatively associated with finger-tapping time (standardized β = -0.123, p = 0.012). However, lacunes, CMBs, or PVS were not found to be associated with motor performance of lower or upper extremities in multivariable analysis. Conclusion: Our findings suggest that cerebral microstructural changes related to CSVD may affect motor performance of both lower and upper extremities. WMH and brain atrophy are most strongly associated with motor function deterioration in community-dwelling populations.
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Affiliation(s)
- Ning Su
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei-Fei Zhai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Xin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gao-Lang Gong
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Tian
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Dhamoon MS, Cheung YK, Bagci A, Alperin N, Sacco RL, Elkind MSV, Wright CB. Differential Effect of Left vs. Right White Matter Hyperintensity Burden on Functional Decline: The Northern Manhattan Study. Front Aging Neurosci 2017; 9:305. [PMID: 28970793 PMCID: PMC5609109 DOI: 10.3389/fnagi.2017.00305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/05/2017] [Indexed: 12/14/2022] Open
Abstract
Asymmetry of brain dysfunction may disrupt brain network efficiency. We hypothesized that greater left-right white matter hyperintensity volume (WMHV) asymmetry was associated with functional trajectories. Methods: In the Northern Manhattan Study, participants underwent brain MRI with axial T1, T2, and fluid attenuated inversion recovery sequences, with baseline interview and examination. Volumetric WMHV distribution across 14 brain regions was determined separately by combining bimodal image intensity distribution and atlas based methods. Participants had annual functional assessments with the Barthel index (BI, range 0-100) over a mean of 7.3 years. Generalized estimating equations (GEE) models estimated associations of regional WMHV and regional left-right asymmetry with baseline BI and change over time, adjusted for baseline medical risk factors, sociodemographics, and cognition, and stroke and myocardial infarction during follow-up. Results: Among 1,195 participants, greater WMHV asymmetry in the parietal lobes (-8.46 BI points per unit greater WMHV on the right compared to left, 95% CI -3.07, -13.86) and temporal lobes (-2.48 BI points, 95% CI -1.04, -3.93) was associated with lower overall function. Greater WMHV asymmetry in the parietal lobes (-1.09 additional BI points per year per unit greater WMHV on the left compared to right, 95% CI -1.89, -0.28) was independently associated with accelerated functional decline. Conclusions: In this large population-based study with long-term repeated measures of function, greater regional WMHV asymmetry was associated with lower function and functional decline. In addition to global WMHV, WHMV asymmetry may be an important predictor of long-term functional status.
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Affiliation(s)
- Mandip S. Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount SinaiNew York, NY, United States
- Department of Epidemiology, Mailman School of Public Health, Columbia UniversityNew York, NY, United States
| | - Ying-Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia UniversityNew York, NY, United States
| | - Ahmet Bagci
- Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of MiamiMiami, FL, United States
| | - Noam Alperin
- Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of MiamiMiami, FL, United States
| | - Ralph L. Sacco
- Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of MiamiMiami, FL, United States
- Departments of Public Health Sciences and Human Genetics, Miller School of Medicine, University of MiamiMiami, FL, United States
| | - Mitchell S. V. Elkind
- Department of Epidemiology, Mailman School of Public Health, Columbia UniversityNew York, NY, United States
- Department of Neurology, College of Physicians and Surgeons, Columbia UniversityNew York, NY, United States
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Sartor J, Bettecken K, Bernhard FP, Hofmann M, Gladow T, Lindig T, Ciliz M, Ten Kate M, Geritz J, Heinzel S, Benedictus M, Scheltens P, Hobert MA, Maetzler W. White Matter Changes-Related Gait and Executive Function Deficits: Associations with Age and Parkinson's Disease. Front Aging Neurosci 2017; 9:213. [PMID: 28713264 PMCID: PMC5491602 DOI: 10.3389/fnagi.2017.00213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/16/2017] [Indexed: 01/22/2023] Open
Abstract
Background: White matter changes (WMC) are a common finding among older adults and patients with Parkinson's disease (PD), and have been associated with, e.g., gait deficits and executive dysfunction. How the factors age and PD influence WMC-related deficits is, to our best knowledge, not investigated to date. We hypothesized that advanced age and presence of PD leads to WMC-related symptoms while practicing tasks with a low complexity level, and low age and absence of PD leads to WMC-related symptoms while practicing tasks with a high complexity level. Methods: Hundred and thirty-eight participants [65 young persons without PD (50–69 years, yPn), 22 young PD patients (50–69 years, yPD), 36 old persons without PD (70–89 years, oPn) and 15 old PD patients (70–89 years, oPD)] were included. Presence and severity of WMC were determined with the modified Fazekas score. Velocity of walking under single and dual tasking conditions and the Trail Making Test (TMT) were used as gait and executive function parameters. Correlations between presence and severity of WMC, and gait and executive function parameters were tested in yPn, yPD, oPn, and oPD using Spearman's rank correlation, and significance between groups was evaluated with Fisher's z-transformed correlation coefficient. Results: yPn and yPD, as well as oPn and oPD did not differ regarding demographic and clinical parameters. Severity of WMC was not significantly different between groups. yPn and yPD displayed significant correlations of WMC with executive function parameters at low levels of task complexity, oPn at intermediate, and oPD at high complexity levels. Conclusion: This study argues for a relevant association of age and PD-related brain pathology with WMC-related gait and executive function deficits.
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Affiliation(s)
- Jennifer Sartor
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Kristina Bettecken
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Felix P Bernhard
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | | | | | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University of TuebingenTuebingen, Germany
| | - Meltem Ciliz
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Mara Ten Kate
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Johanna Geritz
- Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Marije Benedictus
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Markus A Hobert
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
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Microstructural integrity of white matter tracts amongst older fallers: A DTI study. PLoS One 2017; 12:e0179895. [PMID: 28658309 PMCID: PMC5489210 DOI: 10.1371/journal.pone.0179895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 06/06/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives This study assesses the whole brain microstructural integrity of white matter tracts (WMT) among older individuals with a history of falls compared to non-fallers. Methods 85 participants (43 fallers, 42 non-fallers) were evaluated with conventional MRI and diffusion tensor imaging (DTI) sequences of the brain. DTI metrics were obtained from selected WMT using tract-based spatial statistics (TBSS) method. This was followed by binary logistic regression to investigate the clinical variables that could act as confounding elements on the outcomes. The TBSS analysis was then repeated, but this time including all significant predictor variables from the regression analysis as TBSS covariates. Results The mean diffusivity (MD) and axial diffusivity (AD) and to a lesser extent radial diffusivity (RD) values of the projection fibers and commissural bundles were significantly different in fallers (p < 0.05) compared to non-fallers. However, the final logistic regression model obtained showed that only functional reach, white matter lesion volume, hypertension and orthostatic hypotension demonstrated statistical significant differences between fallers and non-fallers. No significant differences were found in the DTI metrics when taking into account age and the four variables as covariates in the repeated analysis. Conclusion This DTI study of 85 subjects, do not support DTI metrics as a singular factor that contributes independently to the fall outcomes. Other clinical and imaging factors have to be taken into account.
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Fischer BL, Bacher R, Bendlin BB, Birdsill AC, Ly M, Hoscheidt SM, Chappell RJ, Mahoney JE, Gleason CE. An Examination of Brain Abnormalities and Mobility in Individuals with Mild Cognitive Impairment and Alzheimer's Disease. Front Aging Neurosci 2017; 9:86. [PMID: 28424612 PMCID: PMC5380746 DOI: 10.3389/fnagi.2017.00086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Mobility changes are concerning for elderly patients with cognitive decline. Given frail older individuals' vulnerability to injury, it is critical to identify contributors to limited mobility. Objective: To examine whether structural brain abnormalities, including reduced gray matter volume and white matter hyperintensities, would be associated with limited mobility among individuals with cognitive impairment, and to determine whether cognitive impairment would mediate this relationship. Methods: Thirty-four elderly individuals with mild cognitive impairment (MCI) and Alzheimer's disease underwent neuropsychological evaluation, mobility assessment, and structural brain neuroimaging. Linear regression was conducted with predictors including gray matter volume in six regions of interest (ROI) and white matter hyperintensity (WMH) burden, with mobility measures as outcomes. Results: Lower gray matter volume in caudate nucleus was associated with slower speed on a functional mobility task. Higher cerebellar volume was also associated with slower functional mobility. White matter hyperintensity burden was not significantly associated with mobility. Conclusion: Our findings provide evidence for associations between subcortical gray matter volume and speed on a functional mobility task among cognitively impaired individuals.
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Affiliation(s)
- Barbara L Fischer
- Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans HospitalMadison, WI, USA
| | - Rhonda Bacher
- Department of Statistics, University of Wisconsin-MadisonMadison, WI, USA
| | - Barbara B Bendlin
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA
| | - Alex C Birdsill
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Martina Ly
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Siobhan M Hoscheidt
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA
| | - Richard J Chappell
- Department of Statistics, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA.,Departments of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Jane E Mahoney
- Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Carey E Gleason
- Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans HospitalMadison, WI, USA.,School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA
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Suda S, Kanamaru T, Okubo S, Aoki J, Shimoyama T, Suzuki K, Nito C, Ishiwata A, Kimura K. Urinary albumin-to-creatinine ratio is associated with white matter lesions severity in first-ever stroke patients. J Neurol Sci 2017; 373:258-262. [DOI: 10.1016/j.jns.2017.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023]
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Bahrani AA, Powell DK, Yu G, Johnson ES, Jicha GA, Smith CD. White Matter Hyperintensity Associations with Cerebral Blood Flow in Elderly Subjects Stratified by Cerebrovascular Risk. J Stroke Cerebrovasc Dis 2017; 26:779-786. [PMID: 28063772 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/19/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study aims to add clarity to the relationship between deep and periventricular brain white matter hyperintensities (WMHs), cerebral blood flow (CBF), and cerebrovascular risk in older persons. METHODS Deep white matter hyperintensity (dWMH) and periventricular white matter hyperintensity (pWMH) and regional gray matter (GM) and white matter (WM) blood flow from arterial spin labeling were quantified from magnetic resonance imaging scans of 26 cognitively normal elderly subjects stratified by cerebrovascular disease (CVD) risk. Fluid-attenuated inversion recovery images were acquired using a high-resolution 3-dimensional (3-D) sequence that reduced partial volume effects seen with slice-based techniques. RESULTS dWMHs but not pWMHs were increased in patients at high risk of CVD; pWMHs but not dWMHs were associated with decreased regional cortical (GM) blood flow. We also found that blood flow in WM is decreased in regions of both pWMH and dWMH, with a greater degree of decrease in pWMH areas. CONCLUSIONS WMHs are usefully divided into dWMH and pWMH regions because they demonstrate differential effects. 3-D regional WMH volume is a potentially valuable marker for CVD based on associations with cortical CBF and WM CBF.
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Affiliation(s)
- Ahmed A Bahrani
- Department of Biomedical Engineering, School of Engineering, University of Kentucky, Lexington, Kentucky; Department of Biomedical Engineering, AL-Khwarizmi College of Engineering, University of Baghdad, Baghdad, Iraq
| | - David K Powell
- Magnetic Resonance Imaging and Spectroscopy Center (MRISC), University of Kentucky, Lexington, Kentucky
| | - Guoquiang Yu
- Department of Biomedical Engineering, School of Engineering, University of Kentucky, Lexington, Kentucky
| | - Eleanor S Johnson
- Magnetic Resonance Imaging and Spectroscopy Center (MRISC), University of Kentucky, Lexington, Kentucky
| | - Gregory A Jicha
- Department of Neurology, University of Kentucky Medical College, Lexington, Kentucky
| | - Charles D Smith
- Department of Biomedical Engineering, School of Engineering, University of Kentucky, Lexington, Kentucky; Magnetic Resonance Imaging and Spectroscopy Center (MRISC), University of Kentucky, Lexington, Kentucky; Department of Neurology, University of Kentucky Medical College, Lexington, Kentucky.
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Vakhnina NN, Zakharov VV. Disturbances of gait and postural stability in chronic cerebral ischemia. Zh Nevrol Psikhiatr Im S S Korsakova 2017. [DOI: 10.17116/jnevro20171171178-84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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