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Wu TS, Wu PH, Lin HF, Chen WC, Huang TH, Lin MY, Chuang YS, Yang FPG, Chiu YW, Chang JM, Kuo MC, Lin YT. Cerebral white matter burden is linked to cognitive function in patients undergoing hemodialysis. Ann Med 2024; 56:2310142. [PMID: 38324920 PMCID: PMC10851831 DOI: 10.1080/07853890.2024.2310142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Chronic kidney disease is related to neurodegeneration and structural changes in the brain which might lead to cognitive decline. The Fazekas scale used for assessing white matter hyperintensities (WMHs) was associated with poor cognitive performance. Therefore, this study investigated the associations between the mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI), and Fazekas scale in patients under hemodialysis (HD). METHODS The periventricular (PV) WMHs and deep WMHs (DWMHs) in brain magnetic resonance images of 59 patients under dialysis were graded using the Fazekas scale. Three cognition function tests were also performed, then multivariable ordinal regression and logistic regression were used to identify the associations between cognitive performance and the Fazekas scale. RESULTS There were inverse associations between the three cognitive function tests across the Fazekas scale of PVWMHs (p = .037, .006, and .008 for MMSE, MoCA, and CASI, respectively), but the associations were attenuated in the DWMHs group. In CASI, significant differences were identified in short-term memory, mental manipulation, abstract thinking, language, spatial construction, and name fluency in the PVWMHs group. However, DWMHs were only significantly correlated with abstract thinking and short-term memory. CONCLUSION An inverse correlation existed between the Fazekas scale, predominantly in PVWMHs, and cognition in patients undergoing HD. The PVWMHs were associated with cognitive performance assessed by MMSE, MoCA, and CASI, as well as with subdomains of CASI such as memory, language and name fluency in patients undergoing HD.
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Affiliation(s)
- Tsai-Shan Wu
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsiu-Fen Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ching Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Teng-Hui Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yun-Shiuan Chuang
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Fan-Pei Gloria Yang
- Department of Foreign Languages and Literature, National Tsing Hua University, Hsinchu, Taiwan
- Center for Cognition and Mind Sciences, National Tsing Hua University, Hsinchu, Taiwan
- Department of Radiology, Graduate School of Dentistry, Osaka University, Suita, Japan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Lin
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Chin KS, Holper S, Loveland P, Churilov L, Yassi N, Watson R. Prevalence of cerebral microbleeds in Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease dementia: A systematic review and meta-analysis. Neurobiol Aging 2024; 134:74-83. [PMID: 38006706 DOI: 10.1016/j.neurobiolaging.2023.11.006] [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: 07/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
Cerebral microbleeds (CMB) are often associated with vascular risk factors and/or cerebral amyloid angiopathy and are frequently identified in people with dementia. The present study therefore aimed to estimate the pooled prevalence and associations of CMB in Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), using meta-analytic methods. Sixty-five MRI studies were included after a systematic search on major electronic databases. We found that the prevalence of CMB was comparable across the three dementia subtypes (31-36%) and was highly influenced by the MRI techniques used. CMB in AD were associated with a history of hypertension and amyloid-β burden. In contrast, CMB in DLB, despite being predominantly lobar, were associated with hypertension, but not amyloid-β burden. These findings suggest that the underlying pathophysiology of CMB in DLB might differ from that of AD. There was substantially larger number of AD studies identified and more studies evaluating CMB in Lewy body dementias are warranted.
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Affiliation(s)
- Kai Sin Chin
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Aged Care, The Royal Melbourne Hospital, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
| | - Sarah Holper
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Paula Loveland
- Department of Aged Care, The Royal Melbourne Hospital, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Leonid Churilov
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Nawaf Yassi
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Rosie Watson
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Aged Care, The Royal Melbourne Hospital, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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Figuracion KCF, Thompson H, Mac Donald CL. Integrating Neuroimaging Measures in Nursing Research. Biol Res Nurs 2023; 25:341-352. [PMID: 36398659 PMCID: PMC10404904 DOI: 10.1177/10998004221140608] [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: 08/09/2023]
Abstract
BACKGROUND Medical and scientific advancement worldwide has led to a longer lifespan. With the population aging comes the risk of developing cognitive decline. The incorporation of neuroimaging measures in evaluating cognitive changes is limited in nursing research. The aim of this review is to introduce nurse scientists to neuroimaging measures employed to assess the association between brain and cognitive changes. METHODS Relevant literature was identified by searching CINAHL, Web of Science, and PubMed databases using the following keywords: "neuroimaging measures," "aging," "cognition," "qualitative scoring," "cognitive ability," "molecular," "structural," and "functional." RESULTS Neuroimaging measures can be categorized into structural, functional, and molecular imaging approaches. The structural imaging technique visualizes the anatomical regions of the brain. Visual examination and volumetric segmentation of select structural sequences extract information such as white matter hyperintensities and cerebral atrophy. Functional imaging techniques evaluate brain regions and underlying processes using blood-oxygen-dependent signals. Molecular imaging technique is the real-time visualization of biological processes at the cellular and molecular levels in a given region. Examples of biological measures associated with neurodegeneration include decreased glutamine level, elevated total choline, and elevated Myo-inositol. DISCUSSION Nursing is at the forefront of addressing upstream factors impacting health outcomes across a lifespan of a population at increased risk of progressive cognitive decline. Nurse researchers can become more facile in using these measures both in qualitative and quantitative methodology by leveraging previously gathered neuroimaging clinical data for research purposes to better characterize the associations between symptom progression, disease risk, and health outcomes.
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Affiliation(s)
- Karl Cristie F. Figuracion
- Department of School of Nursing, University of Washington, Seattle, WA, USA
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Hilaire Thompson
- Biobehavioral Nursing & Health Informatics, University of Washington, Seattle, WA, USA
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4
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Ortner M, Lanz K, Goldhardt O, Müller-Sarnowski F, Diehl-Schmid J, Förstl H, Hedderich DM, Yakushev I, Logan CA, Weinberger JP, Simon M, Grimmer T. Elecsys Cerebrospinal Fluid Immunoassays Accurately Detect Alzheimer's Disease Regardless of Concomitant Small Vessel Disease. J Alzheimers Dis 2023:JAD221187. [PMID: 37212102 DOI: 10.3233/jad-221187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Differentiating dementia due to small vessel disease (SVD) from dementia due to Alzheimer's disease (AD) with concomitant SVD is challenging in clinical practice. Accurate and early diagnosis of AD is critical to delivering stratified patient care. OBJECTIVE We characterized the results of Elecsys ® cerebrospinal fluid (CSF) immunoassays (Roche Diagnostics International Ltd) in patients with early AD, diagnosed using core clinical criteria, with varying extent of SVD. METHODS Frozen CSF samples (n = 84) were measured using Elecsys β-Amyloid(1-42) (Aβ42), Phospho-Tau (181P) (pTau181), and Total-Tau (tTau) CSF immunoassays, adapted for use on the cobas ® e 411 analyzer (Roche Diagnostics International Ltd), and a robust prototype β-Amyloid(1-40) (Aβ40) CSF immunoassay. SVD was assessed by extent of white matter hyperintensities (WMH) using the lesion segmentation tool. Interrelations between WMH, biomarkers, fluorodeoxyglucose F18-positron emission tomography (FDG-PET), and other parameters (including age and Mini-Mental State examinations [MMSE]) were assessed using Spearman's correlation, sensitivity/specificity, and logistic/linear regression analyses. RESULTS The extent of WMH showed significant correlation with Aβ42/Aβ40 ratio (Rho=-0.250; p = 0.040), tTau (Rho = 0.292; p = 0.016), tTau/Aβ42 ratio (Rho = 0.247; p = 0.042), age (Rho = 0.373; p = 0.002), and MMSE (Rho=-0.410; p = 0.001). Sensitivity/specificity point estimates for Elecsys CSF immunoassays versus FDG-PET positivity for underlying AD pathophysiology were mostly comparable or greater in patients with high versus low WMH. WMH were not a significant predictor and did not interact with CSF biomarker positivity but modified the association between pTau181 and tTau. CONCLUSION Elecsys CSF immunoassays detect AD pathophysiology regardless of concomitant SVD and may help to identify patients with early dementia with underlying AD pathophysiology.
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Affiliation(s)
- Marion Ortner
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Korbinian Lanz
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Oliver Goldhardt
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Felix Müller-Sarnowski
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Hans Förstl
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Dennis M Hedderich
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | | | | | - Maryline Simon
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
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Predictive factors for the development of epilepsy after ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31:106858. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
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Tregub PP, Averchuk AS, Baranich TI, Ryazanova MV, Salmina AB. Physiological and Pathological Remodeling of Cerebral Microvessels. Int J Mol Sci 2022; 23:ijms232012683. [PMID: 36293539 PMCID: PMC9603917 DOI: 10.3390/ijms232012683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
There is growing evidence that the remodeling of cerebral microvessels plays an important role in plastic changes in the brain associated with development, experience, learning, and memory consolidation. At the same time, abnormal neoangiogenesis, and deregulated regulation of microvascular regression, or pruning, could contribute to the pathogenesis of neurodevelopmental diseases, stroke, and neurodegeneration. Aberrant remodeling of microvesselsis associated with blood-brain barrier breakdown, development of neuroinflammation, inadequate microcirculation in active brain regions, and leads to the dysfunction of the neurovascular unit and progressive neurological deficits. In this review, we summarize current data on the mechanisms of blood vessel regression and pruning in brain plasticity and in Alzheimer's-type neurodegeneration. We discuss some novel approaches to modulating cerebral remodeling and preventing degeneration-coupled aberrant microvascular activity in chronic neurodegeneration.
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Tu J, Yan J, Liu J, Liu D, Wang X, Gao F. Iron deposition in the precuneus is correlated with mild cognitive impairment in patients with cerebral microbleeds: A quantitative susceptibility mapping study. Front Neurosci 2022; 16:944709. [PMID: 36003962 PMCID: PMC9395124 DOI: 10.3389/fnins.2022.944709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/08/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to define whether mild cognitive impairment (MCI) is associated with iron deposition in rich-club nodes distant from cerebral microbleeds (CMBs) in patients with cerebral small vessel disease (CSVD). Methods A total of 64 participants underwent magnetic resonance imaging (MRI) scanning and were separated into three groups, namely, CMB(+), CMB(–), and healthy controls (HCs). We compared their characteristics and susceptibility values of rich-club nodes [e.g., superior frontal gyrus (SFG), precuneus, superior occipital gyrus (SOG), thalamus, and putamen]. We then divided the CMB(+) and CMB(–) groups into subgroups of patients with or without MCI. Then, we analyzed the relationship between iron deposition and MCI by comparing the susceptibility values of rich-club nodes. We assessed cognitive functions using the Montreal Cognitive Assessment (MoCA) and quantified iron content using quantitative susceptibility mapping (QSM). Results In the putamen, the CMB(+) and CMB(–) groups had significantly different susceptibility values. Compared with the HCs, the CMB(+) and CMB(–) groups had significantly different susceptibility values for the SFG and SOG. In addition, we found significant differences in the putamen susceptibility values of the CMB(+)MCI(+) group and the two CMB(–) groups. The CMB(+)MCI(+) and CMB(+)MCI(–) groups had significantly different precuneus susceptibility values. The binary logistic regression analysis revealed that only higher susceptibility values of precuneus were associated with a cognitive decline in patients with CMBs, and it indicated statistical significance. Conclusion Iron deposition in the precuneus is an independent risk factor for MCI in patients with CMBs. CMBs might influence iron content in remote rich-club nodes and be relevant to MCI.
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Affiliation(s)
- Jing Tu
- Department of Neurology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
- Xi'an Medical University, Xi'an, China
| | - Jin Yan
- Department of Radiology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Juan Liu
- Department of Neurology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Dandan Liu
- Department of Neurology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Xiaomeng Wang
- Department of Neurology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Fei Gao
- Department of Neurology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
- *Correspondence: Fei Gao
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8
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Mojica CV, Yu JMF, Ampil ER, Dy JSH, Torio EF, Pilotin RC, Dominguez JC. Demographic and Clinical Profile of Patients with Mild Cognitive Impairment Seen at St. Luke's Medical Center-Global City Memory Service. Dement Geriatr Cogn Disord 2021; 50:387-393. [PMID: 34537768 DOI: 10.1159/000519171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mild cognitive impairment (MCI) is a dynamic state, which has evolved into a highly defined condition due to its association with dementia syndromes. There are no published data on the demographic and clinical characteristics of MCI in the Philippines. These data will help in defining the population at risk for the condition and in modifying the factors for its prevention. METHODS From 2010 to 2019, 434 subjects were diagnosed with MCI based on the criteria published by the International Working Group on MCI last 2004. The demographic profile, vascular risk factors, and levels of Vitamin B12, Vitamin D, and homocysteine were reviewed. Results of neuropsychological tests, such as Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), Mini-Mental State Exam (MMSE), and Montreal Cognitive Assessment (MoCA), were collected. The Fazekas score of the cranial magnetic resonance imaging of patients was also considered. RESULTS The median age was 72 years [34-97] with 58.3% females. The median years of education were 14 [4-28]. Median ADAS-Cog, MMSE, and MoCA scores were 11.3 [0-27.67], 27 [13-30], and 21 [7-30], respectively. Hypertension and dyslipidemia were present in 66.8% and 64.1%, respectively. Normal homocysteine, Vitamin B12, and Vitamin D levels were found in 64.2%, 59.8%, and 48.8%, respectively. The median Fazekas score was 1 (59.4%). CONCLUSION This is the first study to document the demographic and clinical profile of Filipinos with MCI in a clinical setting. This review serves as a foundation for increased understanding of MCI with the ultimate goal of controlling the factors which may impact its prevention.
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Affiliation(s)
- Christianne V Mojica
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Justine Megan F Yu
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines.,Institute for Dementia Care Asia, Quezon City, Philippines
| | - Encarnita R Ampil
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines.,Department of Neuroscience and Behavioral Medicine, Faculty of Medicine and Surgery, University of Sto. Tomas, Manila, Philippines
| | - Jon Stewart H Dy
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Erickson F Torio
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Ron C Pilotin
- Institute of Radiology, St. Luke's Medical Center, Global City, Philippines
| | - Jacqueline C Dominguez
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines.,Institute for Dementia Care Asia, Quezon City, Philippines
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Sánchez-Arenas R, Doubova SV, Bernabe-Garcia M, Gregory MA, Mejía-Alonso LA, Orihuela-Rodríguez O, Paredes-Manjarrez C, Colín-Martínez T, Mujica-Morales I, Grijalva-Otero I, Basurto-Acevedo L, Manuel-Apolinar L, Cuadros-Moreno J, Bernal-Diaz A, Shigematsu R. Double-task exercise programmes to strengthen cognitive and vascular health in older adults at risk of cognitive decline: protocol for a randomised clinical trial. BMJ Open 2020; 10:e039723. [PMID: 33380479 PMCID: PMC7780518 DOI: 10.1136/bmjopen-2020-039723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Cognitive and physical declines are frequent causes of disability among older adults (OAs) in Mexico that imposes significant burden on the health system and OAs' families. Programmes to prevent or delay OAs' cognitive and physical decline are scarce. METHODS AND ANALYSIS A double-blind randomised clinical trial will be conducted. The study will aim to evaluate two 24-week double-task (aerobic and cognitive) square-stepping exercise programmes for OAs at risk of cognitive decline-one programme with and another without caregiver participation-and to compare these with an aerobic-balance-stretching exercise programme (control group). 300 OAs (100 per group) affiliated with the Mexican Institute of Social Security (IMSS) between 60 and 65 years of age with self-reported cognitive concerns will participate. They will be stratified by education level and randomly allocated to the groups. The intervention will last 24 weeks, and the effect of each programme will be evaluated 12, 24 and 52 weeks after the intervention. Participants' demographic and clinical characteristics will be collected at baseline. The outcomes will include: (1) general cognitive function; (2) specific cognitive functions; (3) dual-task gait; (4) blood pressure; (5) carotid intima-media thickness; (6) OAs' health-related quality of life; and (7) caregiver burden. The effects of the interventions on each outcome variable will be examined using a repeated-measures analysis of variance (ANOVA), with study groups as the between-subjects variable and time as the within-subject variable. ETHICS AND DISSEMINATION The study was approved by the IMSS Ethics and Research Committees (registration number: 2018-785-095). All participants will sign a consent form prior to their participation. The study results will be disseminated to the IMSS authorities, healthcare providers and the research community. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04068376).
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Affiliation(s)
- Rosalinda Sánchez-Arenas
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Mariela Bernabe-Garcia
- Medical Research Unit in Nutrition, Pediatrics Hospital, National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Michel A Gregory
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Alejandra Mejía-Alonso
- Rehabilitation Service, Specialty Hospital, National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Oscar Orihuela-Rodríguez
- Cardiology Service, Specialty Hospital, National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Carlos Paredes-Manjarrez
- Image Service, Specialty Hospital, National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Tania Colín-Martínez
- Continuous Admission Service, Specialty Hospital, National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Irene Mujica-Morales
- Division of Occupational Risk Prevention. Occupational Health Coordination, Mexican Institute of Social Security, Mexico City, Mexico
| | - Israel Grijalva-Otero
- Medical Research Unit in Neurological Diseases, National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Lourdes Basurto-Acevedo
- Research Unit in Endocrine Diseases, National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Leticia Manuel-Apolinar
- Research Unit in Endocrine Diseases, National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Juan Cuadros-Moreno
- Coordination of Health Education, Mexican Institute of Social Security, Mexico City, Mexico
| | - Arcelia Bernal-Diaz
- Aragón School of Higher Education, National Autonomous University of Mexico, Mexico City, Mexico
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Fruhwirth V, Enzinger C, Fandler-Höfler S, Kneihsl M, Eppinger S, Ropele S, Schmidt R, Gattringer T, Pinter D. Baseline white matter hyperintensities affect the course of cognitive function after small vessel disease-related stroke: a prospective observational study. Eur J Neurol 2020; 28:401-410. [PMID: 33065757 PMCID: PMC7839458 DOI: 10.1111/ene.14593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023]
Abstract
Background and purpose Cognitive impairment is a common sequel of recent small subcortical infarction (RSSI) and might be negatively affected by preexisting cerebral small vessel disease (SVD). We investigated whether the course of cognitive function in patients with RSSI is influenced by the severity of white matter hyperintensities (WMH), an important imaging feature of SVD. Methods Patients with magnetic resonance imaging (MRI)‐proven single RSSI were tested neuropsychologically concerning global cognition, processing speed, attention, and set‐shifting. Deep and periventricular WMH severity was assessed using the Fazekas scale, and total WMH lesion volume was calculated from T1‐weighted MRI images. We compared baseline function and course of cognition 15 months after the acute event in patients with absent, mild, and moderate‐to‐severe WMH. Results The study cohort comprised 82 RSSI patients (mean age: 61 ± 10 years, 23% female). At baseline, 40% had cognitive impairment (1.5 standard deviations below standardized mean), and deficits persisted in one‐third of the sample after 15 months. After age correction, there were no significant differences in set‐shifting between WMH groups at baseline. However, although patients without WMH (deep: p < 0.001, periventricular: p = 0.067) or only mild WMH (deep: p = 0.098, periventricular: p = 0.001) improved in set‐shifting after 15 months, there was no improvement in patients with moderate‐to‐severe WMH (deep: p = 0.980, periventricular: p = 0.816). Baseline total WMH volume (p = 0.002) was the only significant predictor for attention 15 months poststroke. Conclusions This longitudinal study demonstrates that preexisting moderate‐to‐severe WMH negatively affect the restoration of cognitive function after RSSI, suggesting limited functional reserve in patients with preexisting SVD.
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Affiliation(s)
- V Fruhwirth
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - S Fandler-Höfler
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - M Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Eppinger
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - R Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - D Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
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11
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Laing KK, Simoes S, Baena-Caldas GP, Lao PJ, Kothiya M, Igwe KC, Chesebro AG, Houck AL, Pedraza L, Hernández AI, Li J, Zimmerman ME, Luchsinger JA, Barone FC, Moreno H, Brickman AM. Cerebrovascular disease promotes tau pathology in Alzheimer's disease. Brain Commun 2020; 2:fcaa132. [PMID: 33215083 PMCID: PMC7660042 DOI: 10.1093/braincomms/fcaa132] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 01/04/2023] Open
Abstract
Small vessel cerebrovascular disease, visualized as white matter hyperintensities on T2-weighted magnetic resonance imaging, contributes to the clinical presentation of Alzheimer's disease. However, the extent to which cerebrovascular disease represents an independent pathognomonic feature of Alzheimer's disease or directly promotes Alzheimer's pathology is unclear. The purpose of this study was to examine the association between white matter hyperintensities and plasma levels of tau and to determine if white matter hyperintensities and tau levels interact to predict Alzheimer's disease diagnosis. To confirm that cerebrovascular disease promotes tau pathology, we examined tau fluid biomarker concentrations and pathology in a mouse model of ischaemic injury. Three hundred ninety-one participants from the Alzheimer's Disease Neuroimaging Initiative (74.5 ± 7.1 years of age) were included in this cross-sectional analysis. Participants had measurements of plasma total-tau, cerebrospinal fluid beta-amyloid, and white matter hyperintensities, and were diagnosed clinically as Alzheimer's disease (n = 97), mild cognitive impairment (n = 186) or cognitively normal control (n = 108). We tested the relationship between plasma tau concentration and white matter hyperintensity volume across diagnostic groups. We also examined the extent to which white matter hyperintensity volume, plasma tau, amyloid positivity status and the interaction between white matter hyperintensities and plasma tau correctly classifies diagnostic category. Increased white matter hyperintensity volume was associated with higher plasma tau concentration, particularly among those diagnosed clinically with Alzheimer's disease. Presence of brain amyloid and the interaction between plasma tau and white matter hyperintensity volume distinguished Alzheimer's disease and mild cognitive impairment participants from controls with 77.6% and 63.3% accuracy, respectively. In 63 Alzheimer's Disease Neuroimaging Initiative participants who came to autopsy (82.33 ± 7.18 age at death), we found that higher degrees of arteriosclerosis were associated with higher Braak staging, indicating a positive relationship between cerebrovascular disease and neurofibrillary pathology. In a transient middle cerebral artery occlusion mouse model, aged mice that received transient middle cerebral artery occlusion, but not sham surgery, had increased plasma and cerebrospinal fluid tau concentrations, induced myelin loss, and hyperphosphorylated tau pathology in the ipsilateral hippocampus and cerebral hemisphere. These findings demonstrate a relationship between cerebrovascular disease, operationalized as white matter hyperintensities, and tau levels, indexed in the plasma, suggesting that hypoperfusive injury promotes tau pathology. This potential causal association is supported by the demonstration that transient cerebral artery occlusion induces white matter damage, increases biofluidic markers of tau, and promotes cerebral tau hyperphosphorylation in older-adult mice.
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Affiliation(s)
- Krystal K Laing
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sabrina Simoes
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Gloria P Baena-Caldas
- Departments of Neurology and Physiology/Pharmacology, SUNY Downstate, Brooklyn, NY, USA
- School of Biomedical Sciences, Health Sciences Division, Universidad del Valle, Cali, Colombia, USA
| | - Patrick J Lao
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Milankumar Kothiya
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kay C Igwe
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Anthony G Chesebro
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alexander L Houck
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lina Pedraza
- Departments of Neurology and Physiology/Pharmacology, SUNY Downstate, Brooklyn, NY, USA
| | - A Iván Hernández
- Department of Pathology. SUNY Downstate, Brooklyn, NY, USA
- The Robert F. Furchgott Center for Neural and Behavioral Science, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
| | - Jie Li
- Departments of Neurology and Physiology/Pharmacology, SUNY Downstate, Brooklyn, NY, USA
| | | | - José A Luchsinger
- Department of Medicine, College of Physicians and Surgeons, Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Frank C Barone
- Departments of Neurology and Physiology/Pharmacology, SUNY Downstate, Brooklyn, NY, USA
- The Robert F. Furchgott Center for Neural and Behavioral Science, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
| | - Herman Moreno
- Departments of Neurology and Physiology/Pharmacology, SUNY Downstate, Brooklyn, NY, USA
- The Robert F. Furchgott Center for Neural and Behavioral Science, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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12
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Román G, Jackson R, Reis J, Román A, Toledo J, Toledo E. Extra-virgin olive oil for potential prevention of Alzheimer disease. Rev Neurol (Paris) 2019; 175:705-723. [DOI: 10.1016/j.neurol.2019.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023]
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13
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Assaf G, Tanielian M. Mild cognitive impairment in primary care: a clinical review. Postgrad Med J 2018; 94:647-652. [DOI: 10.1136/postgradmedj-2018-136035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/07/2018] [Accepted: 10/12/2018] [Indexed: 01/20/2023]
Abstract
Dementia is projected to become a global health priority but often not diagnosed in its earlier preclinical stage which is mild cognitive impairment (MCI). MCI is generally referred as a transition state between normal cognition and Alzheimer’s disease. Primary care physicians play an important role in its early diagnosis and identification of patients most likely to progress to Alzheimer’s disease while offering evidenced-based interventions that may reverse or halt the progression to further cognitive impairment. The aim of this review is to introduce the concept of MCI in primary care through a case-based clinical review. We discuss the case of a patient with MCI and provide an evidence-based framework for assessment, early recognition and management of MCI while addressing associated risk factors, neuropsychiatric symptoms and prognosis.
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